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Transplantation Direct

Zijian Zhang, Nancy A Wilson, Raghavan Chinnadurai, Sarah E Panzer, Robert R Redfield, Shannon R Reese, Jacques Galipeau, Arjang Djamali
Background: We hypothesized that immunomodulatory properties of mesenchymal stromal cells (MSC) may be considered for desensitization. Methods: Autologous or allogeneic bone marrow derived MSC were infused via tail vein at 0.5 M (0.5 × 106 ), 1 M, or 2 M cells/dose on days -2, 3, 6, 9, 12 ( prevention ) or 14, 17, 20, 23, 26 ( treatment ) relative to transfusion in a Brown Norway to Lewis rat model (10 groups total, n = 6 per group). Results: At 4 weeks, pooled analyses demonstrated that autologous and allogeneic MSC were equally effective in reducing IgG1 and IgG2a de novo donor-specific antibody (dnDSA, P < 0...
September 2018: Transplantation Direct
Amit Sharma, Rahul U Nayak, Gaurav Gupta, Adrian Cotterell
Kidney transplantation is usually the best course of treatment for patients with end-stage renal disease. En bloc kidney transplantation (EBKT) is a surgical treatment option that increases available donor organs with excellent graft survival for patients with end-stage renal disease. Herein, we report a case of an unusual bilateral renal parenchymal urine leak after EBKT leading to removal of both moieties of the EBKT. This unfortunate complication after EBKT, to our knowledge, is the only reported of its kind...
September 2018: Transplantation Direct
Renata von Glehn Ponsirenas, Helena B Cazarote, Stanley de Almeida Araújo, David Campos Wanderley, Silvia Shimakura, Joana S Valdameri, Fabiana L C Contieri, Cristina C Q C von Glehn, Michelle F Susin, Vanessa Santos Sotomaior
Background: The identification of low-level antibodies by single-antigen bead methodology has brought advancements to risk evaluation of kidney transplant recipients. However, the use of mean fluorescence intensity (MFI) to quantify antibodies and to guide therapy is not enough. Notably, immunoglobulin G (IgG) subclass switching is hypothesized to follow a programmed sequence after an emergency signal from the germinal center. In transplantation this process is not clear yet. In the present study, we sequentially evaluate anti-HLA donor specific antibody (DSA) subclasses, their profile changes, and C1q-binding ability and the influence of those characteristics on antibody mediated rejection (AMR) occurrence and allograft function...
September 2018: Transplantation Direct
Chandu Vemuri, Gundumi A Upadhya, Batool Arif, Jianluo Jia, Yiing Lin, Joseph P Gaut, Jawad Fazal, Hua Pan, Samuel A Wickline, William C Chapman
Background: Over 100 000 patients await renal transplantation and 4000 die per year. Compounding this mismatch between supply and demand is delayed graft function which contributes to short-term and long-term graft failures. Previously, we reported that thrombin-targeted perfluorocarbon nanoparticles (PFC-NP) protect kidneys from ischemic renal injury after transient arterial occlusion. Here we hypothesize that perfusion of renal allografts with PFC-NP similarly can protect graft function after an ischemic interval...
September 2018: Transplantation Direct
Kendra E Brett, Emily Ertel, Jeremy Grimshaw, Greg A Knoll
Background: There is currently no agreement as to what constitutes quality transplant care, and there is a lack of consistency in the approach to assessing transplantation quality. We aimed to ascertain the views of patients, clinicians, and program administrators about quality care for kidney transplant patients. Methods: Semistructured qualitative interviews were conducted with 20 patients, 17 physicians, and 11 program administrators. Transcripts were analyzed using inductive thematic analysis...
September 2018: Transplantation Direct
Joris J Blok, Hein Putter, Herold J Metselaar, Robert J Porte, Federica Gonella, Jeroen de Jonge, Aad P van den Berg, Josephine van der Zande, Jacob D de Boer, Bart van Hoek, Andries E Braat
Background: Outcome after liver transplantation (LT) is determined by donor, transplant and recipient risk factors. These factors may have different impact on either patient or graft survival (outcome type). In the literature, there is wide variation in the use of outcome types and points in time (short term or long term). Objective of this study is to analyze the predictive capacity of risk factors and risk models in LT and how they vary over time and per outcome type. Methods: All LTs performed in the Netherlands from January 1, 2002, to December 31, 2011, were analyzed with multivariate analyses at 3-month, 1-year, and 5-year for patient and (non-)death-censored graft survival...
September 2018: Transplantation Direct
Joel R Schroering, Richard S Mangus, John A Powelson, Jonathan A Fridell
Introduction: Transplantation of pancreas allografts from donors that have experienced preprocurement cardiopulmonary arrest (PPCA) is not common, though use of PPCA grafts is routine in liver and kidney transplantation. This article reviews a large number of PPCA pancreas grafts at a single center and reports posttransplant outcomes including early graft dysfunction, length of hospital stay, rejection, and early and late graft survival. Methods: Preprocurement cardiopulmonary arrest, arrest time, and donor and recipient pancreatic enzyme levels were collected from electronic and written medical records...
September 2018: Transplantation Direct
Stephan Busque, Flavio G Vincenti, Helio Tedesco Silva, Philip J O'Connell, Atsushi Yoshida, John J Friedewald, Steven M Steinberg, Klemens Budde, Emine N Broeders, Yon Su Kim, Carolyn M Hahn, Huihua Li, Gary Chan
Background: Tofacitinib is an oral Janus kinase inhibitor. This open-label, long-term extension (LTE) study (NCT00658359) evaluated long-term tofacitinib treatment in stable kidney transplant recipients (n = 178) posttransplant. Methods: Patients who completed 12 months of cyclosporine (CsA) or tofacitinib treatment in the phase IIb parent study (NCT00483756) were enrolled into this LTE study, evaluating long-term tofacitinib treatment over months 12 to 72 posttransplant...
September 2018: Transplantation Direct
Stanley C Jordan, Suphamai Bunnapradist, Jonathan S Bromberg, Anthony J Langone, David Hiller, James P Yee, John J Sninsky, Robert N Woodward, Arthur J Matas
Background: Elevated levels of donor-derived cell-free DNA (dd-cfDNA) in the plasma of renal allograft recipients indicates organ injury and an increased probability of active rejection. Donor-specific antibodies (DSA) to HLA antigens are associated with risk of antibody-mediated rejection (ABMR). This study assessed the combined use of dd-cfDNA and DSA testing to diagnose active ABMR. Methods: Donor-derived cell-free DNA was assayed in 90 blood samples with paired DSA and clinically indicated biopsies from 87 kidney transplant patients...
September 2018: Transplantation Direct
Allison B Webber, Vasishta Tatapudi, Thin T Maw, Carmen Peralta, Joey C Y Leung, Flavio Vincenti
Background: The aim of this pilot study was to assess the feasibility of a pharmacodynamics assay that measures Nuclear Factor of Activated T Cell-dependent cytokines expressed as % mean residual expression (MRE) to adjust tacrolimus (tac) dose (intervention [INT] arm) in comparison with the standard of care of tac trough levels (control [CTL] arm). Methods: We conducted a single-center randomized controlled trial involving 40 stable kidney transplant recipients over 1 year...
July 2018: Transplantation Direct
Janet E Squires, Nicole Graham, Mary Coughlin, Michaël Chassé, Stefanie Linklater, Megan Greenough, Jeremy M Grimshaw, Sam D Shemie, Sonny Dhanani, Gregory A Knoll
Background: A shortage of transplantable organs is a global problem. The purpose of this study was to explore frontline intensive care unit professionals' and organ donor coordinators' perceptions and beliefs around the process of, and the barriers and enablers to, donation after circulatory determination death (DCDD). Methods: This qualitative descriptive study used a semistructured interview guide informed by the Theoretical Domains Framework to interview 55 key informants (physicians, nurses, and organ donation coordinators) in intensive care units (hospitals) and organ donation organizations across Canada...
July 2018: Transplantation Direct
Annika Gocht, Bernd Spriewald, Jörg H W Distler, Martina Ramsperger-Gleixner, Stephan M Ensminger, Michael Weyand, Christian Heim
Background: Nintedanib is a small molecule tyrosine kinase inhibitor that blocks the action of the platelet-derived growth factor receptor (PDGFR), the vascular endothelial growth factor receptor (VEGFR) and the fibroblast growth factor receptor. All of these receptors have been shown to be involved in the development of cardiac allograft vasculopathy (CAV) after heart transplantation. We therefore hypothesized that blocking these tyrosine kinase receptors with nintedanib could prevent CAV...
July 2018: Transplantation Direct
Stein Foss, Espen Nordheim, Dag W Sørensen, Torgunn B Syversen, Karsten Midtvedt, Anders Åsberg, Thorleif Dahl, Per A Bakkan, Aksel E Foss, Odd R Geiran, Arnt E Fiane, Pål-Dag Line
Background: Donation after circulatory death (DCD) can increase the pool of available organs for transplantation. This pilot study evaluates the implementation of a controlled DCD (cDCD) protocol using normothermic regional perfusion in Norway. Methods: Patients aged 16 to 60 years that are in coma with documented devastating brain injury in need of mechanical ventilation, who would most likely attain cardiac arrest within 60 minutes after extubation, were eligible...
July 2018: Transplantation Direct
Robert C Williams, Lori J West, Gerhard Opelz
Background: Even in the modern era of kidney transplantation with improved surgical techniques, immunosuppression, and clinical care, HLA matching has been shown to be important in allograft survival in adults who receive an organ from either a deceased or living donor. We now explore the impact of genetic matching in pediatric first-kidney transplants. Methods: Using the United Network for Organ Sharing data, we identified 18 602 first pediatric (<18 years) kidney transplants between October 1, 1987, and December 31, 2016...
July 2018: Transplantation Direct
Mustafa Nazzal, Krista L Lentine, Abhijit S Naik, Rosemary Ouseph, Mark A Schnitzler, Zidong Zhang, Henry Randall, Vikas R Dharnidharka, Dorry L Segev, Bertram L Kasiske, Gregory P Hess, Tarek Alhamad, Mara McAdams-Demarco, David A Axelrod
Background: Variation in the use of immunosuppression regimens after liver transplant has not been well described. Methods: Immunosuppression regimens used after liver transplant were identified in a novel database integrating national transplant registry and pharmacy fill records for 24 238 recipients (2006-2014). Bilevel hierarchical models were developed to quantify the effects of transplant program, recipient, and donor characteristics on regimen choice. Results: In the first 6 months after transplant, triple immunosuppression (tacrolimus, antimetabolite, corticosteroids) was the most common regimen (42...
July 2018: Transplantation Direct
Sara M Lewin, Kimberly Kallianos, M Ilan Nevah, Susan Zhao, Oren K Fix, Gabriel C Brooks, Teresa De Marco, Atif N Qasim, Karen G Ordovas, Neil Mehta
Background: In end-stage liver disease, alterations in iron metabolism can lead to iron overload and development of iron overload cardiomyopathy. In liver transplant candidates, evaluation for cardiac iron overload and dysfunction can help to identify candidates at increased risk for peritransplant morbidity and mortality, though recommendations for pretransplant evaluation of cardiac iron overload are not standardized. Cardiac Magnetic Resonance Imaging T2* (CMRI-T2*) is a validated method to quantify cardiac iron deposition, with normal T2* value of 20 ms or greater...
July 2018: Transplantation Direct
Nicco Krezdorn, Sotirios Tasigiorgos, Luccie Wo, Rachel Lopdrup, Marvee Turk, Harriet Kiwanuka, Salman Ahmed, Palmina Petruzzo, Ericka Bueno, Bohdan Pomahac, Leonardo V Riella
Background: Kidney dysfunction is a major complication after nonrenal solid organ transplants. Transplantation of vascularized composite allografts (VCA) has yielded successful midterm outcomes despite high rates of acute rejection and greater requirements of immunosuppression. Whether this translates in higher risks of kidney complications is unknown. Methods: Ninety-nine recipients of facial or extremity transplants from the Brigham and Women's Hospital (BWH) and the International Registry on Hand and Composite Tissue Transplantation (IR) were reviewed...
July 2018: Transplantation Direct
Martin Kreuzer, Jenny Prüfe, Burkhard Tönshoff, Lars Pape
Background: Transition from pediatric- to adult-based healthcare is a challenging period and bears a high risk of medication nonadherence and transplant loss in adolescents and young adults after kidney transplantation. Yet, it remains unclear how the 2011 International Society of Nephrology (ISN)/International Pediatric Nephrology Association (IPNA) guidelines on transition are implemented in practice and which healthcare transition modalities are currently used in Europe. Methods: We performed an online survey inviting all members of the European Society of Paediatric Nephrology mailing list to participate...
July 2018: Transplantation Direct
Momoko Kono, Kaori Kojima, Sachiko Wakai, Hiroki Shirakawa
No abstract text is available yet for this article.
June 2018: Transplantation Direct
Norihiko Goto, Ai Takahashi-Nakazato, Shinichi Oka
No abstract text is available yet for this article.
June 2018: Transplantation Direct
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