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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
Caitlin Loughery, Ann M Andrews, Nanhua Zhang, Allyce Haney Smith, Ken Resnicow, Remonia Chapman, Holly Jenkins Riley, Sheri Stav, Jerry Yee
Background: The need for transplantable organs drastically outweighs the supply. Misconceptions are a barrier to increasing the rate of donor registration. Individuals with stage 5 chronic kidney disease (CKD) may incorrectly believe they are unable to be donors; however, their attitudes have not been studied. This study aims to explore beliefs of individuals with stage 5 CKD about their ability to donate and test the validity of an organ donation scale. Methods: We examined the psychometric properties of a new 25-item organ donation scale among 554 patients with stage 5 CKD at 12 dialysis units in southeast Michigan...
August 2018: Transplantation Direct
Chethan M Puttarajappa, Sundaram Hariharan, Abhinav Humar, Yuvika Paliwal, Xiaotian Gao, Ruy J Cruz, Armando J Ganoza, Douglas Landsittel, Manoj Bhattarai, Hiroshi Sogawa
Background: Data on dialysis and renal transplantation (RT) after intestinal transplantation (IT) are sparse. Whether changes in immunosuppression and surgical techniques have modified these outcomes is unknown. Methods: Two hundred eighty-eight adult intestinal transplants performed between 1990 and 2014 at the University of Pittsburgh were analyzed for incidence, risk factors and outcomes after dialysis and RT. Cohort was divided into 3 eras based on immunosuppression and surgical technique (1990-1994, 1995-2001, and 2001-2014)...
August 2018: Transplantation Direct
Dimitri Gassmann, Stefan Weiler, Joachim C Mertens, Cäcilia S Reiner, Bart Vrugt, Mirjam Nägeli, Joanna Mangana, Beat Müllhaupt, Fabienne Jenni, Benjamin Misselwitz
Background: Orthotopic liver transplantation (OLT) is a potential curative treatment in patients with hepatocellular carcinoma (HCC); however, treatment options for recurrent HCC after OLT are limited. Immune checkpoint inhibitors, such as nivolumab, an inhibitor of programmed cell death protein 1, have been successfully used for metastatic HCC but data on safety of nivolumab following solid organ transplantation are limited. Methods: We report a 53-year-old woman with HCC who was treated with OLT...
August 2018: Transplantation Direct
Vassilis Filiopoulos, Stratigoula Sakellariou, Konstantinos Papaxoinis, Christina Melexopoulou, Smaragdi Marinaki, John N Boletis, Ioanna Delladetsima
Background: Although colonic injury is a well-known complication of mycophenolic acid (MPA), the involvement of the upper gastrointestinal tract is less extensively documented. We present the occurrence of celiac-like duodenopathy manifested as a severe diarrhea syndrome in 2 renal transplant recipients on enteric-coated mycophenolate sodium. Methods: The patients belong to a setting of 16 renal transplant recipients under MPA suffering from chronic diarrhea in the absence of MPA-related colitis...
August 2018: Transplantation Direct
Guosheng Wu, Qingchuan Zhao, Mian Wang, Jiangpeng Wei, Hao Sun, Jianyong Zheng, Daiming Fan
Background: The availability of an identical twin donor that allows avoidance of complications related to graft rejection and immunosuppression represents an ideal treatment option for irreversible intestinal failure. Methods and Results: We described a 45-year-old woman who lost most of her small bowel due to acute superior mesenteric thrombosis received a living-related small bowel transplant from her identical-twin sister. Monozygosity was established by buccal smear DNA amplification using short tandem repeat...
August 2018: Transplantation Direct
Isaac E Hall, Chirag R Parikh, Bernd Schröppel, Francis L Weng, Yaqi Jia, Heather Thiessen-Philbrook, Peter P Reese, Mona D Doshi
Background: Efforts to maximize transplantation by matching organ quality to recipient longevity require reliable tools. The US kidney allocation system uses the Kidney Donor Risk Index (KDRI) for this purpose, and many centers additionally rely on donor biopsies. The Leuven score combines donor age with procurement histology (glomerulosclerosis and interstitial fibrosis/tubular atrophy) to predict allograft survival. Methods: We compared KDRI with Leuven scores for associations with kidney discard, delayed graft function, and allograft function and survival...
August 2018: Transplantation Direct
Andrej A Petrov, Russell S Traister, Maria M Crespo, Fernanda P Silveira, Maylene Xie, Kara Coffey, Christopher R Ensor, Douglass Landsittel, Joseph M Pilewski
Background: Immunosuppressive therapies have led to improved survival for lung transplant (LT) recipients but these therapies can lead to hypogammaglobulinemia (HGG) and potentially an increased risk of infection. Large prospective studies have not been performed to evaluate the impact of HGG on outcomes for LT recipients. Methods: This is a single-center prospective observational study of LT recipients. Pretransplant and posttransplant IgG levels were measured and related to infection, rejection, antibiotic use, and immunosuppression use...
August 2018: Transplantation Direct
Alicia B Mitchell, Allan R Glanville
No abstract text is available yet for this article.
August 2018: Transplantation Direct
Jesper Magnusson, Johan Westin, Lars-Magnus Andersson, Magnus Lindh, Robin Brittain-Long, Rickard Nordén, Gerdt C Riise
Background: Chronic lung allograft dysfunction (CLAD) is the major limiting factor for long-term survival in lung transplant recipients. Viral respiratory tract infection (VRTI) has been previously associated with CLAD development. The main purpose of this study was to evaluate the long-term effects of VRTI during the first year after lung transplantation in relation to CLAD development. Method: Ninety-eight patients undergoing lung transplantation were prospectively enrolled between 2009 and 2012...
August 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
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