Current Opinion in Organ Transplantation最新文献_第10页

Ethical issues in solid organ transplantation: transfusion-free transplantation in Jehovah's witness patients. 实体器官移植的伦理问题：耶和华见证人患者的无输血移植。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-12-06 DOI: 10.1097/MOT.0000000000001128

Rick Selby, Taylor Selby-Medical, Michael Richman

{"title":"Ethical issues in solid organ transplantation: transfusion-free transplantation in Jehovah's witness patients.","authors":"Rick Selby, Taylor Selby-Medical, Michael Richman","doi":"10.1097/MOT.0000000000001128","DOIUrl":"10.1097/MOT.0000000000001128","url":null,"abstract":"Purpose of review: Jehovah's Witnesses do not accept transfusion of major allogeneic blood fractions. Successful solid organ transplantation is challenging for Jehovah's Witnesses when anemia, coagulation disturbances, and difficult technical aspects co-exist, and key blood bank resources cannot be utilized. Organ availability for transplantation is limited and demand exceeds supply for all organ types. Historically, the likelihood of poor outcomes in Jehovah's Witnesses patients placed ethical limitations on transplant candidacy for this population violating the precept of maximal utilization of a limited resource. The review's purpose is to describe advancements and strategies that make Jehovah's Witnesses transplant outcomes comparable to transfusion-eligible patients and allay the ethical concerns of their candidacy.Recent findings: Immunomodulation from allogeneic transfusion is a cause of significant postop morbidity. Blood conservation strategies have led to improved outcomes across different medical and surgical cohorts and set the stage for expanded utility in Jehovah's Witnesses with organ insufficiency.Published single-center series with descriptions of specific peri-operative strategies describe the path to major blood product avoidance.Summary: Comparable outcomes in solid organ transplantation for Jehovah's Witnesses without allogeneic transfusion are possible when inclusion-exclusion criteria are respected, and blood conservation strategies employed.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"82-87"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138486947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transplantation for colorectal liver metastasis. 大肠癌肝转移的移植治疗。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-11-23 DOI: 10.1097/MOT.0000000000001126

Pål-Dag Line, Svein Dueland

{"title":"Transplantation for colorectal liver metastasis.","authors":"Pål-Dag Line, Svein Dueland","doi":"10.1097/MOT.0000000000001126","DOIUrl":"10.1097/MOT.0000000000001126","url":null,"abstract":"Purpose of review: Liver transplantation has emerged as a possible treatment for selected patients with nonresectable colorectal liver metastasis, but controversy still exists regarding optimal selection criteria and acceptable outcomes.Recent findings: Univariate analysis in the largest cohorts confirms that metachronous disease, Oslo score = 0-1, metabolic tumor volume (MTV) less than 70 cm 3 , and tumor burden score less than 9 are positive predictive factors for good overall survival outcomes. Some recent trials might suggest that technical resectability is not a valid exclusion criterion for patients with high tumor load and favorable prognostic scores in the transplant evaluation. Recent developments in circulation DNA technology and liquid biopsy may play a future role in the selection and monitoring of patients.Summary: Evaluation for transplant needs multidisciplinary involvement and should not be delayed until the failure of conventional oncological therapy. Larger data sets are needed to refine the selection criteria for liver transplantation in colorectal liver metastasis (CRLM).","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"23-29"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10763714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138298616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enhanced recovery after surgery for liver transplantation: a review of recent literature. 肝移植术后恢复增强：近期文献综述。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2024-02-01 Epub Date: 2023-11-08 DOI: 10.1097/MOT.0000000000001117

Cara E Crouch, Erin Stewart, Adrian Hendrickse

{"title":"Enhanced recovery after surgery for liver transplantation: a review of recent literature.","authors":"Cara E Crouch, Erin Stewart, Adrian Hendrickse","doi":"10.1097/MOT.0000000000001117","DOIUrl":"10.1097/MOT.0000000000001117","url":null,"abstract":"Purpose of review: This review was created to highlight important articles from the past year related to the evolving field of enhanced recovery after surgery (ERAS) in liver transplantation that are relevant to the transplant anesthesiologist.Recent findings: The International Liver Transplantation Society (ILTS) recently completed a landmark project, the ERAS4OLT.org project, which culminated in 80 recommendations for ERAS in liver transplantation. These recommendations encompass management for deceased donor recipients, living donor recipients and living donors. This review highlights selected articles relevant to the perioperative management of deceased donor liver transplant recipients.Summary: Though, there are now published internationally agreed upon recommendations for ERAS topics specific to liver transplantation, there is an obvious need for further investigation into this area to provide high quality evidence to support these recommendations. It is reasonable to utilize these recommendations in ERAS protocols for individual institutions; however, more evidence is needed in several areas to confirm the effects of these protocols on short-term outcomes.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"64-71"},"PeriodicalIF":2.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71479205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Advances in desensitization for human leukocyte antigen incompatible kidney transplantation. 人类白细胞抗原不相容肾移植脱敏疗法的进展。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2023-12-14 DOI: 10.1097/mot.0000000000001131

Ashley Vo, Noriko Ammerman, Stanley C Jordan

引用次数: 0

Living liver donor pain management. 活体肝脏捐献者疼痛管理。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2023-12-01 Epub Date: 2023-09-07 DOI: 10.1097/MOT.0000000000001099

Ryung A Kang, Justin Sangwook Ko

{"title":"Living liver donor pain management.","authors":"Ryung A Kang, Justin Sangwook Ko","doi":"10.1097/MOT.0000000000001099","DOIUrl":"10.1097/MOT.0000000000001099","url":null,"abstract":"Purpose of review: Optimal pain control in living liver donors undergoing hepatectomy is strongly recommended considering their unique status as healthy individuals willingly undergoing surgery for the benefit of the recipient. This review aims to examine and evaluate different strategies aimed at ensuring effective postoperative pain management in living liver donors.Recent findings: Enhanced recovery after surgery (ERAS) protocols have proven effective in optimizing patient outcomes, including in living liver donor hepatectomy. By implementing these protocols, healthcare professionals can enhance postoperative pain control and accelerate recovery. Multimodal analgesia, which combines different techniques and agents, is crucial in pain management for living liver donors. Regional analgesia techniques, such as spinal anesthesia and various peripheral nerve blocks, have shown efficacy in reducing pain and facilitating early recovery. Systemic nonopioid analgesics, including acetaminophen, nonsteroidal anti-inflammatory drugs, ketamine, lidocaine, and dexmedetomidine act synergistically to alleviate pain and reduce inflammation. Minimizing the use of opioids is important to avoid adverse effects, and they should be reserved for rescue medication or breakthrough pain.Summary: Applying the principles of ERAS and multimodal analgesia to living liver donors can effectively control pain while promoting early recovery.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"391-396"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10552782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editorial introductions. 编辑介绍。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2023-12-01 Epub Date: 2023-11-02 DOI: 10.1097/MOT.0000000000001112

引用次数: 0

Expanding indications for urogenital transplantation: congenital and oncologic defects, and gender affirmation. 泌尿生殖道移植的扩大适应症：先天性和肿瘤学缺陷，以及性别确认。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2023-12-01 Epub Date: 2023-09-26 DOI: 10.1097/MOT.0000000000001111

Christopher D Lopez, Alisa O Girard, Richard J Redett

{"title":"Expanding indications for urogenital transplantation: congenital and oncologic defects, and gender affirmation.","authors":"Christopher D Lopez, Alisa O Girard, Richard J Redett","doi":"10.1097/MOT.0000000000001111","DOIUrl":"10.1097/MOT.0000000000001111","url":null,"abstract":"Purpose of review: Penile transplantation has become an emerging option for patients with severe genital defects. Only transplantation restores anatomy, sexual, and reproductive function of the penis. However, penile transplantation comes with important technical, psychosocial, ethical, and surgical challenges that must be considered for successful implementation. Indications for penile transplantation have yet to be clearly elucidated.Recent findings: Since 2006, only five penile transplants have been performed globally. Four of the five transplants have been performed following traumatic defects, and one was performed following a total penectomy from squamous cell carcinoma. Only two of the five penile transplants remain intact. However, long-term outcomes are encouraging with optimal surgical planning, patient selection, and immunologic compliance. Clinical implications and ethical considerations are discussed.Summary: Penile transplantation is a novel solution for penile defects not amenable to traditional reconstructive approaches. With an evidence-based surgical technique, potential advantages include improved urinary function, sensation, and cosmesis. While patient selection is challenging, there is an ongoing effort to identify potential candidates. Indications are discussed in this article.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":"28 6","pages":"425-430"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71421483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Respiratory viral infections including COVID-19 in solid organ transplantation. 实体器官移植中的呼吸道病毒感染，包括新冠肺炎。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2023-12-01 Epub Date: 2023-09-26 DOI: 10.1097/MOT.0000000000001106

Carson K L Lo, Deepali Kumar

{"title":"Respiratory viral infections including COVID-19 in solid organ transplantation.","authors":"Carson K L Lo, Deepali Kumar","doi":"10.1097/MOT.0000000000001106","DOIUrl":"10.1097/MOT.0000000000001106","url":null,"abstract":"Purpose of review: Respiratory viral infections are prevalent and contribute to significant morbidity and mortality among solid organ transplant (SOT) recipients. We review updates from literature on respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the SOT recipient.Recent findings: With the wider availability and use of molecular diagnostic tests, our understanding of the epidemiology and impact of respiratory viruses in the SOT population continues to expand. While considerable attention has been given to the coronavirus disease 2019 (COVID-19) pandemic, the advances in prevention and treatment strategies of SARS-CoV-2 offered valuable insights into the development of new therapeutic options for managing other respiratory viruses in both the general and SOT population.Summary: Respiratory viruses can present with a diverse range of symptoms in SOT recipients, with potentially associated acute rejection and chronic lung allograft dysfunction in lung transplant recipients. The epidemiology, clinical presentations, diagnostic approaches, and treatment and preventive strategies for clinically significant RNA and DNA respiratory viruses in SOT recipients are reviewed. This review also covers novel antivirals, immunologic therapies, and vaccines in development for various community-acquired respiratory viruses.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":"28 6","pages":"471-482"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71421484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transplant tourism - a missed opportunity. 移植旅游业——错失良机。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2023-12-01 Epub Date: 2023-10-03 DOI: 10.1097/MOT.0000000000001108

Hadar Merhav

{"title":"Transplant tourism - a missed opportunity.","authors":"Hadar Merhav","doi":"10.1097/MOT.0000000000001108","DOIUrl":"10.1097/MOT.0000000000001108","url":null,"abstract":"Purpose of review: To explore the resurgence of transplant tourism (TT) despite the recent reiteration of the Declaration of Istanbul (DoI) in 2018. As demand grows exponentially and supply remains static, novel approaches to bridging the gap should be explored.Recent findings: TT is estimated to comprise up to 10% of transplants worldwide. Prosecuting patients seeking organs through TT has been unsuccessful. Extra jurisdictional prosecution of brokers, vendors and institutions participating in illicit TT has been difficult. Resurgence of TT has occurred in both \"traditional\" and new countries. The public attitude towards TT and paid donation is largely positive. The Iranian experience with state regulated paid donors merits attention and perhaps emulation. Numerous philosophers, ethicists and transplant professionals find it acceptable to promote financial consideration for organ donors.Summary: Acknowledging the autonomy of persons, including poor and vulnerable ones, to receive financial consideration for their sacrifice should not be considered morally reprehensible. Strict international regulation, oversight and legislation should be implemented to assure adequate compensation, donor wellbeing, elimination of brokers and excellent medical care. Implementing such a system internationally may eliminate kidney waiting lists, provide great benefits to vendors, improve transplant facilities in developing countries and provide substantial savings to insurers.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"457-462"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41101912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pain management for liver transplant recipients. 肝移植受者的疼痛管理。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2023-12-01 Epub Date: 2023-09-20 DOI: 10.1097/MOT.0000000000001102

Simrat Kaur, Patrick Henthorn, Adrian Hendrickse

{"title":"Pain management for liver transplant recipients.","authors":"Simrat Kaur, Patrick Henthorn, Adrian Hendrickse","doi":"10.1097/MOT.0000000000001102","DOIUrl":"10.1097/MOT.0000000000001102","url":null,"abstract":"Purpose of review: Liver transplant recipients pose several pain management challenges. Altered hepatic drug metabolism and clearance in end-stage liver disease patients complicates the use of certain medications, while existing coagulopathy and thrombocytopenia can limit the use of regional anesthetic techniques. Largely due to a high prevalence of substance use disorders, these patients have increased vulnerability to opioid misuse in the perioperative period, which can make acute postoperative pain difficult to control and potentiates prolonged and painful recovery, increasing the risk of developing chronic postsurgical pain. We present current evidence-based literature that reviews optimal pain management strategies for this challenging patient demographic.Recent findings: Multiple studies have shown that thoracic epidurals provide superior pain control in open hepatic resections. Recent data suggests thoracic epidurals may be safely considered in select liver transplant recipients with normal preoperative coagulation status; however, this evidence is limited, and further studies are needed. When the risks of coagulopathy prohibit epidural placement, truncal blocks such as transversus abdominis plane blocks or quadratus lumborum blocks and abdominal wound catheters can serve as alternative regional modalities. Specialized teams should manage pain using a multimodal approach.Summary: Thoracic epidural analgesia may be an option for liver transplant recipients with normal coagulation profiles prior to surgery; however, additional studies are warranted. Other regional techniques are also available. Emphasis should be placed on optimizing multimodal pain medication management. Nonpharmacological interventions should also be considered.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"397-403"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41105703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0