Current Opinion in Organ Transplantation最新文献_第2页

Review: outcomes of transplant candidates with psychotic disorders. 回顾：有精神障碍的移植候选人的结局。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-09-25 DOI: 10.1097/MOT.0000000000001251

Kathy L Coffman

{"title":"Review: outcomes of transplant candidates with psychotic disorders.","authors":"Kathy L Coffman","doi":"10.1097/MOT.0000000000001251","DOIUrl":"10.1097/MOT.0000000000001251","url":null,"abstract":"Purpose of review: Transplantation in candidates with psychotic disorders has been a controversial topic for over 40 years. Reviewing the outcomes of these candidates may inform decisions going forward, though it is unclear whether outcomes with kidney recipients is generalizable to other organs, which are life-sparing not mainly life-enhancing.Recent findings: Outcomes in recipients with psychotic disorders after kidney transplants were described in three studies. Outcomes with heart, lung, pancreas, and small bowel or multivisceral transplants is sparse to nonexistent. There were 26 cases and 8 case series published, mostly highly selected patients, with small sample size, and the majority had less than 3-year follow-up. Guidelines were proposed for this population based on a survey of 12 centers.Summary: More systematic study is needed on the risks and barriers to transplantation in these candidates. More data is needed regarding outcomes in those recipients with life-sparing transplants for whom there is not a rescue plan in case the graft is lost. Candidates should be evaluated on an individual basis based on known risk factors in accordance with the ethical principles of beneficence, justice, and utility in the face of scarce resources.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130139","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

The ethics of buy-in before transplantation. 移植前买进的伦理问题。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-07 DOI: 10.1097/MOT.0000000000001241

Erin Yu, Baddr A Shakhsheer, Sean C Wightman

{"title":"The ethics of buy-in before transplantation.","authors":"Erin Yu, Baddr A Shakhsheer, Sean C Wightman","doi":"10.1097/MOT.0000000000001241","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001241","url":null,"abstract":"Purpose of review: This paper explores the ethical complexities of surgical buy-in within the context of organ transplantation. Surgical buy-in refers to an implicit agreement in which transplant recipients consent not only to the surgery itself, but also to the necessary postoperative care in the context of scarce donor organs. Ethical tensions arise when patients choose to deviate from suggested care pathways after receiving organ transplantation, challenging the balance between respecting individual autonomy and ensuring just stewardship of finite donor organs.Recent findings: Recent literature highlights the experience of transplant teams when patients withdraw from posttransplant care, a phenomenon termed \"cashing out.\" Approximately 60% of surgeons performing high-risk surgeries expect postoperative compliance as a precondition to surgery. In transplant settings, this expectation is intensified by the communal impact of organ allocation, raising justice-based concerns when organ recipients withdraw from postoperative protocols.Summary: This review proposes a modified informed consent process that explicitly delineates a recipient's ethical commitment when receiving an organ transplant. Improving transparency and aligning expectations with patients can help transplant teams better navigate the ethical tension between respecting patient autonomy and responsibly stewarding scarce public resources.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788510","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

Ethics of deceased organ donation and normothermic regional perfusion: donors are 'dead enough'. 死者器官捐献与正常区域灌注的伦理：捐赠者已经“足够死亡”。

IF 1.9 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-07 DOI: 10.1097/MOT.0000000000001246

Hector C Ramos, Emily Beers

{"title":"Ethics of deceased organ donation and normothermic regional perfusion: donors are 'dead enough'.","authors":"Hector C Ramos, Emily Beers","doi":"10.1097/MOT.0000000000001246","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001246","url":null,"abstract":"Purpose of review: Normothermic regional perfusion (NRP) for the donation after circulatory death (DCD) increases the supply and function of organs. However, the procedures used have led to significant ethical controversies. Despite the numerous studies on the subject, moral issues are seldom analyzed comparatively. This article describes and identifies three ethical problems related to NRP, critiquing them with philosophical and ethical suggestions.Recent findings: Current literature suggests that using oxygenated blood instead of cold perfusion enhances the function of transplanted organs, more pronounced in thoracic organs. The blood perfusion requires surgical maneuvers such as stimulating and restarting the heart while in the patient, leading to criticism based on ethical grounds, relating to declaration of death and violation of the dead donor rule (DDR).Summary: These findings are a significant ethical quandary that threatens to eliminate the use of NRP and jeopardize the benefits mainly to recipients of hearts and lungs. The declaration of death, violation of the dead donor rule, informed consent, and public perception are the main moral criticisms of NRP. Neither the declaration of death nor the dead donor rule is violated, and justice is served through the provision of informed consent, thereby preserving public trust and the donors' wishes.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788509","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

Donation after circulatory death; cholangiopathy in the machine age. 循环性死亡后捐赠；机器时代的胆管病。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-05-21 DOI: 10.1097/MOT.0000000000001222

Ian S Currie, Fiona M Hunt

{"title":"Donation after circulatory death; cholangiopathy in the machine age.","authors":"Ian S Currie, Fiona M Hunt","doi":"10.1097/MOT.0000000000001222","DOIUrl":"10.1097/MOT.0000000000001222","url":null,"abstract":"Purpose of review: Published work evaluating machine perfusion of DCD (donation after circulatory death) liver grafts in situ and ex situ is rapidly evolving, with several landmark studies published in the last 6 months. The central question in DCD liver transplant remains; which strategies most effectively reduce cholangiopathy? This condition, which results in repeated hospital admissions, interventions, re-transplantation and death, is a major deterrent to DCD utilization. This review considers current evidence in the mitigation of transplant cholangiopathy by machine perfusion in DCD liver grafts.Recent findings: Studies which directly address DCD cholangiopathy as a primary outcome are few in number, despite their critical importance. In systematic reviews, Normothermic Regional Perfusion and Hypothermic Machine Perfusion consistently and significantly reduce transplant cholangiopathy rates. By contrast, the efficacy of Normothermic Machine Perfusion performed at donor or recipient centres is less well described and cautious interpretation is required. The most recent development, namely hypothermic followed by normothermic perfusion, has only now appeared in the literature but appears to offer advantages compared to either technology alone.Summary: To reduce DCD cholangiopathy, current data best support the use of donor centre NRP or recipient centre HMP. However, utilization is also improved when warm perfusion is involved.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"337-343"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989684","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

Banff 2022 pancreas pathology update: how to make the right diagnosis and decrease inconclusive pathology results. Banff 2022胰腺病理学更新：如何做出正确的诊断并减少不确定的病理结果。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-05-21 DOI: 10.1097/MOT.0000000000001231

Cinthia B Drachenberg, Surya V Seshan, John C Papadimitriou

{"title":"Banff 2022 pancreas pathology update: how to make the right diagnosis and decrease inconclusive pathology results.","authors":"Cinthia B Drachenberg, Surya V Seshan, John C Papadimitriou","doi":"10.1097/MOT.0000000000001231","DOIUrl":"10.1097/MOT.0000000000001231","url":null,"abstract":"Purpose of review: The Banff 2022 pancreas transplant pathology update is the most comprehensive to date. It has improved the criteria for T-cell and antibody mediated rejection, recognized other clinicopathological differential diagnoses, and addressed the critically important islet failures. Nevertheless, multidisciplinary discussions during and after the meeting showed a need to enhance the real and perceived value of pancreas transplant biopsies. In particular, the occurrence of clinicopathological discrepancies and/or inconclusive biopsy findings, result in considerable uncertainty in clinical and pathology decision making.Recent findings: The current review expands on the 2022 report by presenting the most common situations leading to an inconclusive diagnosis (Banff \"indeterminate\" category), a major issue of discussion. The entities discussed herein are: nonspecific infiltrates versus active rejection; residual inflammation after treatment of active rejection; ischemic pancreatitis and peripancreatic reactions in the early posttransplant period; biopsy findings associated with exocrine drainage impairment, and other unusual or nonspecific findings. An algorithm for the evaluation of pancreas allograft biopsies is also presented, that should facilitate the interpretation of morphological findings.Summary: Systematic integration of essential clinical information with the pathology findings can improve the diagnostic yield of pancreas allograft biopsies and reduce the cases with and \"indeterminate\" diagnoses.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"258-265"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109947","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

Pancreas rejection: quieting the storm to preserve graft function. 胰腺排斥反应：消弭风暴，保持移植物功能。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-04-23 DOI: 10.1097/MOT.0000000000001223

Christopher J Webb, Robert J Stratta, Sandesh Parajuli

{"title":"Pancreas rejection: quieting the storm to preserve graft function.","authors":"Christopher J Webb, Robert J Stratta, Sandesh Parajuli","doi":"10.1097/MOT.0000000000001223","DOIUrl":"10.1097/MOT.0000000000001223","url":null,"abstract":"Purpose of review: Allograft rejection remains enigmatic and elusive following pancreas transplantation. In the absence of early technical pancreas graft failure, pancreas allograft rejection is the major cause of death-censored pancreas graft loss both short- and long-term. Despite this circumstance, there are variations in the diagnosis and treatment of pancreas rejection. In this article, we summarize recent literature, review common practices, and discuss various management algorithms.Recent findings: Although pancreas allograft biopsy is the gold standard for the diagnosis of rejection, not all transplant centers have the capability to perform pancreas allograft biopsy. Some centers depend on clinical or laboratory parameters exclusively or rely on dysfunction or biopsy of a simultaneous kidney allograft as a marker for pancreas allograft rejection. New biomarkers are evolving to assess the risk for rejection and may help to diagnose early rejection. In the future, the use of machine learning algorithms and artificial intelligence may play a role identifying patients at risk and detecting pancreas rejection without performing a pancreas allograft biopsy.Summary: Despite decades of experience in pancreas transplantation, the diagnosis and management of pancreas rejection remains challenging. Emerging biomarkers and machine learning algorithms are needed to mitigate immunological complications and guide immunosuppression in these patients.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"266-272"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996055","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

New methods for improving pancreas preservation. 改善胰腺保存的新方法。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-05-02 DOI: 10.1097/MOT.0000000000001224

Mohamed A Elzawahry, Trevor Reichman, Andrew Sutherland

{"title":"New methods for improving pancreas preservation.","authors":"Mohamed A Elzawahry, Trevor Reichman, Andrew Sutherland","doi":"10.1097/MOT.0000000000001224","DOIUrl":"10.1097/MOT.0000000000001224","url":null,"abstract":"Purpose of review: Pancreas and islet transplantation face critical organ shortage challenges, with many potential grafts discarded due to concerns about consequences of ischemia-reperfusion injury, particularly from donation after circulatory death (DCD) donors. Static cold storage remains standard practice but has significant limitations. Novel preservation technologies may improve transplant outcomes, donor selection and even expand the donor pool.Recent findings: Normothermic regional perfusion in DCD donors has increased pancreas utilization with promising one-year graft survival comparable to donation after brain-death (DBD) donors. Hypothermic machine perfusion maintains tissue integrity and shows promising preclinical results. Oxygenated hypothermic machine perfusion successfully restores tissue adenosine triphosphate (ATP) levels without notable tissue injury. Normothermic machine perfusion, despite challenges, offers potential for viability assessment and resuscitation.Summary: Advanced preservation technologies provide platforms for assessment, reconditioning, and therapeutic interventions for pancreas grafts. Clinical translation requires consensus on perfusion parameters and perfusate composition optimized for pancreatic preservation. Future developments should focus on implementing sensitive and specific assessment methods, including beta-cell specific biomarkers, to confidently select and utilize marginal pancreas grafts for transplantation.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"279-288"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972475","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

Simultaneous pancreas and kidney transplant vs. pancreas after kidney transplantation: is one better? 胰肾同时移植vs肾移植后胰：哪个更好？

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-05-02 DOI: 10.1097/MOT.0000000000001229

Sarah Huber, Jonathan A Fridell

{"title":"Simultaneous pancreas and kidney transplant vs. pancreas after kidney transplantation: is one better?","authors":"Sarah Huber, Jonathan A Fridell","doi":"10.1097/MOT.0000000000001229","DOIUrl":"10.1097/MOT.0000000000001229","url":null,"abstract":"Purpose of review: For those with insulin dependent diabetes mellitus and renal failure, both simultaneous pancreas and kidney (SPK) and pancreas after kidney (PAK) transplant can free the recipient of renal replacement and insulin therapies and provide survival advantage over ongoing dialysis and diabetes. Yet, pancreas transplants are notably declining in the United States, particularly for PAK.Recent findings: Pancreas transplant continues to provide better glycemic control than all present medical therapies. Outcomes for both SPK and PAK also continue to improve, and overall patient survival for both SPK and PAK are similar, excellent, and superior to all other transplant or medical options. SPK is associated with better pancreas allograft survival, but this gap is narrowing for PAK, and the best kidney allograft survival is achieved with living donor renal transplant (LDRTx) and PAK.Summary: PAK remains a viable and successful treatment for uremia and insulin dependent diabetes, and, particularly when following a LDRTx, can confer the additional benefits associated with LDRTx and preemptive transplant. To achieve insulin and dialysis independence, either LDRTx followed by PAK (if a living donor is available) or SPK should be offered to candidates with appropriate indications.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"273-278"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982796","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

Pancreas retransplantation. 胰腺再移植。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-05-02 DOI: 10.1097/MOT.0000000000001225

Marcelo Perosa, Tiago G Miranda, Fernanda R Danziere

{"title":"Pancreas retransplantation.","authors":"Marcelo Perosa, Tiago G Miranda, Fernanda R Danziere","doi":"10.1097/MOT.0000000000001225","DOIUrl":"10.1097/MOT.0000000000001225","url":null,"abstract":"Purpose of review: Pancreas retransplantation (PRT) remains a topic of debate due to the increased risks involved and advancements in diabetes mellitus management.Recent findings: The majority of PRT are pancreas after kidney (PAK) transplants, typically performed when a primary simultaneous pancreas-kidney (SPK) transplant results in pancreas graft failure while the kidney graft remains functioning. Over the past few decades, the number of PRT procedures has declined, mirroring the decrease in PAK transplant activity. Technical or late immunological loss of the initial pancreas is associated with better PRT outcomes, whereas early immunological failure and sensitization predict poor post-PRT outcome.Summary: Several critical factors must be considered when evaluating PRT, including the cause and timing of primary pancreas graft failure, as well as the recipient's surgical and immunological profile. PRT outcomes should be interpreted with caution, as most primary pancreas transplants (PT) are SPK, whereas the majority of PRT are solitary PT. When comparing only primary solitary PT to PRT, the outcomes are similar, particularly when performed in high-volume centers.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"323-329"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985338","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

Novel techniques of pancreas and islet preservation. 胰腺和胰岛保存新技术。

IF 1.8 4区医学

Current Opinion in Organ Transplantation Pub Date : 2025-08-01 Epub Date: 2025-06-11 DOI: 10.1097/MOT.0000000000001234

Abraham J Matar, Joseph S Rao, Raja Kandaswamy

{"title":"Novel techniques of pancreas and islet preservation.","authors":"Abraham J Matar, Joseph S Rao, Raja Kandaswamy","doi":"10.1097/MOT.0000000000001234","DOIUrl":"10.1097/MOT.0000000000001234","url":null,"abstract":"Purpose of review: In recent years, rates of pancreas transplantation have remained stagnant in part due to increasingly stringent donor criteria. Compared to other abdominal organs, the use of extended criteria grafts in pancreas transplantation, including donation after cardiac death (DCD) donors, remains limited. The purpose of this review is to highlight recent work in the field of pancreas and islet preservation.Recent findings: Emerging preclinical and clinical data support the use of machine perfusion, both normothermic and hypothermic, as a mechanism by which to assess graft viability in an ex-situ circulation system prior to transplantation. Similarly, as normothermic regional perfusion (NRP) gains popularity, it will have significant implications on the potential organ pool for pancreas transplantation. Finally, recent advancements in cryoprotective agent composition as well as cooling and rewarming technologies have great potential to facilitate subzero preservation of pancreata and islets for long-term storage.Summary: Broad scaling of newer preservation techniques for pancreas and islet transplantation will require overcoming challenges, including optimizing protocols, ensuring cost-effectiveness, and translation of experimental techniques to the clinical setting. Nevertheless, these strategies for pancreas procurement and preservation may facilitate increased use of marginal grafts and increase the donor pool.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"330-336"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224648","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