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Current Opinion in Organ Transplantation最新文献

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Machine wars and policy provisions: how the landscape of organ procurement and allocation is changing in the United States. 机器大战和政策规定：美国器官获取和分配的格局正在发生怎样的变化。
IF 1.8 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-05-01 DOI: 10.1097/MOT.0000000000001145
Anji Wall
{"title":"Machine wars and policy provisions: how the landscape of organ procurement and allocation is changing in the United States.","authors":"Anji Wall","doi":"10.1097/MOT.0000000000001145","DOIUrl":"10.1097/MOT.0000000000001145","url":null,"abstract":"","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":"29 3","pages":"173-174"},"PeriodicalIF":1.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851898","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
Abdominal normothermic regional perfusion in the United States: current state and future directions. 美国的腹部常温区域灌注：现状与未来方向。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-03-20 DOI: 10.1097/MOT.0000000000001144
Anji Wall, Amar Gupta, Giuliano Testa
{"title":"Abdominal normothermic regional perfusion in the United States: current state and future directions.","authors":"Anji Wall, Amar Gupta, Giuliano Testa","doi":"10.1097/MOT.0000000000001144","DOIUrl":"10.1097/MOT.0000000000001144","url":null,"abstract":"<p><strong>Purpose of review: </strong>Normothermic regional perfusion (NRP) is a novel procurement technique for donation after circulatory death (DCD) in the United States. It was pioneered by cardiothoracic surgery programs and is now being applied to abdominal-only organ donors by abdominal transplant programs.</p><p><strong>Recent findings: </strong>Liver and kidney transplantation from thoracoabdominal NRP (TA-NRP) donors in the United States was found to have lower rates of delayed kidney graft function and similar graft and patient survival versus recipients of cardiac super rapid recovery (SRR) DCD donors. The excellent outcomes with NRP have prompted the expansion of NRP technology to abdominal transplant programs.</p><p><strong>Summary: </strong>Excellent early outcomes with liver and kidney transplantation have prompted the growth of NC-NRP procurement for abdominal-only DCD donors across the US, and now requires standardization of technical and nontechnical aspects of this procedure.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"175-179"},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140173999","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
Current challenges in xenotransplantation. 异种移植目前面临的挑战。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-04-16 DOI: 10.1097/MOT.0000000000001146
Marta Vadori, Emanuele Cozzi
{"title":"Current challenges in xenotransplantation.","authors":"Marta Vadori, Emanuele Cozzi","doi":"10.1097/MOT.0000000000001146","DOIUrl":"10.1097/MOT.0000000000001146","url":null,"abstract":"<p><strong>Purpose of review: </strong>In recent years, the xenotransplantation science has advanced tremendously, with significant strides in both preclinical and clinical research. This review intends to describe the latest cutting-edge progress in knowledge and methodologies developed to overcome potential obstacles that may preclude the translation and successful application of clinical xenotransplantation.</p><p><strong>Recent findings: </strong>Preclinical studies have demonstrated that it is now possible to extend beyond two years survival of primate recipients of life saving xenografts. This has been accomplished thanks to the utilization of genetic engineering methodologies that have allowed the generation of specifically designed gene-edited pigs, a careful donor and recipient selection, and appropriate immunosuppressive strategies.In this light, the compassionate use of genetically modified pig hearts has been authorized in two human recipients and xenotransplants have also been achieved in human decedents. Although encouraging the preliminary results suggest that several challenges have yet to be fully addressed for a successful clinical translation of xenotransplantation. These challenges include immunologic, physiologic and biosafety aspects.</p><p><strong>Summary: </strong>Recent progress has paved the way for the initial compassionate use of pig organs in humans and sets the scene for a wider application of clinical xenotransplantation.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"205-211"},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11064916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287100","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
Squaring the Circle. Brain death and organ transplantation. 方圆。脑死亡与器官移植
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-03-14 DOI: 10.1097/MOT.0000000000001104
Howard R Doyle
{"title":"Squaring the Circle. Brain death and organ transplantation.","authors":"Howard R Doyle","doi":"10.1097/MOT.0000000000001104","DOIUrl":"10.1097/MOT.0000000000001104","url":null,"abstract":"<p><strong>Purpose of review: </strong>The adoption of brain death played a crucial role in the development of organ transplantation, but the concept has become increasingly controversial. This essay will explore the current state of the controversy and its implications for the field.</p><p><strong>Recent developments: </strong>The brain death debate, long limited to the bioethics community, has in recent years burst into the public consciousness following several high-profile cases. This has culminated in the reevaluation of the Uniform Determination of Death Act (UDDA), which is in the process of being updated. Any change to the UDDA has the potential to significantly impact the availability of organs.</p><p><strong>Summary: </strong>The current update to the UDDA introduces an element of uncertainty, one the brain death debate had not previously had.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"212-218"},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118982","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
Normothermic machine perfusion for liver transplantation: current state and future directions. 肝移植的常温机器灌注：现状与未来方向。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-03-14 DOI: 10.1097/MOT.0000000000001141
Jessica Lindemann, Jennifer Yu, Mb Majella Doyle
{"title":"Normothermic machine perfusion for liver transplantation: current state and future directions.","authors":"Jessica Lindemann, Jennifer Yu, Mb Majella Doyle","doi":"10.1097/MOT.0000000000001141","DOIUrl":"10.1097/MOT.0000000000001141","url":null,"abstract":"<p><strong>Purpose of review: </strong>The number of patients on the liver transplant waitlist continues to grow and far exceeds the number of livers available for transplantation. Normothermic machine perfusion (NMP) allows for ex-vivo perfusion under physiologic conditions with the potential to significantly increase organ yield and expand the donor pool.</p><p><strong>Recent findings: </strong>Several studies have found increased utilization of donation after cardiac death and extended criteria brain-dead donor livers with implementation of NMP, largely due to the ability to perform viability testing during machine perfusion. Recently, proposed viability criteria include lactate clearance, maintenance of perfusate pH more than 7.2, ALT less than 6000 u/l, evidence of glucose metabolism and bile production. Optimization of liver grafts during NMP is an active area of research and includes interventions for defatting steatotic livers, preventing ischemic cholangiopathy and rejection, and minimizing ischemia reperfusion injury.</p><p><strong>Summary: </strong>NMP has resulted in increased organ utilization from marginal donors with acceptable outcomes. The added flexibility of prolonged organ storage times has the potential to improve time constraints and transplant logistics. Further research to determine ideal viability criteria and investigate ways to optimize marginal and otherwise nontransplantable liver grafts during NMP is warranted.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"186-194"},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118981","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
Normothermic regional perfusion procurement for abdominal organ donors: techniques and troubleshooting. 为腹部器官捐献者进行常温区域灌注采购：技术和故障排除。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-03-11 DOI: 10.1097/MOT.0000000000001140
Stephanie Silpe, Eric Martinez, Anji Wall
{"title":"Normothermic regional perfusion procurement for abdominal organ donors: techniques and troubleshooting.","authors":"Stephanie Silpe, Eric Martinez, Anji Wall","doi":"10.1097/MOT.0000000000001140","DOIUrl":"10.1097/MOT.0000000000001140","url":null,"abstract":"<p><strong>Purpose of review: </strong>Normothermic regional perfusion (NRP) is a novel procurement technique for donation after circulatory death (DCD) in the United States. It was pioneered by cardiothoracic surgery programs and is now being applied to abdominal-only organ donors by abdominal transplant programs. Multiple technical approaches can be used for abdominal-only NRP DCD donors and this review describes these techniques.</p><p><strong>Recent findings: </strong>NRP has been associated with higher utilization of organs, particularly liver and heart grafts, from DCD donors and with better recipient outcomes. There are lower rates of delayed graft function in kidney transplant recipients and lower rates of ischemic cholangiopathy in liver transplant recipients. These benefits are driving increased interest from abdominal transplant programs in using NRP for DCD procurements.</p><p><strong>Summary: </strong>This paper describes the technical aspects of NRP DCD that allow for maximization of its use based on different donor and policy characteristics.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"200-204"},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093483","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 introduction. 编辑介绍。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-05-01 DOI: 10.1097/MOT.0000000000001148
{"title":"Editorial introduction.","authors":"","doi":"10.1097/MOT.0000000000001148","DOIUrl":"https://doi.org/10.1097/MOT.0000000000001148","url":null,"abstract":"","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":"29 3","pages":"v"},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848070","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
Expanding MELD exceptions for colorectal liver metastasis: data and policy. 扩大结直肠肝转移的 MELD 例外：数据与政策。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-03-14 DOI: 10.1097/MOT.0000000000001142
Jenna N Whitrock, Catherine G Pratt, Shimul A Shah
{"title":"Expanding MELD exceptions for colorectal liver metastasis: data and policy.","authors":"Jenna N Whitrock, Catherine G Pratt, Shimul A Shah","doi":"10.1097/MOT.0000000000001142","DOIUrl":"10.1097/MOT.0000000000001142","url":null,"abstract":"<p><strong>Purpose of review: </strong>While liver transplant for unresectable colorectal cancer liver metastases (CRLM) has been demonstrated to be a promising treatment in selected patients, the typically low MELD score of these patients and lack of exception points may lead to challenges in receiving a deceased donor liver for transplant.</p><p><strong>Recent findings: </strong>Several studies have shown improved outcomes in select patients with CRLM who undergo liver transplant, and several trials are ongoing and will conclude in the next several years. MELD exception points have recently been proposed in qualifying patients with CRLM to help this group obtain more timely quality allografts. Under the current proposal, patients with CRLM would receive a score of the median MELD at transplant (MMaT) for their center minus 20 with a minimum score of 15 in cases where MMaT minus 20 would be less than 15. This would allow them to receive transplants faster without competing unnecessarily with those with greater medical need.</p><p><strong>Summary: </strong>Giving MELD exception points to patients with colorectal cancer liver metastases in need of transplant may decrease time on the waitlist and improve outcomes for these patients.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"195-199"},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118980","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
Thoraco-abdominal normothermic regional perfusion for thoracic transplantation in the United States: current state and future directions. 美国用于胸腔移植的胸腹腔常温区域灌注：现状与未来方向。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-03-14 DOI: 10.1097/MOT.0000000000001143
Swaroop Bommareddi, Brian Lima, Ashish S Shah, John M Trahanas
{"title":"Thoraco-abdominal normothermic regional perfusion for thoracic transplantation in the United States: current state and future directions.","authors":"Swaroop Bommareddi, Brian Lima, Ashish S Shah, John M Trahanas","doi":"10.1097/MOT.0000000000001143","DOIUrl":"10.1097/MOT.0000000000001143","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide an update regarding the state of thoracoabdominal normothermic regional perfusion (taNRP) when used for thoracic organ recovery.</p><p><strong>Recent findings: </strong>taNRP is growing in its utilization for thoracic organ recovery from donation after circulatory death donors, partly because of its cost effectiveness. taNRP has been shown to yield cardiac allograft recipient outcomes similar to those of brain-dead donors. Regarding the use of taNRP to recover donor lungs, United Network for Organ Sharing (UNOS) analysis shows that taNRP recovered lungs are noninferior, and taNRP has been used to consistently recover excellent lungs at high volume centers. Despite its growth, ethical debate regarding taNRP continues, though clinical data now supports the notion that there is no meaningful brain perfusion after clamping the aortic arch vessels.</p><p><strong>Summary: </strong>taNRP is an excellent method for recovering both heart and lungs from donation after circulatory death donors and yields satisfactory recipient outcomes in a cost-effective manner. taNRP is now endorsed by the American Society of Transplant Surgeons, though ethical debate continues.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"180-185"},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118983","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
Immunotherapy for transplantation of hepatocellular carcinoma: the next frontier in adjunctive therapy. 肝细胞癌移植免疫疗法：辅助疗法的下一个前沿。
IF 2.2 4区 医学
Current Opinion in Organ Transplantation Pub Date : 2024-04-01 Epub Date: 2023-12-26 DOI: 10.1097/MOT.0000000000001133
Parissa Tabrizian, Marcus Zeitlhoefler, Ahmed Talaat Hassan, Rebecca Marino
{"title":"Immunotherapy for transplantation of hepatocellular carcinoma: the next frontier in adjunctive therapy.","authors":"Parissa Tabrizian, Marcus Zeitlhoefler, Ahmed Talaat Hassan, Rebecca Marino","doi":"10.1097/MOT.0000000000001133","DOIUrl":"10.1097/MOT.0000000000001133","url":null,"abstract":"<p><strong>Purpose of review: </strong>The increasing success of liver transplantation in hepatocellular carcinoma (HCC) drives an ever-evolving search for innovative strategies to broaden eligible patients' pools. Recent advances in immuno-oncology have turned the spotlight on immune checkpoint inhibitors (ICIs). This review offers an updated overview of ICIs in liver transplantation for HCC, exploring neoadjuvant and adjuvant approaches and addressing unanswered questions on safety, patients' selection, and response predictors.</p><p><strong>Recent findings: </strong>ICIs have transitioned from being a last-chance therapeutic hope to becoming an integral cornerstone in the treatment of advanced HCC, holding great promise as a compelling option not only to downstage patients for transplantation but also as an alternative strategy in addressing posttransplantation disease recurrence. Despite ongoing refinements in immunotherapeutic agents, the complex molecular pathways involved emphasize the need for a comprehensive approach to integrate immunotherapy in liver transplantation.</p><p><strong>Summary: </strong>Initial concerns about graft rejection, with ICIs as a bridging therapy to liver transplantation, were successfully addressed using adequate immunosuppressants strategies and minimized with a sufficient washout period. Post-liver transplantation disease recurrence remains challenging, requiring a balance between effective therapy and preserving graft function. Emphasis should be placed on clinical trials validating the risk-benefit ratio of ICIs for liver transplantation, guiding appropriate patients' selection, and establishing clear management pathways.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"144-154"},"PeriodicalIF":2.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073611","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
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