Current Opinion in Organ Transplantation最新文献_第7页

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":"Purpose of review: 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.Recent findings: 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.Summary: 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.","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

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

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":"Purpose of review: 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.Recent findings: 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.Summary: 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.","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":"Purpose of review: To provide an update regarding the state of thoracoabdominal normothermic regional perfusion (taNRP) when used for thoracic organ recovery.Recent findings: 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.Summary: 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.","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":"Purpose of review: 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.Recent findings: 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.Summary: 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.","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

Liver transplantation for intrahepatic cholangiocarcinoma: who, when and how. 肝内胆管癌肝移植：何人、何时、如何进行。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2024-04-01 Epub Date: 2024-01-23 DOI: 10.1097/MOT.0000000000001136

Pablo Achurra, Eduardo Fernandes, Grainne O'Kane, Robert Grant, Mark Cattral, Gonzalo Sapisochin

{"title":"Liver transplantation for intrahepatic cholangiocarcinoma: who, when and how.","authors":"Pablo Achurra, Eduardo Fernandes, Grainne O'Kane, Robert Grant, Mark Cattral, Gonzalo Sapisochin","doi":"10.1097/MOT.0000000000001136","DOIUrl":"10.1097/MOT.0000000000001136","url":null,"abstract":"Purpose of review: Using transplant oncology principles, selected patients with intrahepatic cholangiocarcinoma (iCCA) may achieve long-term survival after liver transplantation. Strategies for identifying and managing these patients are discussed in this review.Recent findings: Unlike initial reports, several modern series have reported positive outcomes after liver transplantation for iCCA. The main challenges are in identifying the appropriate candidates and graft scarcity. Tumor burden and response to neoadjuvant therapies have been successfully used to identify favorable biology in unresectable cases. New molecular biomarkers will probably predict this response in the future. Also, new technologies and better strategies have been used to increase graft availability for these patients without affecting the liver waitlist.Summary: Liver transplantation for the management of patients with unresectable iCCA is currently a reality under strict research protocols. Who is a candidate for transplantation, when to use neoadjuvant and locoregional therapies, and how to increase graft availability are the main topics of this review.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"161-171"},"PeriodicalIF":2.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139520354","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

Regulatory dendritic cell therapy in organ transplantation. 器官移植中的树突状细胞调节性治疗。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2024-04-01 Epub Date: 2023-11-22 DOI: 10.1097/MOT.0000000000001127

Yannis Hadjiyannis, Angus W Thomson

{"title":"Regulatory dendritic cell therapy in organ transplantation.","authors":"Yannis Hadjiyannis, Angus W Thomson","doi":"10.1097/MOT.0000000000001127","DOIUrl":"10.1097/MOT.0000000000001127","url":null,"abstract":"Purpose of review: Regulatory dendritic cells (DCregs; also 'tolerogenic DCs'), innate immune cells that regulate the alloimmune response, are a novel cellular therapy for organ transplantation. Preliminary results from early-phase clinical trials in live donor kidney and liver transplantation are promising. This follows many years of research elucidating mechanisms of action and utility of DCregs. Herein, we review early-phase clinical trial observations and recent advances in the production, modification, and future-trajectory of DCreg in organ transplantation.Recent findings: Preclinical work has demonstrated the ability of adoptively transferred DCreg to abrogate ischemia-reperfusion injury and promote long-term allograft survival. Good Manufacturing Practice-grade DCregs have been generated in adequate numbers for early-phase trials of autologous DCregs in kidney transplantation and donor-derived DCreg in liver transplantation. These trials have demonstrated feasibility and safety, with preliminary evidence of an influence on host immune reactivity. In both kidney and liver transplantation, reduced effector CD8 + T-cells have been noted, together with other changes that may be conducive to reduced dependence on immunosuppressive therapy.Summary: Substantial progress has been made in bringing DCreg to clinical testing in organ transplantation. Additional clinical and mechanistic studies are now needed to further explore and garner the full potential of DCreg in organ transplantation.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"121-130"},"PeriodicalIF":2.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10932828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138290601","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

Emerging phenotypes in kidney transplant rejection. 肾移植排斥反应的新表型。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2024-04-01 Epub Date: 2023-11-30 DOI: 10.1097/MOT.0000000000001130

Michael Mengel, Benjamin A Adam

{"title":"Emerging phenotypes in kidney transplant rejection.","authors":"Michael Mengel, Benjamin A Adam","doi":"10.1097/MOT.0000000000001130","DOIUrl":"10.1097/MOT.0000000000001130","url":null,"abstract":"Purpose of review: This review focuses on more recently emerging rejection phenotypes in the context of time post transplantation and the resulting differential diagnostic challenges. It also discusses how novel ancillary diagnostic tools can potentially increase the accuracy of biopsy-based rejection diagnosis.Recent findings: With advances in reducing immunological risk at transplantation and improved immunosuppression treatment renal allograft survival improved. However, allograft rejection remains a major challenge and represent a frequent course for allograft failure. With prolonged allograft survival, novel phenotypes of rejection are emerging, which can show complex overlap and transition between cellular and antibody-mediated rejection mechanisms as well as mixtures of acute/active and chronic diseases. With the emerging complexity in rejection phenotypes, it is crucial to achieve diagnostic accuracy in the individual patient.Summary: The prospective validation and adoption of novel molecular and computational diagnostic tools into well defined and appropriate clinical context of uses will improve our ability to accurately diagnose, stage, and grade allograft rejection.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"97-103"},"PeriodicalIF":2.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458474","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

Urine CXCL10 as a biomarker in kidney transplantation. 尿液中的 CXCL10 作为肾移植的生物标记物。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2024-04-01 Epub Date: 2024-01-19 DOI: 10.1097/MOT.0000000000001135

Patricia Hirt-Minkowski, Stefan Schaub

引用次数: 0