Current Opinion in Organ Transplantation最新文献_第9页

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

Improving liver transplant outcomes with transplant-omics and network biology. 通过移植组学和网络生物学改善肝移植结果。

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2023-12-01 Epub Date: 2023-09-29 DOI: 10.1097/MOT.0000000000001100

Joseph Scarpa

{"title":"Improving liver transplant outcomes with transplant-omics and network biology.","authors":"Joseph Scarpa","doi":"10.1097/MOT.0000000000001100","DOIUrl":"10.1097/MOT.0000000000001100","url":null,"abstract":"Purpose of review: Molecular omics data is increasingly ubiquitous throughout medicine. In organ transplantation, recent large-scale research efforts are generating the 'transplant-ome' - the entire set of molecular omics data, including the genome, transcriptome, proteome, and metabolome. Importantly, early studies in anesthesiology have demonstrated how perioperative interventions alter molecular profiles in various patient populations. The next step for anesthesiologists and intensivists will be to tailor perioperative care to the transplant-ome of individual liver transplant patients.Recent findings: In liver transplant patients, elements of the transplant-ome predict complications and point to novel interventions. Importantly, molecular profiles of both the donor organ and recipient contribute to this risk, and interventions like normothermic machine perfusion influence these profiles. As we can now measure various omics molecules simultaneously, we can begin to understand how these molecules interact to form molecular networks and emerging technologies offer noninvasive and continuous ways to measure these networks throughout the perioperative period. Molecules that regulate these networks are likely mediators of complications and actionable clinical targets throughout the perioperative period.Summary: The transplant-ome can be used to tailor perioperative care to the individual liver transplant patient. Monitoring molecular networks continuously and noninvasively would provide new opportunities to optimize perioperative management.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"412-418"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232029","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

What is needed to ensure long-term sustainability for the field of vascularized composite allotransplantation? 需要什么来确保血管化复合同种异体移植领域的长期可持续性？

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2023-12-01 Epub Date: 2023-09-28 DOI: 10.1097/MOT.0000000000001114

Yoshiko Toyoda, L Scott Levin

引用次数: 0

Defining chronic rejection in vascularized composite allografts - do we have reliable surrogates to look for? 定义血管化复合同种异体移植物的慢性排斥反应——我们有可靠的替代品吗？

IF 2.2 4区医学

Current Opinion in Organ Transplantation Pub Date : 2023-12-01 Epub Date: 2023-10-09 DOI: 10.1097/MOT.0000000000001110

Jean Kanitakis

{"title":"Defining chronic rejection in vascularized composite allografts - do we have reliable surrogates to look for?","authors":"Jean Kanitakis","doi":"10.1097/MOT.0000000000001110","DOIUrl":"10.1097/MOT.0000000000001110","url":null,"abstract":"Purpose of review: Chronic rejection (CR) is a major threat in the field of vascularized composite tissue allografts (VCAs) as it causes graft dysfunction and usually graft loss. Unfortunately, knowledge of CR in VCA is incomplete because of the limited number of VCA recipients, the heterogeneous nature of VCAs and the short follow-up.Recent findings: The diagnosis of CR in VCA has relied on clinical and pathological findings. Clinical changes include graft fibrosis, dyschromia and ischemic/necrotic ulcerations. Pathological changes primarily affect allograft vessels and manifest with graft vasculopathy (i.e. myo-intimal proliferation and luminal narrowing of allograft vessels, leading to graft ischemia). Attempts are made to diagnose CR with non- or minimally-invasive techniques, such as imaging studies (ultrasound biomicroscopy, functional magnetic resonance imaging) and serum biomarkers. These techniques provide interesting results and further insight into the mechanisms of CR in VCA.Summary: The diagnosis of CR in VCA still relies mainly on clinicopathological graft alterations; unfortunately, these become overt rather late during the rejection process, when reversal of CR is problematic. More recent, minimally- or non-invasive techniques have provided encouraging results, but their usefulness in the diagnosis of CR requires further studies. These data highlight the paramount importance of CR prevention.","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":" ","pages":"440-445"},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41115953","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