Clinical transplants最新文献

{"title":"Recent Trends in Kidney Transplant in the United States.","authors":"Marcelo Sampaio,&nbsp;Grigoriy Shekhtman,&nbsp;Patrick Ahearn,&nbsp;Edmund Huang,&nbsp;Suphamai Bunnapradist","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The number of new wait list registrants has increased in the last decade but not to the same magnitude as the increase in the number of end stage renal disease patients in the United States. The number of wait list patients has increased at a much higher pace due to the lack of kidney supply. The overall number of kidney transplants only increased slightly. Paired exchange kidney transplant is a viable source of increasing the availability of kidney transplant and also offers access to transplant to patients with immunologic barriers to their intended donors. Paired donor exchange results in similar outcomes despite recipients' having a higher immunologic risk profile. The kidney allocation system (KAS) was recently implemented and so far has resulted in more access for patients with very high immunologic risk and allocation of lower kidney donor profile index organs to younger recipients. Longer follow up is needed to determine the net benefit of the KAS.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35004319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BKV Viremia and Development of De Novo DSA in Renal Transplant Recipients.","authors":"Deirdre Sawinski,&nbsp;Jennifer Trofe-Clark","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>BK virus (BKV) viremia is a common complication of kidney transplantation. In 2008, we enacted a screening protocol to detect BKV infection at our institution. The cumulative incidence of BKV viremia at our center is 24%, with most cases being detected in the first year post-transplant. We have previously identified the development of de novo donor specific antibody as a consequence of BKV infection treated with immunosuppression reduction; in this report, we confirm our prior findings and extend them to include an association of both Class I and Class II antibodies with BKV viremia. While with a median time of 4 years follow up there was no difference in patient or allograft survival on the basis of BKV viremia. Identification of treatment strategies for BKV that will prevent complications such as donor specific antibodies should be a research priority in this area.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"249-256"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Liver Transplantation.","authors":"Caroline C Jadlowiec,&nbsp;Timucin Taner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Donor organ scarcity remains a major limitation in liver transplantation and accounts for a great proportion of wait list mortality. As a result, over the past decade, significant efforts have been made to increase the existing donor pool. These efforts have, in part, resulted in greater use of liver allografts following donation after cardiac death (DCD) along with suboptimal (so-called marginal) and extended criteria donors. Improved understanding of the pathophysiology underlying the inferior outcomes of the liver allografts procured after circulatory arrest has not only resulted in better selection and management of DCD donors, but has also helped in the development of mechanical perfusion strategies. Currently, there is much excitement surrounding the clinical applicability of both hypothermic and normothermic perfusion and the potential to impact patient survival and allograft function. Attempts to decrease late mortality following liver transplantation have focused on minimization of and use of new immunosuppressive medications with specific aims of reducing losses as a result of infection, malignancy, and renal failure. Lastly, there has been increased emphasis on gaining a better understanding of liver immunology and redefining the impact of antibody-mediated rejection on allograft function and patient survival.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"181-191"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MELD Exceptions for Hepatocellular Carcinoma: Regional Variations in the Impact of the Share 35 Liver Allocation Policy.","authors":"Elaine Y Cheng","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Historically, the OPTN liver allocation policies have favored candidates listed with MELD exception scores, and the use of exceptions has increased each year since the inception of the MELD era. The implementation of Share 35 and other recent changes in OPTN liver allocation policies have reduced the preference for MELD exception candidates to some extent, but the nature and degree of the impact appears to vary widely from one region to another. This report emphasizes the geographic inequities and regional variations in transplant practices, with a focus on liver transplant candidates with hepatocellular carcinoma exceptions, and highlights the need for strategies to promote equitable organ distribution across geographical regions and patient conditions.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"15-25"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35004320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Transplant at the University of Pennsylvania 2015.","authors":"Kelsey Lloyd,&nbsp;Arwin Thomasson,&nbsp;Kim Olthoff,&nbsp;Abraham Shaked","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In this brief report, we summarize activity and trends in liver transplantation within the Penn Liver Transplant Program, including total program activity, recipient characteristics, waitlist time to transplant, graft and patient survival, rate of retransplantation, and multi-organ transplantation activity, as well as post-transplant hospital length of stay.</p><p><strong>Results: </strong>Penn Transplant has performed 2478 total adult liver transplants to date, consisting of 2382 deceased-donor liver transplants and 96 living-donor liver transplants. Recipient race is approximately 70% white, 20% black, and 10% \"other\" races including Hispanic, Asian, and American Indian/Alaskan Native. Non-cholestatic cirrhosis is the leading indication for liver transplantation, accounting for more than half of all cases throughout the selected time interval. Most patients are not hospitalized at the time of transplantation, and there has been a reduction in the number of patients hospitalized in the intensive care unit at the time of transplant in the past five years. The median time to transplant is 13.2 months. Hazard ratios (HRs) for graft failure after one month, one year, and three years post-transplant were reported as: 0.54, 1.05, 1.01 (adult deceased donor) and 0.58, 0.57, 1.16 (adult living donor); HRs for patient survival were reported as: 0.44, 1.03, 1.04 (adult deceased donor) and 0.73, 0.74, 0.69 (adult living donor) for the same time increments. Penn averaged a 2.3% retransplantation rate and a total multi-organ transplant volume of 13. The mean length of hospital stay following transplantation was 8.83 days.</p><p><strong>Conclusion: </strong>Our program activity data mirrors trends that are seen in many of the established busy liver transplant centers in the United States. There is greater recognition that liver transplantation can be offered to a larger number of candidates who are diagnosed with progressive liver failure of primary cancer in the setting of liver cirrhosis, and there is an increase in donor organs from either extended criteria cadaveric donors or living donors. Despite more complex candidate populations and increased utilization of extended criteria donors, Penn's outcomes continue to be excellent. We postulate that the future depends on an increase in organ procurement organization activity, redesign of the national organ allocation system, and expansion of living donor activity.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"79-85"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35005242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modernization of Chronic Allograft Injury Research: Better Biomarkers, Better Studies, Better Outcomes.","authors":"Michael E Seifert,&nbsp;Roslyn B Mannon","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite dramatic improvements in acute rejection rates and short-term allograft survival, long-term allograft survival remains unchanged in the modern era, largely due to chronic allograft injury, a progressive disease that is common across all solid organ transplantation but has no proven treatment. Studies of novel diagnostic and therapeutic strategies for chronic allograft injury have been relatively sparse, in part due to the time and expense required to conduct traditional long-term clinical studies of a variably progressive disease. In this article, we review the pathophysiology of chronic allograft injury, including recent insights into key mechanisms of the disease. We discuss the barriers to progress in chronic allograft injury research and present alternative approaches to study design that could accelerate improvements in diagnosis, prevention, or treatment of the disease. We integrate these approaches with emerging biomarkers and surrogate endpoints into a model clinical study of chronic renal allograft injury, providing a framework for modern study design in solid organ transplantation.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"211-225"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437558/pdf/nihms-883727.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Diabetes Mellitus on Survival Outcome of Lung Transplant Recipients: An Analysis of OPTN/UNOS Data.","authors":"Nattawat Klomjit,&nbsp;Alireza Mehrnia,&nbsp;Marcelo Sampaio,&nbsp;Suphamai Bunnapradist","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on the outcome of diabetic lung recipients, especially in those with new-onset diabetes after transplantation (NODAT).</p><p><strong>Methods: </strong>We studied prevalence of pre-transplant diabetes mellitus (PDM) and cumulative incidence of NODAT in lung recipients using the Organ Procurement and Transplantation Network /United Network for Organ Sharing database. Between 2004 and 2011, adult (≥18 years old) recipients transplanted with either first single- or double-lung were included. Those who lacked a diabetes record or received multi-organ transplants were excluded. Patient survival were studied in recipients who had functioning grafts for at least one year.</p><p><strong>Results: </strong>There were 10,226 recipients who had at least one diabetes record, the prevalence of PDM was 18.25% and the cumulative incidence of NODAT during the five years post-transplant was 39.43%. Of 9,117 recipients who had functioning grafts for at least one year, adjusted hazard ratios (HR) of PDM and NODAT, compared to the diabetes-free group, were 1.12 (p=0.048) and 1.12 (p=0.025), respectively. Independent risk factors for mortality included the presence of rejection in the one year, cytomegalovirus serology donor positive/recipient negative, and recipient age >60 years. Among recipients with cystic fibrosis, there was no statistical difference in mortality between diabetic recipients and the diabetes-free group. Compared to the diabetes-free group, the adjusted HRs for mortality of PDM and NODAT in recipients without cystic fibrosis were 1.15 (p=0.031) and 1.14 (p=0.011), respectively.</p><p><strong>Conclusions: </strong>Diabetes was associated with mortality in lung transplant recipients overall and in lung recipients without cystic fibrosis. However, there was no association between diabetes and mortality in lung recipients with cystic fibrosis.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"43-55"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35004323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Transplantation in Groningen, The Netherlands: A Single Center Status Report.","authors":"Yvonne de Vries,&nbsp;Iris E M de Jong,&nbsp;Tim A Berendsen,&nbsp;Ton Lisman,&nbsp;Henkjan J Verkade,&nbsp;René Scheenstra,&nbsp;Koen M E M Reyntjens,&nbsp;Marieke T de Boer,&nbsp;Johannes Blokzijl,&nbsp;Paul M G Peeters,&nbsp;Aad P van den Berg,&nbsp;Robert J Porte","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The liver transplantation program of the University Medical Center Groningen in the Netherlands was started in 1979, making it one of the first programs worldwide. During the past 36 years, a total of 1478 liver transplantations have been performed, 459 of which were in children. One of the first patients transplanted in 1979 is still alive and is one of the longest surviving patients after liver transplantation worldwide. During the last decade, an increasing number of donation after circulatory death (DCD) donor livers have been accepted for transplantation. Over 30% of the livers transplanted in Groningen come from DCD donors. These livers have an increased risk of developing biliary complications, such as non-anastomotic biliary strictures (NAS). One of the main research topics in Groningen has been the pathogenesis and prevention of NAS. In an attempt to reduce the incidence of NAS after liver transplantation, machine perfusion technology has been developed as an alternative to the traditional method of static cold storage. Researchers of the Groningen liver transplant team were the first in the world to report a method of ex situ normothermic machine perfusion of human donor livers. The efficacy and safety of various types of machine perfusion are currently studied in both animal models and clinical trials. A second line of research in Groningen focuses on alterations in the blood coagulation system in patients with liver disease and undergoing liver transplantation. Groningen researchers were the first to describe a 'rebalanced state' of the coagulation system in patients with liver disease, making them prone to both bleeding and thrombo-embolic complications. Clinicians and researchers at the Groningen liver transplant program will continue to collaborate with a shared focus and the aim to provide innovation and the highest level of care to patients with endstage liver disease.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"101-111"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35005244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Transplantation: Editorial.","authors":"Randall E Morris","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"147-150"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35005248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BK Virus After Kidney Transplantation: A Review of Screening and Treatment Strategies and a Summary of the Massachusetts General Hospital Experience.","authors":"Kassem Safa,&nbsp;Eliot Heher,&nbsp;Hannah Gilligan,&nbsp;Winfred Williams,&nbsp;Nina Tolkoff-Rubin,&nbsp;David Wojciechowski","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>BK virus (BKV) is a common infection encountered after kidney transplantation. BKV is associated with a spectrum of manifestations, starting with sub-clinical viruria, followed by viremia and BKV-associated nephropathy. Standard of care includes routine post-transplant screening for BK viruria and/or viremia. Both the Kidney Disease Improving Global Outcomes and the American Society of Transplantation Infectious Diseases Community of Practice have published screening recommendations. Although they vary slightly, they both highlight the importance of early detection with serial screening. Once BK viremia is detected, the standard management approach includes a reduction of immunosuppression. Guidelines differ slightly about the sequence of the immunosuppression reduction, but the end result is the same: lowering the overall immunosuppressive burden in the patient with BKV infection. At the Massachusetts General Hospital, from 2007 to 2009, there was no BKV screening protocol in place. The rate of screening during this time period increased from 62% to 81%. A total of 29 of the 243 patients were diagnosed with BK viremia (11.9%), with 23 identified as a result of screening and 6 as a result of testing for graft dysfunction. We developed a BKV screening protocol consisting of BKV polymerase chain reaction testing in blood starting 2 months after kidney transplantation and every 2 months thereafter, continuing through month 24 regardless of the allograft function. Additional screening for 6 more months is performed in patients who receive anti-lymphocyte globulin for the treatment of acute rejection. Finally, all patients with otherwise unexplained allograft dysfunction are screened. Currently, work is being done investigating the use of mammalian target of rapamycin inhibitors to treat BKV infection. Trials are also ongoing evaluating cell-based therapies for BKV. Research to develop a vaccine or a direct-acting antiviral agent is in critical need and an area of research that should be given high priority.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"257-263"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}