Clinical transplants最新文献

{"title":"Complications in Transplantation: Medication Nonadherence.","authors":"Tiffany E Kaiser,&nbsp;Rita R Alloway","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Following solid organ transplant, complex, lifelong medication regimens are required to prevent allograft rejection. Estimates of medication nonadherence in transplant recipients vary and may be as high as 70%. Poor medication adherence post transplant has been recognized as a contributing factor to reduced outcomes, including rejection, graft loss, and survival. Despite the numerous identified approaches for adherence assessment, there remains no gold standard. Ongoing efforts to identify optimal immunosuppressant adherence monitoring and measuring tools in an attempt to identify at risk populations post transplantation continue; however, the link between this information and outcomes remains to be discovered. Future adherence studies within the transplant population should focus on developing surrogate markers of immunosuppressant therapy adequacy and exploring the association amongst this data, adherence interventions, and outcomes so that optimal strategies may be identified. Immunosuppressant adherence should not be assumed, and interventions aimed a priori will provide opportunities to derail the movement of negative health outcomes resulting from preventable causes.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"275-284"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003076","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":"Should We Be Performing More Pancreas Transplants?","authors":"Keisha P Bonner,&nbsp;Yogish C Kudva,&nbsp;Mark D Stegall,&nbsp;Patrick G Dean","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pancreas transplantation can provide insulin independence, improved survival, and improved quality of life for patients with diabetes mellitus. However, there has been a steady decline in the number of pancreas transplants (either alone or with a kidney) performed in the United States over the past decade. This decline has occurred despite a steady increase in the number of diabetic patients with end stage renal disease on the kidney transplant alone waiting list. This paper will review the current status of pancreas transplantation, suggest possible explanations for the declining numbers of transplants, highlight current gaps in knowledge, and suggest possible future studies and developments aimed at increasing the application of this effective therapy.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"173-180"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003608","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":"Hepatitis C and Human Immunodeficiency Virus Kidney Transplantation: The Mount Sinai Experience.","authors":"Vinay Nair,&nbsp;Rafael Khaim,&nbsp;Fadi El-Salem,&nbsp;Rebecca Kent,&nbsp;Susan Lerner,&nbsp;Amnon Berger,&nbsp;Leandra Miko,&nbsp;Brett Rollins,&nbsp;Zeynep Ebcioglu,&nbsp;Veronica Delaney,&nbsp;Vinita Sehgal,&nbsp;Madhav Menon,&nbsp;Scott Ames,&nbsp;Alan Benvenisty,&nbsp;Vikram Wadhera,&nbsp;Antonious Arvelakas,&nbsp;Thomas Schiano,&nbsp;Meena Rana,&nbsp;Shirish Huprikar,&nbsp;Sander Florman,&nbsp;Ron Shapiro","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Mount Sinai Hospital in New York has a long history in the field of organ transplantation. The first kidney transplant at Mount Sinai was performed in 1967 by the late Dr. Lewis Burrows and the first laparoscopic donor nephrectomy in New York was performed at Mount Sinai in 1996. Over 3000 kidney transplantations have been performed at Mount Sinai. In the early 1990s, the first hepatitis C virus (HCV) positive patient at Mount Sinai underwent a kidney transplant and the first kidney transplant in a patient with human immunodeficiency virus (HIV) in New York was performed at Mount Sinai in 2001. In general, these patients have done well after renal transplantation, with outcomes similar to those seen in non-infected patients. This chapter will describe the evolution of immunosuppressive regimens in HCV positive and HIV positive patients, and will describe the outcomes of kidney transplantation in these patients. Given the favorable outcomes, it is reasonable to continue to offer renal transplantation as a treatment for end stage renal disease patients with HCV and/or HIV.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"69-78"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35005241","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":"Strategies to Improve Novel Drug Development in Kidney Transplantation Through the Clinical Trials Process.","authors":"Stanley C Jordan,&nbsp;Jua Choi,&nbsp;Ashley Vo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Kidney transplantation has emerged as the preferred treatment for end-stage renal disease. Despite excellent short-term outcomes with standard T-cell centric immunosuppression, long-term outcomes have not improved. Indeed, approximately 5,000 renal allografts fail in the United States each year. Until recently, the focus on causes for late graft failures was on calcineurin inhibitor toxicity and the effects of primary co-morbid conditions (i.e., diabetes and hypertension) or recurrent glomerular diseases. However, several recent studies have identified donor-specific antibodies and chronic antibody-mediated rejection as the primary causes of late allograft failures. This finding has resulted in a renaissance of interest in the development of new agents focused on modifying B cells and alloantibody responses. In 2015, the Food and Drug Administration (FDA) held a conference of experts focused on delineating a path forward for developing a more streamlined clinical trials process to obtain labeling for novel agents in transplantation. The particular focus was on developing new drugs to deal with desensitization and prevention and treatment of antibody-mediated rejection since there are currently no approved drugs in this area. In this manuscript, we will discuss each of these important issues in depth, with particular focus on how to improve the clinical trials process to obtain FDA approval for new drugs that would be of benefit to our patients. It is also encouraging that since the FDA meeting, two new labeling trials have gone forward and one has already begun patient entry.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"163-172"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003607","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 Histocompatibility Testing for Solid Organ Transplantation - What is Needed? A Personal Opinion.","authors":"Matthew F Cusick,&nbsp;Anat R Tambur","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The field of histocompatibility testing has seen significant changes and advancements in the past quarter of a century. The introduction of polymerase chain reaction amplification into routine human leukocyte antigen (HLA) typing has informed us on the magnitude of polymorphism among HLA alleles. Solid phase testing for antibodies has provided unparalleled insight into antibody specificity and the role of antibody mediated rejection in transplant outcomes. Herein, we provide a brief overview of advancements in the field that are currently in progress. We also provide our own personal opinion on what is on the horizon and the direction in which we think the field should progress.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"193-201"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003610","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":"ISMETT: An International Collaboration on Organ Transplantation.","authors":"Giovan B Vizzini,&nbsp;Salvatore Gruttadauria,&nbsp;Marco Spada,&nbsp;Alessandro Bertani,&nbsp;Tullio Bertani,&nbsp;Anna Casu,&nbsp;Giuseppe Raffa,&nbsp;Sergio Sciacca,&nbsp;Gabriele Di Gesaro,&nbsp;Michele Pilato,&nbsp;Lavinia De Monte,&nbsp;Patrizio Vitulo,&nbsp;Angelo Luca,&nbsp;Antonio Arcadipane,&nbsp;Bruno Gridelli","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Institute of the Mediterranean for Transplantation and High Specialty Therapies (ISMETT) is a multi-organ transplant and high specialty center located in Palermo, Italy and managed by the University of Pittsburgh Medical Center. Clinical transplant activity started in 1999 and, herein, we illustrate the outcomes achieved over the past 15 years. In total, ISMETT has performed 997 liver transplants (83.9% adults, 16.1% pediatrics) with a significant percentage of liver transplants from cadaver split livers (17%) and partial grafts from living donors (11.5%). Among liver transplant recipients, the overall five-year graft survival was 74.3% in the adult population and 79% in the pediatric population. ISMETT has also performed 419 kidney transplants in total: 211 from cadaveric donors (22 double), 176 from living donors, and 32 combined (19 with liver, 11 with pancreas, and 2 with heart). The 5-year renal graft survival was 82.2% (cadaveric donor) and 92.2% (living donor). More recently, in 2005, ISMETT started pancreas, lung, and heart transplant programs. In total, 16 pancreas transplants have been performed, of which 12 were simultaneous pancreas-kidney transplants, 1 was pancreas after kidney, and 3 were pancreas alone transplants. One pancreatic islet transplant was also performed in a patient who had already undergone kidney transplantation. Patient and pancreas graft survivals at 1 year were 86.7% and 73.3%, respectively, and 80% and 73.3% at five years (pancreas survival is defined as normoglycemia and insulin-independence). Lung transplant has been performed in 133 patients (116 double and 17 single lung). Eleven were pediatric (8% of all transplants). The 1-month, 1-year, and 5-year overall graft survivals were, 93.8%, 81.4%, and 75.6%, respectively. Heart transplantation has been performed in 133 adults (85% were male). Coronary artery disease and cardiomyopathy were the leading underlying heart disease diagnoses leading to transplant. Mechanical support (ventricular assist device or extracorporeal membrane oxygenation) as a bridge to transplant was used in 18% of the heart transplant cases. One-year heart graft survival was 83% and 5-year heart graft survival was 81%.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"87-99"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35005243","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":"A Single Center 11 Year Experience with 202 Pancreas Transplants in the New Millennium: Evolving Trends.","authors":"Jeffrey Rogers,&nbsp;Alan C Farney,&nbsp;Giuseppe Orlando,&nbsp;Samy S Iskandar,&nbsp;William Doares,&nbsp;Michael D Gautreaux,&nbsp;Scott Kaczmorski,&nbsp;Amber Reeves-Daniel,&nbsp;Amudha Palanisamy,&nbsp;Hany El-Hennawy,&nbsp;Muhammad Khan,&nbsp;Jason Bodner,&nbsp;L Beth Moraitis,&nbsp;Roberta Brown,&nbsp;Debra Felts,&nbsp;Robert J Stratta","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Our single center experience with pancreas transplantation (PTx) over an 11+ year period is reviewed.</p><p><strong>Methods: </strong>We retrospectively studied outcomes in 202 consecutive PTxs in 192 patients at our center. All patients received either rabbit anti-thymocyte globulin (rATG) or alemtuzumab (Alem) induction with tacrolimus/mycophenolate mofetil and tapered steroids or early withdrawal. 179 PTxs (89%) were performed with portal-enteric and 23 with systemic-enteric drainage.</p><p><strong>Results: </strong>From 11/01 to 3/13, we performed 162 simultaneous kidney-PTxs (SKPT), 35 sequential PTxs after kidney, and 5 PTx alone (40 solitary PTxs, SPT). 186 PTxs (92%) were primary and 16 were pancreas retransplants. With a mean follow-up of 5.5 years, overall patient (86% SKPT versus 87% SPT), kidney (74% SKPT versus 80% SPT), and pancreas graft survival (both 65%) rates were comparable. Causes of PTx loss were also similar between SKPT and SPT; the rates of early thrombosis were 8.6% and 5%, respectively. Acute rejection rates were similar between groups (SKPT 29% versus SPT 28%, p= not significant). A randomized trial of Alem versus rATG induction in SKPT demonstrated lower rates of acute rejection and infection in the Alem group. Consequently, Alem induction has been used exclusively in all PTxs since 2009. Early steroid elimination has been feasible in most patients. Surveillance PTx biopsy-directed immunosuppression has contributed to equivalent long-term outcomes in SKPT and SPT. Good results have been achieved in African-American patients and in patients with a type 2 diabetes phenotype.</p><p><strong>Conclusions: </strong>Excellent 5-year outcomes following PTx can be achieved as >86% of patients are alive, >87% of surviving patients are dialysis-free, 80% of surviving patients remain insulin-free, and 88% of surviving patients have detectable C-peptide levels.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"121-138"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35005246","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":"Immunologic and Infectious Complications in Highly Sensitized Patients Post-Kidney Transplantation.","authors":"Joseph Kahwaji,&nbsp;Jua Choi,&nbsp;Ashley Vo,&nbsp;Stanley C Jordan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Desensitization therapies evolved more than a decade ago to deal with the growing numbers of highly human leukocyte antigen sensitized patients who have an immunologic barrier to successful transplantation. Two protocols have evolved and have been adopted for primary desensitization. These include high dose intravenous immune globulin (IVIG), plasma exchange + low doses IVIG +/- rituximab. These protocols have been very successful and have extended and improved the lives of numerous sensitized patients who would otherwise languish on dialysis. Despite these successes, problems do exist with desensitization. These include the risks for antibody-mediated rejection (ABMR) and infections related to increased immunosuppression. Here, we discuss current and evolving therapies for the prevention and treatment of ABMR. In addition, we discuss current data regarding infection risks, especially BK virus, that may predispose patients to development of de novo donor specific antibodies and antibody rejection. Novel therapies will also be discussed.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"265-273"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003075","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":"The 25th Anniversary of the National Transplantation Pregnancy Registry.","authors":"Lisa A Coscia,&nbsp;Serban Constantinescu,&nbsp;Dawn P Armenti,&nbsp;Michael J Moritz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The National Transplantation Pregnancy Registry (NTPR) is a unique resource for comprehensive information about parenthood after transplantation. To date, 1461 female solid organ transplant recipients with 2609 pregnancies and 879 male recipients who fathered 1358 pregnancies have participated in the NTPR. Over the first 25 years of the NTPR, pregnancy after transplantation has progressed from a situation where termination was once advised, to a topic of pre-transplant counselling with likelihood for success if established criteria are met. Pregnancy after transplantation remains high-risk; it should be carefully considered, planned, and monitored by a multidisciplinary health care team. Pregnancy and maternal outcomes vary based on multiple factors, especially on the type of organ transplanted and the pre-pregnancy graft function. As an open-ended condition-based study, the NTPR accumulates a vast amount of data that is used for comparisons that measure the reliability and benefits of treatments and for developing state-of-the-art management guidelines based on a review of current practices at participating transplant centers. NTPR data analyses have contributed to quantifying issues surrounding post-transplant parenthood such as location of the transplanted organ in proximity to the developing fetus, the safety of various immunosuppressive regimens for pregnancy and fatherhood, the teratogenicity of maternal exposure to mycophenolate during pregnancy, the advisability and timing of planning a posttransplant pregnancy, the dosing of medications during pregnancy, the incidence and treatment of comorbidities during pregnancy, and the effect of in utero or breast milk exposure to immunosuppressants on the developing child. As the face of transplantation evolves, the NTPR will continue to collect and disseminate information to assist recipients and their healthcare providers in making informed decisions about the advisability of pregnancy and care for those who choose to become parents after a solid organ transplant. To insure the continued success of our study, all transplant centers and recipients are encouraged to contact the NTPR to report any post-transplant pregnancy.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"57-68"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35005240","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":"Pancreas Transplant at the University of Maryland.","authors":"Soo Y Yi,&nbsp;Katie Shaw,&nbsp;Nadiesda Costa,&nbsp;David B Leeser","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The characteristic of our diabetic population has been ever changing. No longer are our Type 1 diabetics young and thin; they too suffer from the obesity epidemic and now present later with the complications of diabetes (renal dysfunction, hypoglycemic unawareness, vision loss, neuropathy, etc.). Even with all of our medical and technological advances to combat diabetes, there are many who are not very well controlled. We evaluated the pancreas transplant recipients in the last three years at the University of Maryland to study the outcomes of these older and higher body mass index (BMI) recipients, as well as the impact of using older and higher BMI donors. We saw no difference in the survival of the patient or the allograft of recipients who were older or had higher BMIs. We also saw no difference in morbidity for these patients. There also was no difference when using older or higher BMI donor organs, longer cold ischemic times, different types of donors (donation after cardiac death versus brain dead donors), or different types of organs (simultaneous pancreas kidney, pancreas transplant alone, or pancreas after kidney). In reviewing our waitlist, our patients range widely in age and BMI. As long as they are fit for surgery, we will continue to transplant our ever growing population of older and obese diabetics without any more adverse outcomes than occur in our normal weight and younger patients.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":"31 ","pages":"113-119"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35005245","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}