Clinical transplants最新文献

{"title":"The New Zealand Liver Transplant Unit: Auckland District Health Board.","authors":"Stephen R Munn,&nbsp;Helen M Evans,&nbsp;Edward J Gane","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>New Zealand is a geographically isolated country with 4.55 million inhabitants. It has endemic hepatitis B (HBV) infection that is especially evident in Maori and Pacific Island communities and impacts indications for liver transplantation. The country has a socialised medical system that allows for full coverage of the assessment for, and completion of liver transplants in suitable recipients. Between February 1998 and December 2014, the New Zealand Liver Transplant Unit (NZLTU) had performed 595 liver transplants in 568 patients, indicating a crude re-transplant rate of 4.8%. Overall 1, 5, and 10 year patient survival rates for all adult (96%, 89%, and 81%, respectively) and pediatric (93%, 92%, and 92%, respectively) recipients compare very favourably with international outcomes from Europe and the United States. Eligibility criteria could be modestly expanded if deceased donor rates improved from the current level of around 10 per million of population per year. This somewhat meagre supply of deceased donor organs, along with significant waiting list attrition, has necessitated the use of living donors, which have been used in more than 50 recipients to date. Despite these limitations, the NZLTU has contributed to improvements in the outcome of transplantation for HBV and hepatitis C through the development of effective antiviral prophylaxis regimes. Furthermore, innovative changes have been made to the manner in which pediatric patients are transitioned to the adult service.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":" ","pages":"91-8"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34099325","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":"Efficacy of Intravenous Immunoglobulin in the Treatment of Persistent BK Viremia and BK Virus Nephropathy in Renal Transplant Recipients.","authors":"Tariq Shah,&nbsp;Don Vu,&nbsp;Robert Naraghi,&nbsp;Annabelle Campbell,&nbsp;David Min","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>BK virus associated nephropathy (BKVN) can cause clinically significant viral infections in renal transplant recipients, leading to allograft dysfunction and loss. The usual management of BKVN involves reduction of immunosuppression and the addition of leflunomide, quinolones, and cidofovir, but the rate of graft loss remains high. The aim of this study was to assess the impact of treatment with intravenous immunoglobulin (IVIG) on the outcome of BKVN in renal transplant recipients. Upon diagnosis of BKVN, patients remained on anti-polyomavirus treatment consisting of reduction of immunosuppression and the use of leflunomide therapy. Treatment with IVIG was given only to patients who did not respond to 8 weeks of the adjustment of immunosuppression and leflunomide. All 30 patients had persistent BK viremia and BKVN with their mean BK viral loads higher than the baseline (range 15,000 - 2 millions copies/mL). Mean peak BK load was 205,314 copies/mL compared to 697 copies/mL after one year follow-up. Twenty-seven patients (90%) had positive responses in clearing viremia. The actuarial patient and graft survival rates after 12 months were 100% and 96.7%, respectively. IVIG administration appeared to be safe and effective in treating BK viremia and BKVN and in preventing graft loss in patients who had inadequate response to immunosuppression reduction and leflunomide therapy.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":" ","pages":"109-16"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34099327","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":"Beyond Criteria and Definitions: Outcome of a Standardized Antibody-Mediated Rejection Protocol with a Diagnostic Schema Different from the Banff 2009 Criteria.","authors":"TrisAnn Rendulic,&nbsp;Daniel S Ramon,&nbsp;Paul D Killen,&nbsp;Milagros Samaniego-Picota,&nbsp;Jeong M Park","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A new clinical diagnostic schema is needed for the diagnosis of antibody-mediated rejection (AMR) in kidney transplant recipients due to the limited utility of C4d staining, lack of standardized quantitative tests for donor specific antibodies, and potential new diagnostic markers. The treatment of AMR remains controversial because previous studies included heterogeneous treatment modalities, small sample sizes, and short follow-up time. At the University of Michigan Transplant Center, 26 patients were diagnosed with AMR based on our diagnostic protocol including C4d-negative AMR in thesetting of graft dysfunction and Banff tissue injury type II (capillaritis) or type III (arteritis). After diagnosis, these patients received six sessions of plasmapheresis (PP) and IVIG (100 mg/kg after the first to fifth PP and 500 mg/kg with the last PP). Our novel finding in this analysis was the association between persistent C1q detection and graft loss. We confirmed that C4d positivity at diagnosis is associated with worse outcomes. Also, we found that response to our treatment protocol is dependent on C4d staining and Banff tissue injury type.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":" ","pages":"179-87"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33996231","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":"25 Years of Kidney Transplantation--A Period of Change.","authors":"Dirk L Stippel,&nbsp;Tülay Cingöz,&nbsp;Roger Wahbal,&nbsp;Roman-Ulrich Müller,&nbsp;Ursula Bauerfeind,&nbsp;Georg Dieplinger","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>At the University of Cologne Hospital, 1062 kidney transplants in adults and 136 pediatric transplants were performed between 1990 and 2014. Immunosuppressive therapy was changed during this time period from a therapy with anti-lymphocyte globulin induction followed by a triple therapy to a period using induction (IL2 receptor antagonists) followed by low dose tacrolimus, mycophenolate mofetil and steroids. Antiviral therapy has been constant during the 25 years, consisting of ganciclovir or valganciclovir. Major change occurred in the age of donors and recipients, with more than a third of both now being older than 65 years. Living donation has increased in number and proportion, at the same time the number of deceased donors rapidly declined. Longer time periods on dialysis resulted not only in an increased risk profile of the recipients, but were also accompanied by a significantly higher number of mismatches for the allocated kidney, since the relative importance of waiting time in the allocation process increased. Multivariate analysis showed that immunological factors such as HLA-match and panel reactive antibody are relevant factors, even in a single center analysis.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":" ","pages":"69-76"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34098268","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 Alfred Hospital Lung Transplant Experience.","authors":"Miranda A Paraskeva,&nbsp;Glen P Westall,&nbsp;David Pilcher,&nbsp;David McGiffin,&nbsp;Bronwyn J Levvey,&nbsp;Trevor J Williams,&nbsp;Gregory I Snell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The management of patients undergoing lung transplantation has continued to evolve, leading to improvements in 90-day and 1-year survival. The significant advancements in donor management and utilization at our center have led to significant increases in lung transplant activity without any compromise in recipient outcomes. Through the use of a patient-centered multidisciplinary model of care involved in all aspects of recipient management, from assessment and waitlisting to pre-, peri- and post-operative care, our lung transplant outcomes represent 2015 world's best lung transplant practice.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":" ","pages":"99-108"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34099326","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 Role of Donor-Specific Antibodies in Intestinal Transplantation: Experience at the University of California Los Angeles and Literature Review.","authors":"Elaine Y Cheng,&nbsp;Hugo Kaneku,&nbsp;Douglas G Farmer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Intestinal transplantation is a viable treatment strategy for patients with irreversible intestinal failure for whom parenteral nutrition is no longer an option. Although improvements have been made in short-term post-transplant survival outcomes, long-term allograft loss, mainly to acute or chronic rejection, remains a major obstacle to successful transplantation. In all types of solid organ transplants, there is increasing evidence that antibodies directed against human leukocyte antigens, and in particular donor-specific antibodies (DSA), contribute to acute and chronic rejection as well as allograft loss. In this single-center review of intestinal transplant recipients, we report that the presence of pretransplant circulating DSA and the de novo induction of DSA posttransplant are both associated with increased risks of allograft loss. Although the cumulative incidence of acute rejection was not significantly affected by the presence of DSA, the power of this single-center study may be limited. Prospective, multicenter studies are needed to further elucidate the role of DSA in intestinal transplant recipients. In the published literature, there is a clear link between the presence of pre-formed DSA and early injury to the mucosal vasculature of the allograft. Two groups have reported an association between pretransplant DSA and the frequency of acute rejection episodes and subsequent graft loss. Similarly, studies investigating the effects of de novo DSA have demonstrated a relationship between the presence of post-transplant circulating antibodies and the occurrence of acute rejection and the risk of allograft failure. The use of a liver-containing graft appears to facilitate the clearance of pre-formed antibodies and prevents the de novo induction of post-transplant antibodies. The most recent report stated that the de novo induction of DSA is concurrently accompanied by signs or rejection, such that the detection of circulating antibodies may signify impending graft injury, and supports the potential utility of DSA as a non-invasive biomarker for rejection in intestinal transplantation.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":" ","pages":"153-9"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33996228","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":"Highly Sensitized Patients: Miami Transplant Institute Experience.","authors":"Adela D Mattiazzi,&nbsp;Alexandra Centeno,&nbsp;Alexandra Amador,&nbsp;Casiana Fernandez-Bango,&nbsp;Catherine Dillard Scowby,&nbsp;Marian O'Rourke,&nbsp;Tamieka Hill-Matthie,&nbsp;Ronak Patel,&nbsp;Frances Barrios,&nbsp;Phillip Ruiz,&nbsp;Linda Chen,&nbsp;Junichiro Saghesima,&nbsp;Gaetano Ciancio,&nbsp;George W Burke,&nbsp;Michael Goldstein,&nbsp;Jayanthi Chandar,&nbsp;Gabriel Contreras,&nbsp;David Roth,&nbsp;Warren Kupin,&nbsp;Giselle Guerra,&nbsp;Rodrigo Vianna","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Transplantation continues to be challenging in highly sensitized patients. Herein, we compared induction immunosuppression (IS) based on immunologic risk stratification and desensitization with intravenous immunoglobulin (IVIG).</p><p><strong>Methods: </strong>Of the 42 highly sensitized kidney and 3 kidney-pancreas transplant recipients who underwent IVIG for desensitization from 2008-2014, 10 (Control group) received standard induction IS with antithymocyte globulin, basiliximab, and methylprednisolone, and 35 (Rituximab group) received standard IS with rituximab ± IVIG ± plasmapheresis. Immunologic risk stratification was based on donor specific antibodies (DSA), flow crossmatch ratio, and calculated panel reactive antibody. All patients received tacrolimus, mycophenolate, and steroids for maintenance IS. Unacceptable antigen cut-offs for class I and II DSA were 6000 and 9000 mean fluorescence intensity and 2.0 and 4.4 channel shift ratios for T and B cell flow cytometry crossmatch, respectively. All complement dependent cytotoxicity T cell crossmatch negative patients were transplanted.</p><p><strong>Results: </strong>Characteristics between groups, including high risk level, previous transplantation rate, number of human leukocyte antigen mismatches, delayed graft function rate, rejection rate, serum creatinine, and estimated glomerular filtration rate at 1 year (1.48 ± 0.6 and 50 ± 17 versus 1.1 ± 0.4 mg/dl and 66 25 ml/min) were not statistically significant between the Control and the Rituximab groups, respectively. Waiting time for the Control group was 6.4 years versus 4.1 years for the Rituximab group (p = 0.009). The cumulative proportion of patients who remain free of death or allograft failure was significantly higher in the Rituximab (87%) versus the Control group (60%) (p = 0.047).</p><p><strong>Conclusions: </strong>In highly sensitized patients who received desensitization with IVIG, the addition of Rituximab to our standard IS (and/or IVIG and plasmapheresis as per the immunologic risk stratification model) resulted in higher cumulative patient and graft survival.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":" ","pages":"171-8"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33996230","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":"Effects of Two Preemptive Post-transplant Desensitization Regimens Upon Renal Allograft Survival and DSA Elaboration.","authors":"Pamela M Kimball,&nbsp;Felecia A McDougan,&nbsp;Anne King","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We used a simple point-based algorithm to identify patients who might benefit from desensitization because of their higher risk of antibody-mediated chronic rejection and graft failure. Points were assigned to known but easily determined risk factors (panel reactive antibody, flow crossmatch, delayed graft function) and calculated immediately after deceased donor kidney transplantation. Point totals were used to identify: 1) which patients would receive desensitization; and, 2) which regimen each patient would receive. This standardized approached resulted in improved overall graft survival in both modalities compared to historically untreated sensitized patients. While preemptive desensitization positively impacted clinical metrics, the improvements were unequal between regimens. PP/IVIG treatment clearly resulted in greater elimination of preexisting donor specific antibodies against HLA antigens (DSA), fewer late rejections, and superior 3-year graft survival among patients who resolved their DSA as well as those with persistent DSA. Since graft survival among PP/IVIG recipients was excellent even when preexisting DSA were still present one year post-transplant, it suggests that the benefit of this regimen is two-fold: first to increase DSA elimination among patients, and secondly, to minimize downstream immune activating events such as rejection. In contrast, IVIG patients with persistent DSA had more rejections and graft survival only slightly better than if they had no treatment at all. Since the IVIG group also had a preponderance of Class II directed DSA, we cannot discount the influence of that specificity upon graft outcomes. Additional studies are needed to confirm our findings and to allow more effective assessment of the impact of DSA specificity upon desensitization efficacy and graft success.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":" ","pages":"197-203"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33996233","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 Thirty-Six Year Experience in Kidney Transplantation at Changzheng Hospital.","authors":"Youhua Zhu,&nbsp;Lei Zhang,&nbsp;Zhilian Min,&nbsp;Changmin He","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Between June 1978 and June 2014, 4,199 kidney transplants were performed at the Transplantation Center of PLA, Changzheng Hospital, Second Military Medical University. In our initial practice period (1978-1985), graft and patient survivals were 48.2% and 56.5%, 27.3% and 31.7%, 22.5% and 24.4%, 20.1% and 23.2%, and 16.5% and 20.8%, at 1, 5, 10, 15, and 20 years, respectively. These results improved tremendously after cyclosporine A (1986-1998) was used at our center. The rates of 1-, 5-, 10-, 15-, and 20-year graft and patient survival were 84.3% and 88.5%, 72.3% and 76.7%, 60.4% and 65.4%, 55.1% and 58.2%, and 49.0% and 51.8%, respectively. Tacrolimus (1999-2014) further increased graft survival to 95.1%, 84.4%, 77.1%, and 70.9%, and patient survival to 98.3%, 90.4%, 80.7%, and 73.4%, at 1, 5, 10, and 15 years, respectively. Multivariate Cox analysis suggested that transplant year, delayed graft function, rejection, immunosuppressive regimen, and original disease were independent predictors of graft survival and that poor HLA matching with 5-6 mismatches had an adverse effect on graft survival compared with 1-2 mismatches. The major causes of patient death included infection (38.1%), cardio-cerebral accident (30.2%), and malignancy (16.3%). As one of the pioneer transplant centers in China, our greatest contribution to organ transplantation in China is our self-developed organ preservation solution (HC-A), which has been used in more than 100,000 grafts and for more than 30 years.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":" ","pages":"77-81"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34098269","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":"Allo-Hematopoietic Stem Cell Transplant in China: 2014 Update.","authors":"Meng Lv,&nbsp;Xiao-Jun Huang","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Allogeneic hematopoietic stem cell transplantation (allo-HSCT) provides powerful curative weapons for patients with certain hematological diseases. Great improvements have been made within recent years, particularly in the fields of haploidentical HSCT, allo-HSCT for aplastic anemia, and strategies to overcome relapse and graft versus host disease. This review updates the current state of allo-HSCT in China.</p>","PeriodicalId":77074,"journal":{"name":"Clinical transplants","volume":" ","pages":"235-44"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33928586","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}