journal

American Journal of Transplantation

journal
https://read.qxmd.com/read/32594653/response-to-letters-to-the-editor-re-kidney-transplantation-and-donation-in-the-transgender-population-a-single-institution-case-series
#1
LETTER
Omar I Ramadan, Ali Naji, Matthew H Levine, Paige M Porrett, Ty B Dunn, Robert M Weinrieb, Mary Kaminski, Jennifer Trofe-Clark, Ilona S Lorincz, Emily Blumberg, Blair C Weikert, Melissa Bleicher, Peter L Abt
We appreciate the two thoughtful responses to our manuscript describing the first case series of transgender kidney transplant recipients and donors. Jue, et al., and Greene, et al., both highlight the importance of accurately assessing renal function in transgender patients. Specifically, they call attention to the effect of gender on estimated glomerular filtration rate (eGFR), and its influence on medication dosing as well as access to deceased donor organs. As they suggest, a transgender patient's reported eGFR may be based upon the gender assigned to them at birth, legal gender, or the gender they identify with...
June 28, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32594646/factors-associated-with-kidney-graft-survival-in-pure-antibody-mediated-rejection-at-the-time-of-indication-biopsy-importance-of-parenchymal-injury-but-not-disease-activity
#2
Gunilla Einecke, Jeff Reeve, Gaurav Gupta, Georg Bohmig, Farsad Eskandary, Jonathan Bromberg, Klemens Budde, Philip F Halloran
We studied the relative association of clinical, histologic, and molecular variables with risk of kidney transplant failure after an indication biopsy, both in all kidneys and in kidneys with pure antibody-mediated rejection (ABMR). From a prospective study of 1679 biopsies with histologic and molecular testing, we selected one random biopsy per patient (N=1120), including 321 with pure molecular ABMR. Diagnoses were associated with actuarial survival differences but not good predictions. Therefore we concentrated on clinical (eGFR, proteinuria, time post-transplant, DSA) and molecular and histologic features reflecting injury (acute kidney injury (AKI) and atrophy-fibrosis (chronic kidney disease (CKD)) and rejection...
June 28, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32594632/we-are-transplant-surgeons-first-bariatric-surgeons-second
#3
LETTER
Tayyab S Diwan
I greatly appreciate the time taken by the authors of the editorial to point out issues that are so very important in the field of transplantation obesity. The clinical activity and research in this field has finally reached a point where discussions of why are now almost moot and replaced with questions of how, and when. Thought is now being applied to some of the nuances to the utilization of bariatric surgery in transplantation, such as appropriate bariatric surgery procedure selection, timing of bariatric surgery in relationship to transplant, the effect of bariatric surgery on immunosuppressive absorption, and appropriate candidate selection...
June 28, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32594616/extracellular-vesicles-for-treatment-of-solid-organ-ischemia-reperfusion-injury
#4
REVIEW
Mojahid Ali, Anthony Pham, Xinghua Wang, Joy Wolfram, Si M Pham
As the incidence of ischemia reperfusion (I-R) injury has substantially increased, there is a pressing need to develop effective strategies to treat this global health issue. I-R injury can affect all organs and is associated with high morbidity and mortality rates. Pathological settings such as myocardial infarction, stroke, hemorrhagic shock, and solid organ transplantation are particularly prone to cause I-R injury. Ischemia (hypoxia) and/or reperfusion (re-oxygenation) induce various forms of cellular and structural damage...
June 28, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32594614/type-3-innate-lymphoid-cells-are-associated-with-a-successful-intestinal-transplant
#5
Jiman Kang, Katrina Loh, Leonid Belyayev, Priscilla Cha, Mohammed Sadat, Khalid Khan, Yuriy Gusev, Krithika Bhuvaneshwar, Habtom Ressom, Sangeetha Moturi, Jason Kaiser, Jason Hawksworth, Simon C Robson, Cal S Matsumoto, Michael Zasloff, Thomas M Fishbein, Alexander Kroemer
While innate lymphoid cells (ILCs) play fundamental roles in mucosal barrier functionality and tissue homeostasis, ILC-related mechanisms underlying intestinal barrier function, homeostatic regulation, and graft rejection in intestinal transplantation (ITx) patients have yet to be thoroughly defined. We found protective type 3 NKp44+ ILCs (ILC3s) to be significantly diminished in newly transplanted allografts, compared to allografts at 6 months, while proinflammatory type 1 NKp44- ILCs (ILC1s) were higher. Moreover, serial immunomonitoring revealed that in healthy allografts, protective ILC3s repopulate by 2-4 weeks postoperatively, but in rejecting allografts they remain diminished...
June 28, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32594613/use-of-expanded-criteria-donors-and-85-kdpi-kidneys-for-pediatric-kidney-transplantation-in-the-united-states
#6
Sarah J Kizilbash, Michael D Evans, Srinath Chinnakotla, Blanche M Chavers
Pediatric kidney transplant outcomes associated with expanded-criteria-donors (ECD) and high kidney-donor-profile-index (KDPI) kidneys are unknown. We reviewed the SRTR data from 1987-2017 to identify 96 ECD and 92 >85 KDPI kidney recipients (<18 years). Using propensity scores, we created comparison groups of 375 non-ECD and 357 ≤85 KDPI recipients for comparisons with ECD and >85 KDPI transplants, respectively. We used Cox regression for patient/graft survival, and sequential Cox approach for survival benefit of ECD and >85 KDPI transplantation versus (vs...
June 28, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32594606/early-national-and-center-level-changes-to-kidney-transplantation-in-the-united-states-during-covid-19-epidemic
#7
Brian J Boyarsky, William A Werbel, Christine M Durand, Robin K Avery, Kyle R Jackson, Amber B Kernodle, Jon Snyder, Ryutaro Hirose, Indraneel M Massie, Jacqueline M Garonzik-Wang, Dorry L Segev, Allan B Massie
In March 2020, COVID-19 spread rapidly nationally, causing widespread emergent changes to the health system. Our goal was to understand the impact of the epidemic on kidney transplantation (KT), at both the national and center-levels, accounting statistically for waitlist composition. Using SRTR data, we compared data on observed waitlist registrations, waitlist mortality, living-donor and deceased-donor kidney transplants (LDKT/DDKT) March 15-April 30, 2020 to expected events calculated from pre-epidemic data January 2016-February 2020...
June 28, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32592536/nomenclature-for-kidney-function-and-disease-executive-summary-and-glossary-from-a-kidney-disease-improving-global-outcomes-kdigo-consensus-conference
#8
LETTER
Andrew S Levey, Kai-Uwe Eckardt, Nijsje M Dorman, Stacy L Christiansen, Michael Cheung, Michel Jadoul, Wolfgang C Winkelmayer
No abstract text is available yet for this article.
June 27, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32583615/the-nlrp3-inflammasome-regulates-corneal-allograft-rejection-through-enhanced-phosphorylation-of-stat3
#9
Chao Wei, Li Ma, Hao Chi, Lin Li, Sai Zhang, Wenhui Yin, Ting Liu, Hua Gao, Weiyun Shi
The success of corneal transplantation is limited by allograft rejection, but the pathogenic mechanisms of this disease remain poorly defined. In this study, we showed that the NOD, LRR-and pyrin domain-containing protein3 (NLRP3) inflammasome-mediated interleukin-1β (IL-1β) production exacerbated corneal allograft rejection. Extracellular ATP contributed to the NLRP3 inflammasome-mediated IL-1β release, which in turn was preferentially skewed toward Th17 differentiation via enhanced phosphorylation of STAT3...
June 24, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32580235/the-role-of-low-dose-calcineurin-inhibitor-regimens-in-pediatric-kidney-transplantation
#10
EDITORIAL
Eileen T Chambers
Despite the clinical advancements made in pediatric kidney transplantation, long-term outcomes remain sub-optimal. According to recent data from the North American Pediatric Renal Trial and Collaborative Studies (NAPRTCS), pediatric allograft function and survival continue to decline over time on predominantly calcineurin inhibitor (CNI) based regimens (1). Remarkably, rates of acute rejection (1) and de novo donor specific antibody (dnDSA) development continue to rise, especially in children >12 years of age...
June 24, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32579288/afterlife-for-lungs-a-way-to-increase-donor-lungs-for-transplant
#11
LETTER
Thomas M Egan, John J Requard
No abstract text is available yet for this article.
June 24, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32568471/there-are-no-best-practices-in-a-pandemic-organ-donation-within-the-covid-19-epicenter
#12
Amy L Friedman, Kristin W Delli Carpini, Chad Ezzell, Helen Irving
LiveOnNY, the organ procurement organization (OPO) for the greater New York metropolitan area, suspended several best practices to manage the rising referrals of deaths from hospitals during the SARS-CoV-2 pandemic. On April 2, 2020 hospitals in the donor service area were notified that COVID-19 referrals should be deferred. Still, only 2% of referred patients to the OPO in April, 2020 were on ventilators and considered possible organ donors, versus a baseline of 11% in 2019. Few of these deaths were unrelated to COVID-19...
June 22, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32564513/competing-risks-and-the-risks-of-children-and-adults-competing-for-livers
#13
EDITORIAL
Paul A MacLennan, Babak J Orandi
Model for End-Stage Liver Disease (MELD) and Pediatric End-Stage Liver Disease (PELD; for children <12 years old) scores are intended to prioritize allocation of livers to end-stage liver disease patients with the highest likelihood of dying. Pediatric and adult candidates are frequently eligible for the same allografts, as allocation occurs via two similar, but not quite parallel systems. This overlap often leads to direct competition among pediatric and adult patients. An equitable system for children would describe the same endpoint as MELD (i...
June 21, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32558252/stem-cell-donor-hla-typing-improves-cpra-in-kidney-allocation
#14
Evan P Kransdorf, Marcelo J Pando, Darren Stewart, Kelsi Lindblad, Robert Bray, Cathi Murphey, Navchetan Kaur, Jignesh K Patel, Irene Kim, Xiaohai Zhang, Martin Maiers, Jon A Kobashigawa, Loren Gragert
The Organ Procurement and Transplantation Network (OPTN) Kidney Allocation System provides a priority to sensitized candidates based on the calculated panel reactive antibody (CPRA) value. The human leukocyte antigen (HLA) haplotype reference panel used for calculation of the CPRA by the United Network for Organ Sharing (UNOS), the OPTN contractor, has limitations. We derived a novel panel from the National Marrow Donor Program HLA haplotype dataset and compared the accuracy of CPRA values generated with this panel (NMDP-CPRA) to those generated from the UNOS panel (UNOS-CPRA), using predicted and actual deceased donor kidney offers for a cohort of 24,282 candidates...
June 18, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32558226/the-use-of-a-bluetooth-tablet-based-technology-to-improve-outcomes-in-lung-transplantation-a-pilot-study
#15
Felicia A Schenkel, Mark L Barr, C Christopher McCloskey, Tammie Possemato, Jeremy O'Conner, Roya Sadeghi, Maria Bembi, Marian Duong, Jaynita Patel, Amy E Hackmann, Sivagini Ganesh
The impact of remote patient monitoring platforms to support the post-operative care of solid organ transplant recipients is evolving. In an observational pilot study, 28 lung transplant recipients were enrolled in a novel post-discharge home monitoring program and compared to 28 matched controls during a two-year period. Primary endpoints included hospital readmissions and total days readmitted. Secondary endpoints were survival and inflation-adjusted hospital readmission charges. In univariate analyses, monitoring was associated with reduced readmissions (IRR: 0...
June 18, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32558199/avoidance-of-cni-and-steroids-using-belatacept-results-of-the-clinical-trials-in-organ-transplantation-16-trial
#16
Roslyn B Mannon, Brian Armstrong, Peter G Stock, Aneesh K Mehta, Alton B Farris, Natasha Watson, Yvonne Morrison, Nancy Bridges, Mark Robien, Kenneth A Newell, Christian P Larsen
Immunosuppression devoid of corticosteroids has been investigated to avoid long term comorbidities. Likewise, alternatives to calcineurin inhibitors have been investigated as a strategy to improve long-term kidney function following transplanion. Costimulatory blockade strategies that include corticosteroids have recently shown promise, despite their higher rates of early acute rejection. We designed a randomized clinical trial utilizing depletional induction therapy to mitigate early rejection risk while limiting calcineurin inhibitors and corticosteroids...
June 18, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32558174/effects-of-mtor-inhibitor-related-proteinuria-on-progression-of-cardiac-allograft-vasculopathy-and-outcomes-among-heart-transplant-recipients
#17
Rabea Asleh, Hilmi Alnsasra, Amir Lerman, Alexandros Briasoulis, Naveen L Pereira, Brooks Edwards, Takumi Toya, John M Stulak, Alfredo L Clavell, Richard C Daly, Sudhir S Kushwaha
We have previously described the use of sirolimus (SRL) as primary immunosuppression following heart transplantation (HT). The advantages of this approach include attenuation of cardiac allograft vasculopathy (CAV), improvement in glomerular filtration rate (GFR) and reduced malignancy. However, in some patients SRL may cause significant proteinuria. We sought to investigate the prognostic value of proteinuria after conversion to SRL. CAV progression and adverse clinical events were studied. CAV progression was assessed by measuring the Δ change in plaque volume (PV) and plaque index (PI) per year using coronary intravascular ultrasound (IVUS)...
June 18, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32558135/reply-to-living-liver-donation-in-previous-kidney-donors-a-single-center-experience
#18
LETTER
Whitney E Jackson, Michael S Kriss, James R Burton, Trevor L Nydam, Kendra D Conzen, James J Pomposelli, Elizabeth A Pomfret
We want to thank Nair et al.[1] for their experience highlighting the feasibility and safety of living liver donation after prior kidney donation. As the authors point out, while living donor liver transplantation remains a small percentage of total transplants in the United States, multiorgan donation is becoming more common [2]. This emphasizes the need to continue to pool multicenter experiences. We wish to contribute our center experience to this population of donors.
June 18, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32558153/economic-analysis-of-screening-for-subclinical-rejection-in-kidney-transplantation-using-protocol-biopsies-and-non-invasive-biomarkers
#19
Chethan M Puttarajappa, Rajil Mehta, Mark S Roberts, Kenneth J Smith, Sundaram Hariharan
Subclinical rejection (SCR) screening in kidney transplantation (KT) using protocol biopsies and non-invasive biomarkers has not been evaluated from an economic perspective. We assessed cost-effectiveness from health sector perspective of SCR screening in the first year after KT using a Markov model that compared no screening with screening using protocol biopsy or biomarker at 3 months, 12 months, 3 and 12 months, or 3, 6 and 12 months. We used 12% subclinical cellular rejection and 3% subclinical antibody mediated rejection (SC-ABMR) for the base-case cohort...
June 17, 2020: American Journal of Transplantation
https://read.qxmd.com/read/32531122/n-glycosylated-igg-in-patients-with-kidney-transplants-increases-calcium-calmodulin-kinase-iv-in-podocytes-and-causes-injury
#20
Rhea Bhargava, Kayaho Maeda, Maria G Tsokos, Martha Pavlakis, Isaac E Stillman, George C Tsokos
Transplant glomerulopathy (TG) is a major cause of late allograft loss. Increased urine podocin/creatinine ratio in TG signifies accelerated podocyte loss. The mechanisms that lead to podocyte injury in TG remain unclear. We report that IgG from kidney transplant recipients with TG, but not from those without TG, cause a reduction in the expression of nephrin, significant podocyte actin cytoskeleton and motility changes. These changes are preceded by increased expression of calcium/calmodulin kinase IV (CAMK4)...
June 12, 2020: American Journal of Transplantation
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