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American Journal of Transplantation

Cynthia L Russell, Donna Hathaway, Laura M Remy, Dana Aholt, Debra Clark, Courtney Miller, Catherine Ashbaugh, Mark Wakefield, Sangbeak Ye, Vincent S Staggs, Rebecca J Ellis, Kathy Goggin
This study determined if a SystemCHANGETM intervention was more efficacious than attention control in increasing immunosuppressive medication adherence and improving outcomes in adult kidney transplant recipients during a 6-month intervention phase and subsequent 6-month (no intervention) maintenance phase. The SystemCHANGETM intervention taught patients to use person-level quality improvement strategies to link adherence to established daily routines, environmental cues and supportive people. Eighty-nine patients (average age 51...
July 10, 2019: American Journal of Transplantation
Yizhan Guo, Qing Wang, Dongge Li, Oscar Okwudiri Onyema, Zhongcheng Mei, Amir Manafi, Anirban Banerjee, Bayan Mahgoub, Mark H Stoler, Thomas H Barker, David S Wilkes, Andrew E Gelman, Daniel Kreisel, Alexander Sasha Krupnick
Despite standardized post-operative care some lung transplant patients suffer multiple episodes of acute and chronic rejection while others avoid graft problems for reasons that are poorly understood. Using an established model of C57BL/10 to C57BL/6 minor antigen mismatched single lung transplantation we now demonstrate that the recipient microbiota contributes to variability in the alloimmune response. Specifically, mice from the Envigo facility in Frederick Maryland contain nearly double the number of CD4+ Foxp3+ regulatory T cells (Tregs ) than mice from the Jackson facility in Bar Harbor Maine or the Envigo facility in Indianapolis Indiana (18 vs...
July 6, 2019: American Journal of Transplantation
François Gaillard, Catherine Fournier, Christophe Legendre
In the editorial entitled "Amending a historic paradigm for selecting living kidney donors" Robert Steiner discusses the study by Al Ammary et al. which examined the evolution of living kidney donor characteristics in the United States1 . Despite recent findings on consequences of living kidney donation2 , no change in the selection of living kidney donors in the USA has occurred between 2005 and 2017. This editorial, highlights how difficult it is to change practice in light of the "new paradigm" concepts of: 1/ increased end stage kidney disease (ESKD) risk for related donors and 2/ increased ESKD risk of younger donors...
July 6, 2019: American Journal of Transplantation
Reem E Hamoda, Laura J McPherson, Kristie Lipford, Kimberly J Arriola, Laura Plantinga, Jennifer C Gander, Erica Hartmann, Laura Mulloy, Carlos F Zayas, Kyung Na Lee, Stephen O Pastan, Rachel E Patzer
Although research shows that minorities exhibit higher levels of medical mistrust, perceived racism, and discrimination in healthcare settings, the degree to which these underlying sociocultural factors preclude end-stage renal disease (ESRD) patients from initiating kidney transplant evaluation is unknown. We telephone surveyed 528 adult ESRD patients of black or white race referred for evaluation to a Georgia transplant center (N=3) in 2014-2016. We used multivariable logistic regression to examine associations between sociocultural factors and evaluation initiation, adjusting for demographic, clinical, and socioeconomic characteristics...
July 6, 2019: American Journal of Transplantation
Michaela R Anderson, Nicholas Kolaitis, Ying Gao, Jasleen Kukreja, John Greenland, Steven Hays, Paul Wolters, Jeff Golden, Joshua Diamond, Scott Palmer, Selim Arcasoy, Jayaram Udupa, Jason D Christie, David J Lederer, Jonathan P Singer
Frailty is a state of decreased physiologic reserve associated with poor outcomes before and after lung transplantation. Obesity, particularly central obesity characterized by excess pro-inflammatory visceral adipose tissue (VAT), is associated with incident frailty in middle-aged and older adults. The association between VAT and frailty in advanced lung disease, however, is unknown. In two, non-overlapping multicenter cohorts of adults listed for lung transplantation, we measured VAT area on bioelectrical impedance assay (BIA) in one cohort and cross-sectional VAT and subcutaneous adipose tissue (SAT) areas on abdominal computed tomography (CT) in the other...
July 6, 2019: American Journal of Transplantation
Nima Nassiri, Lorna Kwan, Aswani Bolagani, Alvin G Thomas, Joseph Sinacore, Matthew Ronin, Matthew Cooper, Dorry L Segev, J Michael Cecka, Jeffrey L Veale
To date, thousands of living donor kidneys have been shipped through kidney paired donation (KPD). To expand on this growing segment of living donor transplantation, we evaluated the effect of advanced age donation ("oldest kidneys") and prolonged cold ischemia time ("coldest kidneys") on graft function and survival using the National Kidney Registry database from February 2008 to May 2018. Donors were stratified by age at time of donation (<65 or ≥ 65 years) and kidneys were stratified by cold ischemia time (<16 or ≥16 hours)...
July 6, 2019: American Journal of Transplantation
Antonio Citro, Silvia Pellegrini, Erica Dugnani, Dirk Eulberg, Sven Klussmann, Lorenzo Piemonti
The blockade of pro-inflammatory mediators is a successful approach to improve the engraftment after islet transplantation. L-aptamers are chemically synthesized, non-immunogenic bio-stable oligonucleotides that bind and inhibit target molecules conceptually similar to antibodies. We aimed to evaluate if blockade-aptamer-based inhibitors of CCL2/MCP-1 and CXCL12/SDF-1 are able to favour islet survival in mouse models for islet transplantation and for type 1 diabetes. We evaluated the efficacy of the CCL2-specific mNOX-E36 and the CXCL12-specific NOX-A12 on islet survival in a syngeneic mouse model of intraportal islet transplantation and in a multiple low doses of streptozotocin (MLD-STZ) diabetes induction model...
July 3, 2019: American Journal of Transplantation
Alexandra K Glazier
For most in the transplant and donation community the recent legal activity is an unfamiliar sequence of events. The following is not a legal analysis of the Acuity Circle (AC) liver distribution policy or of the Final Rule regulatory requirements but rather a summary of the legal proceedings currently playing out in the federal courts. This article is protected by copyright. All rights reserved.
July 3, 2019: American Journal of Transplantation
Daniel R Kaul
Transmission of disease from donor to recipient remains an inevitable consequence of solid organ transplantation. In fact, the intentional transmission of viruses such as cytomegalovirus is routine; management strategies reduce the negative consequences of these transmissions. Unexpected transmission of disease is much less common, complicating less than 1% of organ transplants. Nonetheless, consequences can be severe with significant recipient morbidity and mortality and the potential to reduce public trust in the safety of the organ procurement system...
July 3, 2019: American Journal of Transplantation
Eduardo Miñambres, Patricia Ruiz, Maria Angeles Ballesteros, Carlos Álvarez, Jose Manuel Cifrián, Lander Atutxa, Alberto Ventoso, Federico Castillo, Mikel Gastaca
Combining simultaneously lungs and liver procurement in controlled donation after circulatory death (cDCD) using normothermic abdominal perfusion (NRP) for abdominal grafts and cooling and rapid recovery technique (RR) for the lungs increases the complexity of the procurement procedure and might injure the grafts. A total of 19 cDCDs from two centers using this combined procedure were evaluated, and 16 liver and 21 lung transplants were performed. As controls 34 donors after brain death (DBD) were included (29 liver and 41 lung transplants were performed)...
July 2, 2019: American Journal of Transplantation
J R Rodrigue, A Fleishman, J D Schold, P Morrissey, J Whiting, J Vella, L K Kayler, D Katz, J Jones, B Kaplan, M Pavlakis, D A Mandelbrot
This study sought to identify the prevalence, pattern and predictors of clinical fatigue in 193 living kidney donors (LKDs) and 20 healthy controls (HCs) assessed at pre-donation and 1, 6, 12, and 24 months post-donation. Relative to HCs, LKDs had significantly higher fatigue severity (P=0.01), interference (P=0.03), frequency (P=0.002), and intensity (P=0.01), and lower vitality (P<0.001), at 1-month post-donation. Using published criteria, significantly more LKDs experienced clinical fatigue at 1-month post-donation, compared to HCs, on both the Fatigue Symptom Inventory (60% vs...
July 2, 2019: American Journal of Transplantation
Robert R Redfield, Stanley C Jordan, Stephan Busque, Flavio Vincenti, E Steve Woodle, Niraj Desai, Elaine F Reed, Simon Tremblay, Andrea A Zachary, Ashley A Vo, Richard Formica, Thomas Schindler, Ha Tran, Caroline Looney, Candice Jamois, Cherie Green, Alyssa Morimoto, Richa Rajwanshi, Aaron Schroeder, Matthew D Cascino, Paul Brunetta, Dominic Borie
The limited effectiveness of rituximab plus intravenous immunoglobulin (IVIG) in desensitization may be due to incomplete B-cell depletion. Obinutuzumab is a type 2 anti-CD20 antibody that induces increased B-cell depletion relative to rituximab and may therefore be more effective for desensitization. This open-label Phase 1b study assessed the safety, pharmacokinetics, and pharmacodynamics of obinutuzumab in highly sensitized patients with end-stage renal disease. Patients received 1 (day 1, n=5) or 2 (days 1 and 15; n=20) infusions of 1000-mg obinutuzumab followed by 2 doses of IVIG on days 22 and 43...
July 1, 2019: American Journal of Transplantation
G Michael La Muraglia, Maylene E Wagener, Mandy L Ford, I Raul Badell
Donor-specific antibodies (DSA) contribute to renal allograft loss. However, biomarkers to guide clinical management of DSA post-transplant or detect humoral alloimmune responses before alloantibodies develop are not available. Circulating T follicular helper (Tfh) cells are CD4+ CXCR5+ Tfh-like cells in the blood that have been associated with alloantibodies in transplant recipients, but whether they precede antibody formation for their evaluation as a predictive biomarker in transplantation is unknown. To evaluate the ability of circulating Tfh (cTfh) cells to predict DSA, we utilized murine transplant models to determine the temporal relationship between cTfh cells, germinal center (GC) formation, and DSA development...
June 28, 2019: American Journal of Transplantation
Estela Giménez, Ignacio Torres, Eliseo Albert, José-Luis Piñana, Juan-Carlos Hernández-Boluda, Carlos Solano, David Navarro
Controversy surrounds the potential association between cytomegalovirus (CMV) infection and increased risk of mortality after allogeneic hematopoietic stem cell transplantation (Allo-HSCT). A systematic literature search was conducted using the Pubmed, EMBASE and Web of Science databases assessing the association between CMV infection, as documented by the pp65 antigenemia assay or by PCR using blood specimens, and overall mortality (OM) and non-relapse mortality (NRM) in the allo-HSCT setting. Pooled effects were estimated using the generic inverse variance random effects model...
June 27, 2019: American Journal of Transplantation
F Caballero, M Puig, J Leal, O Trejo, I Díaz, S Herrera, M Turbau, J Ris, S Benito
We read with interest the report by Martin-Delgado et al regarding the summary of Spanish recommendations on intensive care to facilitate organ donation (1). The report promotes innovation and targeted actions to allow successful organ donation for transplantation beyond the ICU, particularly in patients admitted to the emergency department (ED) with a devastating brain injury and imminent evolution to brain death (2, 3). The option for organ donation should be proposed as a usual part of end-of-life care for all patients with catastrophic brain injury and futile medical prognosis in EDs, in absence of medical contraindications for organ donation (2, 3)...
June 27, 2019: American Journal of Transplantation
Therese Bittermann, Rebecca A Hubbard, James D Lewis, David S Goldberg
The use of induction immunosuppression in liver transplantation (LT) remains controversial. This was a retrospective cohort study of adult, first-time liver alone recipients (N=69,349) at 114 U.S. centers between 2005-2018 using data from the United Network for Organ Sharing. The comparative effectiveness of non-depleting and depleting induction (NDI and DI) was assessed. Overall, 27% of recipients received induction with 65.7% of the variance in the receipt of induction being attributed to transplant center alone...
June 27, 2019: American Journal of Transplantation
Tomas Reischig, Martin Kacer, Ondrej Hes, Jana Machova, Jana Nemcova, Daniel Lysak, Pavel Jindra, Kristyna Pivovarcikova, Stanislav Kormunda, Mirko Bouda
Polyomavirus BK (BKV) is the cause of polyomavirus-associated nephropathy resulting in premature graft loss. There are limited data regarding the role of cytomegalovirus (CMV) infection and its prevention in developing BKV viremia and PVAN. In a prospective study, we analyzed 207 consecutive renal transplant recipients previously enrolled to 2 randomized trials evaluating different CMV prevention regimens with routine screening for BKV and CMV. Of these, 59 received valganciclovir and 100 valacyclovir prophylaxis, 48 patients were managed by preemptive therapy...
June 20, 2019: American Journal of Transplantation
Thomas M Egan, John Jacob Requard
We write to congratulate Dr. Suberviola and colleagues for their success transplanting lungs recovered from uncontrolled Donation after Circulatory Determination of Death donors (uDCDDs)(1). Although their institution is not in a densely populated area, they showed convincingly that uDCDDs can provide lungs that can be safely transplanted. Their excellent survival (only one death from sepsis with 7 survivors, mean follow-up 52 months), is very encouraging and may be due to their careful and rigorous selection criteria...
June 20, 2019: American Journal of Transplantation
Brianna L Doby, Brian J Boyarsky, Sommer Gentry, Dorry L Segev
Although many acknowledge that the available metrics for OPO performance are flawed, they cannot be optimized with currently available data. In this manuscript, we propose a simple, feasible, and comprehensive system for collecting the data necessary for research, regulation, and quality improvement of the organ donation pathway. This article is protected by copyright. All rights reserved.
June 20, 2019: American Journal of Transplantation
Stuart C Sweet, Hyunsook Chin, Carol Conrad, Don Hayes, Peter S Heeger, Albert Faro, Samuel Goldfarb, Ernestina Melicoff-Portillo, Thalachallour Mohanakumar, Jonah Odim, Marc Schecter, Gregory A Storch, Gary Visner, Nikki M Williams, Karen Kesler, Lara Danziger-Isakov
Based on reports in adult lung transplant recipients, we hypothesized that community acquired respiratory viral infections (CARV) would be a risk factor for poor outcome after pediatric lung transplant. We followed 61 pediatric lung transplant recipients for 2+ years or until they met a composite primary endpoint including bronchiolitis obliterans syndrome (BOS)/obliterative bronchiolitis, re-transplantation or death. Blood, bronchoalveolar lavage and nasopharyngeal specimens were obtained with standard of care visits...
June 19, 2019: American Journal of Transplantation
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