Journals American Journal of Transplant...

American Journal of Transplantation
Samira Alliouachene, Julius E Kieswich, Benoit Bilanges, Kieran McCafferty, Christoph Thiemermann, Bart Vanhaesebroeck, Muhammad M Yaqoob
Uninephrectomy (UNx) in living kidney donors for transplantation is now routine clinical practice. While chronic kidney disease, due to bilateral kidney dysfunction, is associated with insulin resistance, liver steatosis and type 2 diabetes, the metabolic impact of UNx remains unclear. To better understand the crosstalk between the kidney and insulin target tissues, we studied the metabolic consequences of UNx and the potential involvement of class II PI3K-C2β, the inactivation of which has been reported to result in insulin sensitization...
December 28, 2020: American Journal of Transplantation
Federica Casiraghi, Norberto Perico, Manuel Alfredo Podestà, Marta Todeschini, Marco Zambelli, Michele Colledan, Stefania Camagni, Stefano Fagiuoli, Antonio Daniele Pinna, Matteo Cescon, Valentina Bertuzzo, Lorenzo Maroni, Martino Introna, Chiara Capelli, Josee Therese Golay, Marina Buzzi, Marilena Mister, Pamela Yossenaidy Rodriguez Ordonez, Matteo Breno, Caterina Mele, Alessandro Villa, Giuseppe Remuzzi
Mesenchymal stromal cells (MSC) have emerged as a promising therapy to minimize the immunosuppressive regimen or induce tolerance in solid organ transplantation. In this randomized open-label phase Ib/IIa clinical trial, 20 liver transplant patients were randomly allocated (1:1) to receive a single pre-transplant intravenous infusion of third-party bone marrow-derived MSC or standard of care alone. The primary end-point was the safety profile of MSC administration during the one-year follow-up. Nineteen patients completed the study, and none of those who received MSC experienced infusion-related complications...
December 28, 2020: American Journal of Transplantation
Yoshihiro Shono, Yoshihiro Kushida, Shohei Wakao, Yasumasa Kuroda, Michiaki Unno, Takashi Kamei, Shigehito Miyagi, Mari Dezawa
Small-for-size syndrome (SFSS) has a poor prognosis due to excessive shear stress and sinusoidal microcirculatory disturbances in the acute phase after living-donor liver transplantation (LDLT). Muse cells are reparative stem cells found in various tissues and currently under clinical trials. These cells selectively home to damaged sites via the sphingosine-1-phosphate (S1P)-S1P receptor 2 system and repair damaged tissue by pleiotropic effects, including tissue protection and damaged/apoptotic cell replacement by differentiating into tissue-constituent cells...
December 22, 2020: American Journal of Transplantation
Timothy L Pruett
I am sick of Covid-19. Covid fatigue is real. However, viral spread is unfettered and continues to affect daily life, including the systems for organ retrieval and transplantation. In this edition of the American Journal of Transplantation, Goff et al report the OPTN data during healthcare's "learning period" of navigating the Covid-19 pandemic1 . When the manuscript was submitted there were 6.6 million cases; but 2.5 months later, infections have doubled to over 13 million, with over 260 thousand deaths and 200,000 new daily infections2 ...
December 22, 2020: American Journal of Transplantation
Brian I Shaw, Mariya L Samoylova, Scott Sanoff, Andrew S Barbas, Debra L Sudan, L Ebony Boulware, Lisa M McElroy
The incidence of simultaneous kidney heart transplant (SHK) has increased markedly in the last 15 years. There are no universally agreed upon indications for SHK vs. heart alone (HA) transplant, and center evaluation processes vary widely. We utilized Scientific Registry of Transplant Recipients data from 2003-2017 to quantify changes in the practice of SHK, examine the survival of SHK vs. HA, and identify patients with marginal benefit from SHK. We used Kaplan-Meier curves and Cox proportional hazards to assess differences in survival...
December 22, 2020: American Journal of Transplantation
Phuoc H Pham, Lily N Stalter, Eric J Martinez, Jesse F Wang, Bridget M Welch, Glen Leverson, Nicholas Marka, Talal Al-Qaoud, Didier Mandelbrot, Sandesh Parajuli, Hans W Sollinger, Dixon Kaufman, Robert R Redfield, Jon S Odorico
Studies have found similar outcomes of Simultaneous Pancreas-Kidney transplantation (SPKT) in patients with Type 2 (T2D) and Type 1 diabetes (T1D). However, there are few data evaluating the association of recipient factors such as age, BMI, or pre-transplant insulin requirements with outcomes, thus the criteria for the optimal recipient selection remains unclear. In this study, 284 T1D and 39 T2D patients, who underwent SPKT between 2006-2017 with 1 year of follow-up at minimum, were assessed for potential relationship of pre-transplant BMI and insulin requirements with post-transplant diabetes and pancreatic graft failure...
December 22, 2020: American Journal of Transplantation
Bonnie E Lonze, Gillian Baptiste, Nicole M Ali, Nabil N Dagher, Bruce E Gelb, Aprajita Mattoo, Irfana Soomro, Vashista S Tatapudi, Robert A Montgomery, Zoe A Stewart
Despite utilization of hepatitis C viremic organs for hepatitis C naïve recipients (HCV D+/R-) in other solid organ transplants, HCV viremic pancreata remain an unexplored source of donor organs. This study reports the first series of HCV D+/R- pancreas transplants. HCV D+/R- had shorter wait list times compared to HCV D-/R-, waiting a mean of 16 days from listing for HCV positive organs. HCV D+/R- had a lower match allocation sequence than HCV D-/R-, and this correlated to receipt of organs with a lower Pancreas Donor Risk Index (PDRI) score...
December 21, 2020: American Journal of Transplantation
Laureline Berteloot, Romain Berthaud, Sarah Temmam, Cécile Lozach, Elisa Zanelli, Thomas Blanc, Yves Heloury, Carmen Capito, Christophe Chardot, Sabine Sarnacki, Nicolas Garcelon, Florence Lacaille, Marina Charbit, Myriam Pastural, Marion Rabant, Nathalie Boddaert, Marianne Leruez-Ville, Marc Eloit, Isabelle Sermet-Gaudelus, Laurène Dehoux, Olivia Boyer
Graft artery stenosis can have a significant short- and long-term negative impact on renal graft function. From the beginning of the COVID-19 pandemic, we noticed an unusual number of graft arterial anomalies following kidney transplant (KTx) in children. Nine children received a KTx at our center between February and July 2020, eight boys and one girl, of median age 10 years. Seven presented Doppler features suggesting arterial stenosis, with an unusual extensive pattern. For comparison, over the previous five-year period, persistent spectral Doppler arterial anomalies (focal anastomotic stenoses) following KTx were seen in 5% of children at our center...
December 21, 2020: American Journal of Transplantation
Emilio D Poggio, Joshua J Augustine, Susana Arrigain, Daniel C Brennan, Jesse D Schold
Current short term kidney post-transplant survival rates are excellent, but longer term outcomes have historically been unchanged. This study used data from the national Scientific Registry of Transplant Recipients (SRTR) and evaluated 1-year and 5-year graft survival and half-lives for kidney transplant recipients in the US. All adult (≥18 years) solitary kidney transplants (n=331,216) from 1995 to 2017 were included in the analysis. Mean age was 49.4 years (SD +/-13.7), 60% male, and 25% Black. The overall (deceased and living donor) adjusted hazard of graft failure steadily decreased from 0...
December 21, 2020: American Journal of Transplantation
Willemijn Y van der Plas, António W Gomes Neto, Stefan P Berger, Robert A Pol, Schelto Kruijff, Stephan J L Bakker, Martin H de Borst
Disturbances in calcium-phosphate homeostasis are common after kidney transplantation. We aimed to assess the relationship between deregulations in plasma calcium and phosphate over time and mortality and death-censored graft failure (DCGF). In this prospective cohort study we included kidney transplant recipients with ≥2 plasma calcium and phosphate measurements. Data were analyzed using time-updated Cox regression analyses adjusted for potential confounders including time-updated kidney function. We included 2,769 patients (mean age 47±14 years, 42...
December 17, 2020: American Journal of Transplantation
Sindhu Chandran, Joey Leung, Crystal Hu, Zoltan G Laszik, Qizhi Tang, Flavio G Vincenti
Interleukin-6 (IL-6) is a proinflammatory cytokine and key regulator of Treg: T effector cell (Teff) balance. We hypothesized that IL-6 blockade with tocilizumab, a monoclonal antibody to IL-6R, would increase Tregs, dampen Teff function, and control graft inflammation. We conducted a randomized controlled clinical trial (2014-2018) of clinically stable kidney transplant recipients on calcineurin inhibitor, mycophenolate mofetil and prednisone, with subclinical graft inflammation noted on surveillance biopsies during the first year post-transplant...
December 17, 2020: American Journal of Transplantation
Vinay Nair, Nicholas Jandovitz, Jamie S Hirsch, Mersema Abate, Sanjaya K Satapathy, Nitzan Roth, Santiago J Miyara, Sara Guevara, Adam M Kressel, Alec Xiang, Grace Wu, Samuel D Butensky, David Lin, Stephanie Williams, Madhu C Bhaskaran, David T Majure, Elliot Grodstein, Lawrence Lau, Gayatri Nair, Ahmed E Fahmy, Aaron Winnick, Nadine Breslin, Ilan Berlinrut, Christine Molmenti, Lance B Becker, Prashant Malhotra, Pranisha Gautam-Goyal, Brian Lima, Simon Maybaum, Samit K Shah, Ryosuke Takegawa, Kei Hayashida, Koichiro Shinozaki, Lewis W Teperman, Ernesto P Molmenti
We compared the outcome of COVID-19 in immunosuppressed solid organ transplant (SOT) patients to a transplant naïve population. In total, 10 356 adult hospital admissions for COVID-19 from March 1, 2020 to April 27, 2020 were analyzed. Data were collected on demographics, baseline clinical conditions, medications, immunosuppression, and COVID-19 course. Primary outcome was combined death or mechanical ventilation. We assessed the association between primary outcome and prognostic variables using bivariate and multivariate regression models...
December 16, 2020: American Journal of Transplantation
Marcos Iglesias, Saami Khalifian, Byoung Chol Oh, Yichuan Zhang, Devin Miller, Sarah Beck, Gerald Brandacher, Giorgio Raimondi
Costimulation blockade-based regimens are a promising strategy for management of transplant recipients. However, maintenance immunosuppression via CTLA4-Ig monotherapy is characterized by high frequency of rejection episodes. Recent evidence suggests that inflammatory cytokines contribute to alloreactive T cell activation in a CD28-independent manner, a reasonable contributor to the limited efficacy of CTLA4-Ig. In this study, we investigated the possible synergism of a combined short-term inhibition of cytokine signaling and CD28 engagement on the modulation of rejection...
December 16, 2020: American Journal of Transplantation
Sanjay Kulkarni, Keren Ladin
Racial inequity in access to kidney transplantation continues to be an area of focus. Rightly so, as deceased donor organs represent a scarce resource and disparities in access require attention. In this month's AJT, Reese et al. provide insights into the disparate allocation of preemptive deceased donor kidneys, show why Blacks have lower rates of preemptive transplants, and propose interventions that are targeted at reducing this disparity (1). One important aspect of this work is the focus on listing criteria that currently requires only a single test of eGFR ≤20 ml/min/1...
December 16, 2020: American Journal of Transplantation
Thomas M Egan, Stephen Wall, Lewis Goldfrank, John Jacob Requard
We write about Boyarsky et. al.'s estimate of uncontrolled Donation after Circulatory determination of Death donors (uDCDs)(1) using data from the 2013-2016 Nationwide Emergency Department Sample (NEDS). They identified 9,828 Emergency Department (ED)-based refractory cardiac arrests potentially eligible for uDCD; 91% had traumatic deaths. This estimate is <50% of 22,000 predicted by the National Academies of Medicine (NAM) 15 years ago.(2) Unfortunately, their methods challenge their findings.
December 15, 2020: American Journal of Transplantation
Qiang Zhong, TuRun Song, Jun Zeng, Tao Lin, Yu Fan, Xin Wei
Ureteral stenosis(US) is one of the most common urologic complications after kidney transplantation (KT), and the incidence ranged from 2.6% to 15% among different transplant unit(1). Reoperation has a definite effect on US, but it is also associated with greater morbidity, prolonged recovery and a higher risk of more serious complications including graft loss and perioperative mortality(2).
December 15, 2020: American Journal of Transplantation
Irene Cassaniti, Anna Amelia Colombo, Paolo Bernasconi, Michele Malagola, Domenico Russo, Anna Paola Iori, Corrado Girmenia, Raffaella Greco, Jacopo Peccatori, Fabio Ciceri, Francesca Bonifazi, Elena Percivalle, Giulia Campanini, Giulia Piccirilli, Tiziana Lazzarotto, Fausto Baldanti
Letermovir (LMV) inhibits HCMV replication by binding to components of the HCMV terminase complex showing a potential role in prevention of HCMV-related complications in allogenic hematopoietic stem cell transplant recipients (allo-HSCTRs). However, little is known about breakthrough HCMV infection and the relevance of HCMV DNAemia during prophylaxis. We reported the results of a multicenter prospective study involving five Italian centers in the management of HCMV DNAemia in 75 adult HCMV-seropositive allo-HSCTRs undergoing LMV prophylaxis...
December 15, 2020: American Journal of Transplantation
Lara Danziger-Isakov, Emily A Blumberg, Oriol Manuel, Martina Sester
The Coronavirus disease 19 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exploded onto the world stage in early 2020. The impact on solid organ transplantation (SOT) has been profound affecting potential donors, candidates, and recipients. Importantly, decreased donations and the pressure of limited resources placed on healthcare by the pandemic also disrupted transplant systems. We address the impact of COVID-19 on organ transplantation globally and review current understanding of the epidemiology, outcomes, diagnosis and treatment of COVID-19 in SOT recipients...
December 14, 2020: American Journal of Transplantation
Eduardo Miñambres, Mario Royo-Villanova, Marina Pérez-Redondo, Elisabeth Coll, Susana Villar-García, Sergio Juan Canovas, Juan Francisco Nistal, Iris P Garrido, Manuel Gómez-Bueno, Manuel Cobo, Beatriz Dominguez-Gil
Heart transplantation from controlled donation after the circulatory determination of death (cDCDD) may help to increase the availability of hearts for transplantation. During 2020, four heart transplants were performed at three different Spanish hospitals based on the use of thoraco-abdominal normothermic regional perfusion (TA-NRP) followed by cold storage (CS). All donors were young adults < 45 years. The functional warms ischemic time ranged from 8 to 16 minutes. In all cases the heart recovered sinus rhythm within 1 minute of TA-NRP...
December 14, 2020: American Journal of Transplantation
Parissa Tabrizian, Sander S Florman, Myron E Schwartz
The use of anti-programmed cell death protein 1/programmed death ligand 1 (PD-1/PD-L1) checkpoint inhibitors in the treatment of cancer has rapidly increased and is approved to treat hepatocellular carcinoma (HCC). PD-1 blockade has been discouraged in transplant candidates and recipients due to reports of severe rejection and graft loss.1-3 The clinical outcome of patients receiving immunotherapy before transplant, however, remains unknown.
December 14, 2020: American Journal of Transplantation
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