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Clinical Transplantation

Petter Svenberg, Tengyu Wang, Michael Uhlin, Emma Watz, Mats Remberger, Olle Ringden, Jonas Mattsson, Mehmet Uzunel
BACKGROUND: Graft-versus-host disease (GVHD) and relapse remain major obstacles for treatment success in allogeneic hematopoietic stem cell transplantation (HSCT). In the present study, we evaluated the immune cell profile of the graft to outcome after HSCT. STUDY DESIGN AND METHOD: Flow cytometry data of graft cell subsets [CD34+, CD3+, CD19+, CD4+, CD8+, CD3-CD56+CD16+, CD4+CD127low CD25high ] from G-CSF primed peripheral blood stem cell (PBSC) donors was collected retrospectively from 299 patients with hematological malignancies undergoing HSCT between 2006 and 2013...
March 15, 2019: Clinical Transplantation
Samuel Jacob, Brian Lima, Gonzalo V Gonzalez-Stawinski, Magdy M El-Sayed Ahmed, Parag C Patel, Erol V Belli, Ian A Makey, Mathew Thomas, Kevin Landolfo, Carolyn Landolfo, Juan Carlos Leoni Moreno, Daniel S Yip, Si M Pham
BACKGROUND: Severe primary graft dysfunction (PGD) is the leading cause of early death after heart transplant. AIM: To examine the outcomes of heart transplant recipients who received venoarterial extracorporeal membrane oxygenation (VA-ECMO) for severe PGD. METHODS: We reviewed electronic health records of adult patients who underwent heart transplant from November 2005 through June 2015. We defined severe PGD according to International Society for Heart and Lung Transplantation consensus statements...
March 14, 2019: Clinical Transplantation
Emilie Savoye, Marie-Alice Macher, Michel Videcoq, Philippe Gatault, Marc Hazzan, Imad Abboud, Antoine Thierry, Dominique Bertrand, Sarah Drouin, Johnny Sayegh, Benoit Barrou, Lionel Badet, Olivier Bastien, Olivier Huot, Christian Lamotte, Hélène Logerot, Camille Legeai, Corinne Antoine
In 2012, an expert working group from the French Transplant Health Authority recommended the use of hypothermic machine perfusion (HMP) to improve kidneys preservation and transplant outcomes from expanded criteria donors, deceased after brain death . This study compares HMP and cold storage (CS) effects on delayed graft function (DGF) and transplant outcomes. We identified 4,316 kidney transplants from expanded criteria donors (2011-2014) in France through the French Transplant Registry. DGF occurrence was analyzed with a logistic regression, excluding preemptive transplants...
March 14, 2019: Clinical Transplantation
Tracy Sparkes, Bharath Ravichandran, Onumara Opara, Richard Ugarte, Cinthia B Drachenberg, Benjamin Philosophe, Jonathan S Bromberg, Rolf N Barth
We performed a prospective, 12-month, single center, non-randomized, open-label pilot study to investigate the use of belatacept therapy combined with alemtuzumab induction in renal allografts with pre-existing pathology, as these kidneys may be more susceptible to additional toxicity when exposed to calcineurin inhibitors post-transplant. Nineteen belatacept recipients were matched retrospectively to a cohort of tacrolimus recipients on the basis of pre-implantation pathology. The estimated glomerular filtration rate was not significantly different between belatacept and tacrolimus recipients at either 3 or 12 months post-transplant (59 versus 45, p=0...
March 13, 2019: Clinical Transplantation
Jose F Camargo, Shweta Anjan, Nafeesa Chin-Beckford, Michele I Morris, Lilian M Abbo, Jacques Simkins, Gaetano Ciancio, Linda J Chen, George W Burke, Jose Figueiro, Giselle Guerra, Warren L Kupin, Adela Mattiazzi, Mariella Ortigosa-Goggins, Kalyan Ram Bhamidimarri, David Roth
BACKGROUND: Previous studies have demonstrated inferior patient and graft survival following kidney transplant (KT) in HIV+/HCV+ coinfected patients compared to HIV+/HCV- recipients. However, these studies were conducted prior to the availability of direct acting antiviral (DAA) agents and data in the modern era is lacking. METHODS: Single center retrospective study of HIV+/HCV+ coinfected KT recipients (2007-2017). Outcomes were assessed for the pre-DAA and post-DAA (i...
March 13, 2019: Clinical Transplantation
Allyson Hart, Marilyn Bruin, Sauman Chu, Arthur Matas, Melissa R Partin, Ajay K Israni
BACKGROUND: Kidney transplant candidates face complex decisions about transplant options such as living donation or acceptance of lower quality kidneys. We sought to characterize knowledge and decision support needs regarding kidney transplant outcomes and options. METHODS: We conducted 10 interviews and 4 focus groups of 28 adult kidney transplant candidates from 2 centers in Minnesota. Transcripts were analyzed thematically using a grounded theory approach. RESULTS: We identified four themes: First, candidates have a limited understanding of treatment options, and demonstrate confusion or a lack of awareness about waiting list outcomes and prognosis...
March 13, 2019: Clinical Transplantation
Hyunwook Kwon, Young Hoon Kim, Jee Yeon Kim, Ji Yoon Choi, Sung Shin, Joo Hee Jung, Su-Kil Park, Duck Jong Han
BACKGROUND: Crossmatching (XM) between organ donors and recipients is correlated with clinical outcomes. This study evaluates the results of HLA-incompatible kidney transplant (HLA-i KT) according to pre-transplant XM modalities. METHODS: This study included 731 consecutive patients. HLA-i KT was defined as a transplant under conditions of complement-dependent cytotoxicity (CDC) XM positivity, flow-cytometric XM (FCXM) positivity, and/or maximal donor-specific antibody (DSA) mean fluorescence intensity (MFI) ≥5000...
March 12, 2019: Clinical Transplantation
Brett Rollins, Samira Farouk, Graciela DeBoccardo, Susan Lerner, Meenakshi Rana, Shirish Huprikar, Leandra Miko, Veronica Delaney, Sander Florman, Ron Shapiro
Rejection rates in HIV-infected kidney transplant (KTx) recipients are higher than HIV-negative recipients. Immunosuppression and highly active antiretroviral therapy (HAART) protocols vary with potentially significant drug-drug interactions, likely influencing outcomes. This is an IRB-approved, single-center, retrospective study of adult HIV infected KTx patients between 5/2009-12/2014 with three-year follow-up, excluding antibody-depleting induction. 42 patients were included; median age was 52 years, 81% male, 50% African American, 29% Hispanic, 17% Caucasian...
March 12, 2019: Clinical Transplantation
Steffan H Kim, Grayson L Baird, George Bayliss, Basma Merhi, Adena Osband, Reginald Gohh, Paul E Morrissey
BACKGROUND: Thirty-day (30d) readmission rates (early hospital readmission, EHR) are an important benchmark for quality improvement. Nationally, patients undergoing renal transplantation incur a 31% EHR rate. While national databases provide useful data, the impact of EHR on individual centers has received little attention. We proposed that an institutional review of EHR after renal transplantation may provide a benchmark for individual transplant programs and identify modifiable program-specific issues to reduce EHR...
March 12, 2019: Clinical Transplantation
Shawn C West, Josh M Friedland-Little, Kenneth O Schowengerdt, David C Naftel, Elizabeth Pruitt, Kelli S Smith, Simon Urschel, Marian G Michaels, James K Kirklin, Brian Feingold
Post-transplant lymphoproliferative disorder (PTLD) is a significant complication after pediatric heart transplantation (HT), occurring in 5-15% of patients within 3 years. Data > 3 years from HT are limited. We sought to describe the prevalence, risk factors, and outcomes of PTLD occurring late (> 3 years) after pediatric HT in the Pediatric Heart Transplant Study from 1993 to 2010. Among 3,844 primary HT patients, 110 (3%) developed late, non-recurrent PTLD. The hazard rate for late PTLD was constant at 0...
March 12, 2019: Clinical Transplantation
Cory R Schaffhausen, Marilyn J Bruin, Warren T McKinney, Jon J Snyder, Arthur J Matas, Bertram L Kasiske, Ajay K Israni
Little is known about how patients make the critical decision of choosing a transplant center. In the US, acceptance criteria, waiting times and mortality vary significantly by geography and center. We sought to understand patients' experiences and perspectives when selecting transplant centers. We included 82 kidney transplant patients in 20 semi-structured interviews, 9 focus groups with local candidates, and 3 focus groups with national recipients. Sites included 2 local transplant centers in Minneapolis, Minnesota, and national recipients from across the US...
March 12, 2019: Clinical Transplantation
Erin R Weeda, Zemin Su, David J Taber, John Bian, Thomas A Morinelli, Nicole A Pilch, Patrick D Mauldin, Derek A DuBay
Reducing acute care utilization is a means of improving long-term patient outcomes. We sought to assess high inpatient[IP] admission and standalone emergency department[ED] utilization within a 9-month period post-kidney transplantation, and to identify mutable factors to reduce utilization. In this ten-year retrospective study, 1,599 adult kidney transplant recipients were identified. A previous transplant, graft loss, or death within 3 months post-transplantation excluded 319 patients. Comprehensive resource utilization data were obtained from a statewide database...
March 12, 2019: Clinical Transplantation
Danya Traboulsi, Olivia V Potok, Shannon M Ruzycki, Philip Surmanowicz, Jori Hardin, Bushra Khokhar, Doreen M Rabi, Glen Hazlewood, P Régine Mydlarski
BACKGROUND: Long-term use of immunosuppressive medications by organ transplant recipients (OTRs) leads to increased risk of non-melanoma skin cancers (NMSCs). The objective of this study was to assess photoprotective knowledge and practices among OTRs and to identify predictors of poor sunscreen adherence and barriers to photoprotection. METHODS: A written survey was administered to 300 solid OTRs attending the Southern Alberta Transplant Program. Demographics, transplant and NMSC history, ultraviolet radiation (UVR) exposure, photoprotective knowledge and practices, and barriers to implementing photoprotection were collected...
March 12, 2019: Clinical Transplantation
Shmuel Shoham, Edward A Dominguez
These updated AST-IDCOP guidelines review the epidemiology, diagnosis, and management of emerging fungi after organ transplantation. Infections due to numerous generally innocuous fungi are increasingly recognized in solid organ transplant (SOT) recipients, comprising about 7 to10% of fungal infections in this setting. Such infections are collectively referred to as emerging fungal infections and include Mucormycetes, Fusarium, Scedospordium, and dematiaceous fungi among others. The causative organisms are diverse in their pathophysiology, uncommon in the clinical setting, have evolving nomenclature and are often resistant to multiple commonly used antifungal agents...
March 12, 2019: Clinical Transplantation
D H Lee, R A Zuckerman
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention and management of HSV in the pre- and post-transplant period. A majority of transplant recipients are seropositive for HSV-1 or 2. Compared with immunocompetent persons, SOT recipients shed HSV more frequently, have more severe clinical manifestations, and are slower to respond to therapy. Most HSV infection is diagnosed on clinical grounds, but patients may present with atypical lesions and/or other clinical manifestations...
March 12, 2019: Clinical Transplantation
D F Florescu, J M Schaenman
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of adenovirus infections after solid organ transplantation. Adenovirus is an important cause of infectious complications in both stem cell transplant and SOT patients, causing a range of clinical syndromes including pneumonitis, colitis, and disseminated disease. The current update of the guidelines highlights that adenovirus surveillance testing should not be performed in asymptomatic recipients...
March 12, 2019: Clinical Transplantation
C Arianne Buchan, Camille Nelson Kotton
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review recommendations for prevention and management of travel related infection in solid organ transplant (SOT) recipients as well as risks associated with transplant tourism. Counseling regarding travel post-transplant should be included during the pre-transplant evaluation and all SOT recipients should be seen by a travel medicine specialist prior to traveling to destinations with higher rates of infection...
March 12, 2019: Clinical Transplantation
Hans H Hirsch, Parmjeet S Randhawa
The present AST-IDCOP guidelines update information on BK polyomavirus (BKPyV) infection, replication and disease, which impact kidney transplantation (KT), but rarely non-kidney solid organ transplantation (SOT). As pre-transplant risk factors in KT-donors and -recipients presently do not translate into clinically validated measures regarding organ allocation, antiviral prophylaxis, or screening, all KT-recipients should be screened for BKPyV-DNAemia monthly until month 9, and then every 3 months until 2 years posttransplant...
March 12, 2019: Clinical Transplantation
John R Greenland, Ping Wang, Joshua J Brotman, Rahul Ahuja, Tiffany A Chong, Mary Ellen Kleinhenz, Lorriana E Leard, Jeffrey A Golden, Steven R Hays, Jasleen Kukreja, Jonathan P Singer, Raja Rajalingam, Kirk Jones, Zoltan G Laszik, Neil N Trivedi, Nancy Y Greenland, Paul D Blanc
Lymphocytic bronchitis (LB) precedes chronic lung allograft dysfunction (CLAD). The relationships of LB (classified here as Endobronchial or E-grade rejection) to small airway (A- and B-grade) pathologies are unclear. We hypothesized that gene signatures common to allograft rejection would be present in LB. We studied LB in two partially overlapping lung transplant recipient cohorts: Cohort 1 included large airway brushes (6 LB cases and 18 post-transplant referents). Differential expression using DESeq2 was used for pathway analysis and to define an LB-associated metagene...
March 8, 2019: Clinical Transplantation
Marion Hemmersbach-Miller, Barbara D Alexander, Debra L Sudan, Carl Pieper, Kenneth E Schmader
Infections threaten successful outcomes after kidney transplantation. Our aim was to determine if the number, types of infections and the risk factors for common infections differed between older compared to younger kidney transplant (KT) recipients in the first year after surgery. We performed a single center retrospective cohort study. Between 2011-2015, 91 KTs were performed in patients ≥ 65 years of age; these were matched 1:1 (by year of transplantation, sex and race) to controls aged 40-60 years. Over 90% of both groups had an infectious complication...
March 8, 2019: Clinical Transplantation
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