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Transplantation Reviews

Amarpali Brar, Ernie Yap, Angelika Gruessner, Rainer Gruessner, Rahul M Jindal, Robert Nee, Moin Sattar, Moro O Salifu
Dual kidney transplantation (DKT) is a viable option to increase the donor pool and improve access equity to kidney transplantation. Dual kidneys are procured from carefully selected marginal donors that are not generally acceptable to most transplant centers. This is a narrative review of literature focusing on donor kidney allocation systems and selection of the ideal recipient for DKT. We also discussed surgical approaches for DKTs as well as patient and allograft outcomes. We found that most studies to date showed that DKTs has similar graft survival and delayed graft function rates when compared to single kidney transplants (SKTs)...
January 14, 2019: Transplantation Reviews
Manuela Cesaretti, Alban Zarzavajian Le Bian, Sara Moccia, Antonio Iannelli, Luigi Schiavo, Alberto Diaspro
In the worldwide context of graft shortage, several strategies have been explored to increase the number of grafts available for liver transplantation (LT). These include the use of marginal and living donors, split livers, and the improvement of marginal donor grafts (machine perfusion). However, recent advances in the understanding of liver organogenesis, stem cells, and matrix biology provide novel insights in tissue engineering. Today, the newest technologies and discoveries open the door to the development of new methods for organ implementation such as the recellularization of natural scaffolds, liver organoids, bio-printing, and tissue or generation of chimeric organs...
December 26, 2018: Transplantation Reviews
Vincent Kabir, Johan Maertens, Dirk Kuypers
Invasive fungal infections constitute an important cause of morbidity and mortality in solid organ transplantation recipients. Since solid organ transplantation is an effective therapy for many patients with end-stage organ failure, prevention and treatment of fungal infections are of vital importance. Diagnosis and management of these infections, however, remain difficult due to the variety of clinical symptoms in addition to the lack of accurate diagnostic methods. The use of fungal biomarkers can lead to an increased diagnostic accuracy, resulting in improved clinical outcomes...
December 13, 2018: Transplantation Reviews
Lisa Ghyselen, Maarten Naesens
In this review, we describe the indications, surgical aspects, benefits and risks of nephrectomy after graft failure. There is a great variation in the number of allograft nephrectomies performed among different centers. Nephrectomy of a failed allograft is associated with significant morbidity and mortality with a complication rate of 20-30% and mortality rates between 0% and 11%. A systematic review through Medline (Pubmed) and Embase identified thirteen retrospective studies that compared patients with and patients without allograft nephrectomy prior to retransplantation...
January 2019: Transplantation Reviews
Jing L Han, Eliza W Beal, Khalid Mumtaz, Ken Washburn, Sylvester M Black
Combined liver-lung transplantation (CLLT) is a rare, life-saving procedure to treat concomitant lung and liver disease. There have been 93 combined lung and liver transplantations performed in the United States since 1994. Techniques include both lung first and liver first sequential transplants with selective extracorporeal circulation of either thoracic or abdominal portions, with either end-to-end or Roux-en-Y choledochojejunostomy for biliary reconstruction. This review evaluates the existing literature regarding combined lung and liver transplantation (CLLT), describing the candidates, operation, perioperative complications, associated management strategies, and recommendations for immunosuppressive therapy and follow up...
November 22, 2018: Transplantation Reviews
Merel M Tielemans, Gerben A J van Boekel, Teun van Gelder, Eric T Tjwa, Luuk B Hilbrands
Gastrointestinal (GI) discomfort is common after renal transplantation and can be caused by the use of various immunosuppressive drugs. GI symptoms affect the quality of life, lead to an impaired graft survival and an increased mortality. Moreover, diseases and disturbances of the GI tract also affect the pharmacokinetics of immunosuppressive drugs. This review addresses the interaction between immunosuppressive agents and GI disorders. The GI tract is involved in the metabolism of several immunosuppressive drugs...
November 14, 2018: Transplantation Reviews
Cortlandt M Sellers, Nariman Nezami, Michael L Schilsky, Hyun S Kim
Liver transplantation is one of the mainstays of treatment for liver failure due to severe chronic liver disease. Bridging therapies, such as placement of a transjugular intrahepatic portosystemic shunt (TIPS), are frequently employed to control complications of portal hypertension such as ascites, hydrothorax, and variceal bleeding, and thereby reduce morbidity in patients awaiting transplant. There is no significant difference seen in either graft survival or patient survival between those receiving TIPS pre-transplant and those who do not, although those receiving TIPS placement on average have a longer waiting time on the transplant waitlist...
October 31, 2018: Transplantation Reviews
Daniella F Pinho, Amit Banga, Fernando Torres, Dana Mathews
Lung transplantation is an established treatment for patients with a variety of advanced lung diseases. Imaging studies play a valuable role not only in evaluation of patients prior to lung transplantation, but also in the follow up of patients after transplantation for detection of complications. After lung transplantation, complications can occur as a result of surgical procedure, pulmonary embolism and ultimately chronic lung allograft dysfunction. Lung scintigraphy, which includes physiologic assessment of lung ventilation and perfusion by imaging, has become an important procedure in the evaluation of these patients, assuming a complementary role to high resolution anatomic imaging (computed tomography [CT]), as well as spirometry...
October 23, 2018: Transplantation Reviews
Sonja Beckmann, Gerda Drent, Todd Ruppar, Nataša Nikolić, Sabina De Geest
BACKGROUND: Weight gain and obesity can increase liver transplant (LTx) recipients' disease burden. We aimed to summarize and synthesize the evidence on pre- and post-transplant factors related to post-LTx BMI, weight gain, and obesity. METHODS: For this systematic review and meta-analysis we searched Medline (PubMed), Cochrane library, CINAHL, PsycINFO, and EMBASE for quantitative studies on 6 classes of factors (i.e., genetic, sociodemographic, behavioral, biomedical, psychological, and environmental) linked to body weight parameters in adult first-time LTx patients...
October 12, 2018: Transplantation Reviews
Claire Dendle, William R Mulley, Stephen Holdsworth
Despite improvements in graft survival, solid organ transplantation is still associated with considerable infection induced morbidity and mortality. If we were able to show that serious infection risk was associated with excessive suppression of immune capacity, we would be justified in "personalizing" the extent of immunosuppression by carefully monitored reduction to see if we can improve immune compromize without increasing the risk of rejection. Reliable biomarkers are needed to identify this patients at an increased risk of infection...
October 9, 2018: Transplantation Reviews
Fahad Aziz, Dana Clark, Neetika Garg, Didier Mandelbrot, Arjang Djamali
Hypertension is common among kidney transplant recipients and may result from traditional risk factors or transplant specific variables, which commonly include donor associated causes, immunosuppression, or transplant renal artery stenosis. Uncontrolled blood pressure in this patient population is associated with increased cardiovascular mortality and morbidity, and decreased graft survival. Despite these negative associations, there are no randomized controlled trials looking at the optimal blood pressure targets and identifying the best antihypertensive regimen for this special patient population...
October 2018: Transplantation Reviews
Maogen Chen, Xiaohong Lin, Cheukfai Li, Nancy Olsen, Xiaoshun He, Song Guo Zheng
B cells play a crucial role in alloreactivity of organ transplant rejection and graft versus host diseases (GVHD). Over the past decade, it has been well recognized that B-cell infiltration in allografts and de novo donor-specific antibodies (DSA) were strongly associated with severe graft rejection and loss, as well as glucocorticoid resistance. Emerging evidence has demonstrated that Follicular T helper (Tfh) cells are key effectors to promote the proliferation and differentiation of B cells into antibody-producing plasmablasts and memory B cells...
October 2018: Transplantation Reviews
Anne C van Erp, Leon F A van Dullemen, Rutger J Ploeg, Henri G D Leuvenink
BACKGROUND: Currently, there is no consensus on which treatments should be a part of standard deceased-donor management to improve graft quality and transplantation outcomes. The objective of this systematic review was to evaluate the effects of treatments of the deceased, solid-organ donor on graft function and survival after transplantation. METHODS: Pubmed, Embase, Cochrane, and were systematically searched for randomized controlled trials that compared deceased-donor treatment versus placebo or no treatment...
October 2018: Transplantation Reviews
Sergio A Acuna
Over the past decades, there has been an encouraging increase in survival after solid organ transplantation. However, with longer life spans, more transplant recipients are at risk of dying with functioning grafts from illnesses such as cancer and cardiovascular conditions. Malignancy has emerged as an important cause of death in transplant recipients and is expected to become the leading cause of death in transplanted patients within the next decade. While it is known that solid organ transplant recipients have a three to five-fold increased risk of developing cancer compared with the general population, the mechanisms that lead to the observed excess risk in transplant recipients are less clear...
October 2018: Transplantation Reviews
Vikram L Sundararaghavan, Sivjot Binepal, David E Stec, Puneet Sindhwani, Terry D Hinds
In patients with end-stage renal disease, kidney transplantation has been associated with numerous benefits, including increased daily activity, and better survival rates. However, over 20% of kidney transplants result in rejection within five years. Rejection is primarily due to a hypersensitive immune system and ischemia/reperfusion injury. Bilirubin has been shown to be a potent antioxidant that is capable of potentially reversing or preventing damage from reactive oxygen species generated from ischemia and reperfusion...
October 2018: Transplantation Reviews
Markus J Barten, Uwe Schulz, Andres Beiras-Fernandez, Michael Berchtold-Herz, Udo Boeken, Jens Garbade, Stephan Hirt, Manfred Richter, Arjang Ruhpawar, Tim Sandhaus, Jan Dieter Schmitto, Felix Schönrath, Rene Schramm, Martin Schweiger, Markus Wilhelm, Andreas Zuckermann
Donor-specific antibodies (DSA) are integral to the development of antibody-mediated rejection (AMR). Chronic AMR is associated with high mortality and an increased risk for cardiac allograft vasculopathy (CAV). Anti-donor HLA antibodies are present in 3-11% of patients at the time of heart transplantation (HTx), with de novo DSA (predominantly anti-HLA class II) developing post-transplant in 10-30% of patients. DSA are associated with lower graft and patient survival after HTx, with one study suggesting a three-fold increase in mortality in patients who develop de novo DSA (dnDSA)...
October 2018: Transplantation Reviews
Fabienne Dobbels, Kris Denhaerynck, Mary Lou Klem, Susan M Sereika, Sabina De Geest, Paolo De Simone, Lut Berben, Isabelle Binet, Hanna Burkhalter, Gerda Drent, Nathalie Duerinckx, Sandra J Engberg, Tracy Glass, Elisa Gordon, Monika Kirsch, Christiane Kugler, Stacee Lerret, Anja Rossmeissl, Cynthia Russell, Arno Schmidt-Trucksäss, Samira Scalso de Almeida
BACKGROUND: Reviews on alcohol use in transplant recipients focus on liver recipients and their risk of post-transplant rejection, but do not assess alcohol use in kidney, heart, or lung transplant recipients. This systematic review and meta-analysis aims to synthesize the evidence on correlates and outcomes of any alcohol use and at-risk drinking after solid organ transplantation (Tx). METHODS: We searched 4 databases for quantitative studies in adult heart, liver, kidney and lung Tx recipients, investigating associations between post-Tx alcohol use and correlates and/or clinical, economic or quality of life outcomes...
September 28, 2018: Transplantation Reviews
Sandesh Parajuli, Rachna Tiwari, Dana F Clark, Didier A Mandelbrot, Arjang Djamali, Kenneth Casey
In patients with chronic kidney disease (CKD) and kidney transplant recipients who continue to have some degree of CKD, the prevalence of sleep-related disorders is very high. Common sleep disorders in both groups include insomnia, sleep-disordered breathing (SDB), restless legs syndrome (RLS), excessive daytime sleepiness (EDS), and others. Depending on the kidney graft function, some patients see sleep disorders resolve after kidney transplantation, while others continue to have persistent sleep disorders or develop new ones...
September 26, 2018: Transplantation Reviews
Alberto Molina-Pérez, David Rodríguez-Arias, Janet Delgado-Rodríguez, Myfanwy Morgan, Mihaela Frunza, Gurch Randhawa, Jeantine Reiger-Van de Wijdeven, Eline Schiks, Sabine Wöhlke, Silke Schicktanz
No abstract text is available yet for this article.
September 22, 2018: Transplantation Reviews
Michele Molinari, Puneet Sood, Patrick Bou Samra, Amit Tevar, Armando Ganoza, Naudia Jonassaint, Chethan Puttarajappa
BACKGROUND: The prevalence of atrial fibrillation (AF) in patients undergoing renal (RT) or liver transplantation (LT) has increased during the last decades. Yet, there is still uncertainty on the association between AF and patient and graft survival. METHODS: Multiple electronic databases were searched using various combinations of keywords and MeSH terms pertinent to the exposure (AF), and outcomes (graft and patient survival). Randomized or quasi-randomized controlled studies, cohort and case-control studies on adults with documented AF undergoing RT or LT were included...
August 9, 2018: Transplantation Reviews
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