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Current Opinion in Organ Transplantation

Armando Ganoza, George V Mazariegos, Ajai Khanna
PURPOSE OF REVIEW: Over the past decades, visceral transplantation has become the standard of care for patients with irreversible intestinal failure who suffer complications of total parenteral nutrition (TPN). Graft-versus-host disease (GVHD) after solid organ transplantation is a rare but often fatal complication with high mortality. GVHD after intestinal transplantation, given the large lymphoid content of the graft, is more frequent compared with other solid organs. It is a complex condition that may have varied clinical presentations...
February 11, 2019: Current Opinion in Organ Transplantation
Joel Lim, Alexandra Oschman, Kayla Curiel
PURPOSE OF REVIEW: The current review provides a summary of available lipid products and discusses current literature and the limitations to the use of various lipid products for treatment and prevention of intestinal failure-associated liver disease (IFALD) in pediatric patients dependent on parenteral nutrition. RECENT FINDINGS: Improvements in markers of cholestasis and liver function have been seen with minimizing soybean lipid, fish oil lipid, and mixed fish oil-containing lipid emulsions...
February 11, 2019: Current Opinion in Organ Transplantation
Einar Hafberg, Scott C Borinstein, Sophoclis P Alexopoulos
PURPOSE OF REVIEW: Hepatoblastoma is the most common primary pediatric liver malignancy. The goal of treatment in hepatoblastoma is complete surgical resection. Recently published multinational collaborative studies are better defining risk factors for disease recurrence and guide optimal treatment strategy. RECENT FINDINGS: Successful margin-negative resection of hepatoblastoma is dependent on the location and extent of disease as defined by the PRETEXT classification...
February 11, 2019: Current Opinion in Organ Transplantation
Jack W Harbell, Amit K Mathur
PURPOSE OF REVIEW: With an increasing demand for donor organs, strategies to increase the number of available donor organs have become more focused. Compensating donors for donation is one strategy proposed to increase the availability of organs for transplant. This has been implemented in several systems internationally, but debate continues in the United States with respect to appropriate strategies. The National Organ Transplant Act (NOTA) currently prohibits the transfer of any human organ 'for valuable consideration' for transplantation, but allows for the removal of financial disincentives...
February 11, 2019: Current Opinion in Organ Transplantation
Sherif Kandil
PURPOSE OF REVIEW: Liver transplantation in patients with portopulmonary hypertension (POPH) is associated with increased perioperative risk. Important recent advances in the management of liver transplantation recipients with POPH are discussed. RECENT FINDINGS: The presence of POPH at the time of liver transplantation should not be a contraindication for liver transplantation, as POPH is common and may be related to volume overload and/or high cardiac output (CO)...
February 11, 2019: Current Opinion in Organ Transplantation
Sophoclis P Alexopoulos, Prachi Deshpande
No abstract text is available yet for this article.
February 5, 2019: Current Opinion in Organ Transplantation
Alexis L Lo, Elizabeth M Sonnenberg, Peter L Abt
PURPOSE OF REVIEW: With the ongoing organ shortage, several mechanisms to facilitate organ exchanges and expand the scope of living kidney or liver donation have been proposed. Although each addresses at least one barrier to transplantation, these innovative programs raise important ethical, logistical, and regulatory considerations. RECENT FINDINGS: This review addresses four recent proposals to expand living donor transplantation. For kidney transplantation, we discuss global paired exchange and advanced donation programs ('vouchers') and for liver transplantation, liver paired exchange...
February 5, 2019: Current Opinion in Organ Transplantation
Jason S Hawksworth, Cal S Matsumoto
PURPOSE OF REVIEW: In this review, we appraise the current status of donor-specific antibody (DSA) monitoring and treatment in the literature and highlight the current challenges in DSA management for the intestine transplant community. RECENT FINDINGS: Sensitizing events are common in patients referred for intestinal transplant, as these patients universally are repeatedly exposed to immune activation and inflammatory events. Both preformed and de novo DSA have been shown to increase rejection and graft loss in intestine recipients...
January 28, 2019: Current Opinion in Organ Transplantation
Priyal Patel, Joseph DiNorcia
PURPOSE OF REVIEW: Despite advances in the field, perioperative morbidity is common after liver transplantation. This review examines the current literature to provide up-to-date management of common surgical complications associated with liver transplantation. RECENT FINDINGS: Research focuses on problems with anastomoses of the vena cava, portal vein, hepatic artery, and bile ducts. Interventional endoscopic and radiological techniques are used more frequently to avoid reoperation...
January 28, 2019: Current Opinion in Organ Transplantation
Nicolas Goldaracena, Andrew S Barbas
PURPOSE OF REVIEW: As experience grows, living donor liver transplantation (LDLT) has become an effective treatment option to overcome the deceased donor organ shortage. RECENT FINDINGS: Donor safety is the highest priority in LDLT. Strict donor selection according to structured protocols and center experience are the main factors that determine donor safety. However, with increased experience, many centers have explored increasing organ availability within living donation by means of ABO incompatible LDLT, dual graft LDLT, and anonymous living donation...
January 28, 2019: Current Opinion in Organ Transplantation
Pranit Chotai, Lea Matsuoka
PURPOSE OF REVIEW: Early studies reported poor survival rates following liver transplantation for metastatic colorectal cancer to the liver and liver transplantation has thus traditionally been contraindicated for these patients. However, improvements in liver transplantation outcomes, immunosuppression and the treatment of colorectal cancer warrant a reassessment of the role of liver transplantation for metastatic colorectal cancer. RECENT FINDINGS: The literature on this topic is sparse, the majority of publications being isolated cases of liver transplantation for patients with metastatic colorectal cancer to the liver...
January 28, 2019: Current Opinion in Organ Transplantation
Makenzie Cook, Edward Zavala
PURPOSE OF REVIEW: The current review provides an overarching examination of liver transplant finances and factors contributing to cost of care. RECENT FINDINGS: Transplant hospitals must seek to optimize areas of revenue and cut costs as the cost of transplantation continues to rise and public policies strain reimbursement. SUMMARY: Transplantation remains a complicated multipayor system that requires focused attention and care. With rising costs and increased focus on quality in the healthcare market, it is integral that both the clinical and business teams work together to strive for optimization of costs and revenue...
January 28, 2019: Current Opinion in Organ Transplantation
Leonid Belyayev, Katrina Loh, Thomas M Fishbein, Alexander Kroemer
PURPOSE OF REVIEW: A significant shift in our understanding of the molecular and cellular basis for inflammatory bowel disease (IBD) mirrors research that has been ongoing in intestinal transplantation. The blurring of lines between these two disease states creates an avenue into potential therapeutic interventions which take advantage of these molecular similarities. RECENT FINDINGS: Traditional knowledge of T-cell involvement in IBD has expanded to highlight the role of T helper 17 (Th17) cells as key effector cells...
January 28, 2019: Current Opinion in Organ Transplantation
Manhal Izzy, Lisa B VanWagner, Samuel Lee, Mario Altieri, Mounika Angirekula, Kymberly D Watt
PURPOSE OF REVIEW: Cardiovascular disease (CVD) is a common cause of mortality after liver transplantation. The transplant community is focused on improving long-term survival. Understanding the prevalence of CVD in liver transplant recipients, precipitating factors as well as prevention and management strategies is essential to achieving this goal. RECENT FINDINGS: CVD is the leading cause of death within the first year after transplant. Arrhythmia and heart failure are the most often cardiovascular morbidities in the first year after transplant which could be related to pretransplant diastolic dysfunction...
January 22, 2019: Current Opinion in Organ Transplantation
Choon Hyuck David Kwon, Gyu-Seong Choi, Jae-Won Joh
PURPOSE OF REVIEW: Many institutions have started or are planning to start a purely laparoscopic right hepatectomy (PLRH) for adult living donor recipients but the experience is relatively very limited. The present review will look at the current status of PLRH and go over some of the technical details important for a safe operation. Necessary elements and different strategies to start a safe and reproducible PLRH program will be discussed. RECENT FINDINGS: Several publications with a relatively large number of cases have been published in the last few years...
January 22, 2019: Current Opinion in Organ Transplantation
Arpit Amin, Douglas G Farmer
PURPOSE OF REVIEW: In this article, we will review the outcomes of patients with intestinal transplant (ITx) with a focus on factors affecting long-term graft and patient survival. RECENT FINDINGS: The most recent International Intestinal Transplant Registry reports a 1-, 5-, and 10-year graft survival of 71%, 50%, and 41% respectively, for ITx grafts transplanted since 2000. Over the past decades, significant improvements have been achieved in short-term graft and patient outcomes for ITx recipients...
January 22, 2019: Current Opinion in Organ Transplantation
Bertram L Kasiske, Nicholas Salkowski, Andrew Wey, Ajay K Israni, Jon J Snyder
PURPOSE OF REVIEW: Reporting provider data on quality to patients and the general public is increasingly common in healthcare. Reporting outcomes in solid organ transplantation has always been controversial and deserves careful consideration to ensure optimal results. RECENT FINDINGS: As mandated by Federal law, the Scientific Registry of Transplant Recipients publishes program-specific reports on transplant candidates, recipients, donors, and transplant outcomes every 6 months...
December 19, 2018: Current Opinion in Organ Transplantation
Branislav Kollar, Bohdan Pomahac, Leonardo V Riella
PURPOSE OF REVIEW: Vascularized composite allotransplantation (VCA) is a promising approach to restore the quality of life of carefully selected patients that suffered extensive injury. Although acute rejection occurs very frequently, still little is known about the specific characteristics of the VCA immune response. This review aims to highlight the current development in the field of VCA concerning the immunobiology and management of upper extremity and face transplant recipients. RECENT FINDINGS: T-cell mediated rejection is the predominant mechanism of allograft injury in VCA...
December 6, 2018: Current Opinion in Organ Transplantation
Giuliano Testa, Liza Johannesson
No abstract text is available yet for this article.
November 30, 2018: Current Opinion in Organ Transplantation
Rosalind L Ang, Adrian T Ting
PURPOSE OF REVIEW: Regulated cell death (RCD) is likely to play a role in organ rejection but it is unclear how it may be invoked. A well-known trigger of regulated cell death is tumor necrosis factor-alpha (TNF), which activates both caspase-dependent apoptosis and caspase-independent necroptosis. TNF is best known as a pro-inflammatory cytokine because it activates NFκB and MAPK signaling to induce expression of pro-inflammatory genes. RECENT FINDINGS: Emerging data from animal models now suggest that TNF-induced cell death can also be inflammatory...
November 30, 2018: Current Opinion in Organ Transplantation
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