7,234 results match your criteria American Journal of Transplantation[Journal]


Frailty in Liver Transplantation : An Expert Opinion Statement from the American Society of Transplantation Liver and Intestinal Community of Practice.

Am J Transplant 2019 Apr 13. Epub 2019 Apr 13.

Cirrhosis Care Clinic, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.

Frailty has emerged as a powerful predictor of outcomes in patients with cirrhosis and has inevitably made its way into decision-making within liver transplantation. In an effort to harmonize integration of the concept of frailty among transplant centers, the AST and ASTS supported the efforts of our working group to develop this statement from experts in the field. Frailty is a multi-dimensional construct that represents the end-manifestation of derangements of multiple physiologic systems leading to decreased physiologic reserve and increased vulnerability to health stressors. Read More

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http://dx.doi.org/10.1111/ajt.15392DOI Listing

Quantifying the Risk of Undetected HIV, Hepatitis B Virus, or Hepatitis C Virus Infection in Public Health Service Increased Risk Donors.

Am J Transplant 2019 Apr 13. Epub 2019 Apr 13.

Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

To reduce the risk of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) transmission through organ transplantation, donors are universally screened for these infections by nucleic acid tests (NAT). Deceased organ donors are classified as "increased risk" if they engaged in specific behaviors during the 12 months before death. We developed a model to estimate the risk of undetected infection for HIV, HBV, and HCV among NAT-negative donors specific to the type and timing of donors' potential risk behavior to guide revisions to the 12-month timeline. Read More

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http://dx.doi.org/10.1111/ajt.15393DOI Listing
April 2019
1 Read

Beyond Death and Graft Survival - Variation in Outcomes after Kidney Transplant. Results from the NSQIP Transplant Beta Phase.

Am J Transplant 2019 Apr 12. Epub 2019 Apr 12.

Montefiore Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

The National Surgical Quality Program (NSQIP) Transplant program was designed by transplant surgeons from the ground up to track post-transplant outcomes beyond basic recipient and graft survival. After an initial pilot phase, the program has expanded to 29 participating sites and enrolled more than 4300 recipient-donor pairs into the database, including 2876 complete kidney transplant cases. In this analysis, surgical site infection (SSI), urinary tract infection (UTI) and re-operation/intervention were evaluated for kidney transplant recipients. Read More

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http://dx.doi.org/10.1111/ajt.15391DOI Listing

Patterns of geographic variability in mortality and eligible deaths between organ procurement organizations.

Am J Transplant 2019 Apr 12. Epub 2019 Apr 12.

Department of Surgery, Division of Transplantation, University of Kentucky, Lexington, Kentucky.

Eligible deaths are currently utilized as the denominator of the donor conversion ratio in order to mitigate the effect of varying mortality patterns in the populations served by different organ procurement organizations (OPOs). Eligible death is an OPO reported metric rather than a product of formal epidemiological analysis, however, and may be confounded with OPO performance. Using Scientific Registry of Transplant Recipients and Centers for Disease Control data, patterns of mortality and eligible deaths within each OPO were analyzed using formal geostatistical analysis in order to determine whether eligible deaths truly reflect the geographic patterns they are intended to mitigate. Read More

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http://dx.doi.org/10.1111/ajt.15390DOI Listing

Bi-organ Paired Exchange - Sentinel Case of a Liver-Kidney Swap.

Am J Transplant 2019 Apr 12. Epub 2019 Apr 12.

Connie Frank Transplant Center, Division of Nephrology and Hypertension, Department of Medicine, University of California, San Francisco.

Organ transplantation is the optimal treatment for patients with ESLD and ESRD. However, due to the imbalance in the demand and supply of deceased organs, most transplant centers worldwide have consciously pursued a strategy for living donation. Paired exchanges were introduced as a means to bypass various biologic incompatibilities (blood- and tissue-typing), while expanding the living donor pool. Read More

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http://dx.doi.org/10.1111/ajt.15386DOI Listing
April 2019
5.683 Impact Factor

Isolated pancreas transplantation: is rank list position related to outcomes of imported grafts?

Am J Transplant 2019 Apr 9. Epub 2019 Apr 9.

Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI.

Transplant centers may decline an import pancreas offer because based on demographics and labs, absent information about actual gland quality. The relationship between position on the match run, indicative of number of centers who chose not to utilize a pancreas, and patient and death-censored graft survival, is not known. We studied all 199 isolated pancreas grafts transplanted at the University of Wisconsin since July 2000 and compared overall patient and death-censored graft survival based on import versus local status. Read More

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http://dx.doi.org/10.1111/ajt.15387DOI Listing

Impact of U.S. Public Health Service Increased Risk Deceased Donor Designation on Organ Utilization.

Am J Transplant 2019 Apr 8. Epub 2019 Apr 8.

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention.

Under U.S. Public Health Service (PHS) guidelines, organ donors with risk factors for human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) are categorized as Increased Risk Donors (IRD). Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.15388
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http://dx.doi.org/10.1111/ajt.15388DOI Listing
April 2019
3 Reads

Tacrolimus Troughs and Genetic Determinants of Metabolism in Kidney Transplant Recipients: A comparison of four ancestry groups.

Am J Transplant 2019 Apr 6. Epub 2019 Apr 6.

Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.

Tacrolimus trough and dose requirements vary dramatically between individuals of European and African American ancestry. These differences are less well described in other populations. We conducted an observational, prospective, multi-center study from which 2595 kidney transplant recipients of European, African, Native American, and Asian ancestry were studied for tacrolimus trough, doses and genetic determinants of metabolism. Read More

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http://dx.doi.org/10.1111/ajt.15385DOI Listing
April 2019
1 Read

Moving Towards Personalizing MELD Exceptions in Liver Transplantation for Hepatocellular Carcinoma.

Am J Transplant 2019 Apr 6. Epub 2019 Apr 6.

Division of Liver and Pancreas Transplant, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Hepatocellular carcinoma (HCC) has become a leading indication for liver transplantation (LT) in the United States over the past 2 decades, accounting for nearly 25% of all LTs conducted yearly.(1) Access to HCC-related LT has been primarily accomplished through granting Model of End-Stage Liver Disease (MELD) exception points, which aim to balance the risk of death and waitlist dropout with post-LT HCC recurrence. Given the finite number of organs, this increase in HCC-related LT has come at the expense of end-stage liver disease patients. Read More

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http://dx.doi.org/10.1111/ajt.15389DOI Listing
April 2019
4 Reads

Using Computer Assisted Morphometrics of 5-Year Biopsies to Identify Biomarkers of Late Renal Allograft Loss.

Am J Transplant 2019 Apr 4. Epub 2019 Apr 4.

Department of Surgery and Immunology, Mayo Clinic, Rochester, Minnesota.

The current Banff scoring system was not developed to predict graft loss and may not be ideal for use in clinical trials aimed at improving allograft survival. We hypothesized that scoring histologic features of digitized renal allograft biopsies using a continuous, more objective, computer-assisted morphometric (CAM) system might be more predictive of graft loss. We performed a nested case-control study in kidney transplant recipients with a surveillance biopsy obtained 5 years after transplantation. Read More

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http://dx.doi.org/10.1111/ajt.15380DOI Listing
April 2019
1 Read

A clinically relevant murine model unmasks a 'Two-Hit' mechanism for reactivation and dissemination of cytomegalovirus following kidney transplantation.

Am J Transplant 2019 Apr 4. Epub 2019 Apr 4.

Comprehensive Transplant Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.

Reactivation of latent cytomegalovirus (CMV) remains an important complication following transplantation. While immunosuppression (IS) has been implicated as a primary cause, we have previously shown that the implantation response of a kidney allograft can lead to early transcriptional activation of latent murine CMV (MCMV) genes in an immune-competent host, and to MCMV reactivation and dissemination to other organs in a genetically immune-deficient recipient. We now describe a model that allows us to separately analyze the impact of the implantation effect, versus that of a clinically relevant IS regimen. Read More

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http://dx.doi.org/10.1111/ajt.15376DOI Listing
April 2019
7 Reads

Catastrophic sickling crisis in patient undergoing cardiac transplantation with sickle cell trait.

Am J Transplant 2019 Apr 3. Epub 2019 Apr 3.

Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom.

There is debate in the literature regarding management of patients with sickle cell trait (SCT) undergoing cardiac surgery since it is recognised that cardiopulmonary bypass presents many precipitating risk factors for a sickling crisis. Despite this, many report successful outcomes without any modification to perioperative management. A 49-year old female with SCT (HbS 38%) with post-partum cardiomyopathy underwent cardiac transplantation. Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.15379
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http://dx.doi.org/10.1111/ajt.15379DOI Listing
April 2019
6 Reads

Liver transplantation for metastatic wild-type gastrointestinal stromal tumor in the era of molecular targeted therapies: report of a first case.

Am J Transplant 2019 Apr 3. Epub 2019 Apr 3.

Hepato-pancreato-biliary surgery and Transplantation, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.

The gastrointestinal stromal tumor (GIST) is a digestive neoplasm of mesenchymal lineage. The treatment strategy for receptor tyrosine kinase-mutated GISTs is well defined. Wild-type GISTs (WT-GISTs) respond unsatisfactorily to specific kinase inhibitors. Read More

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http://dx.doi.org/10.1111/ajt.15377DOI Listing
April 2019
1 Read

Pirfenidone exerts beneficial effects in patients with IPF undergoing single lung transplantation.

Am J Transplant 2019 Apr 3. Epub 2019 Apr 3.

Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M),, Member of the German Center for Lung Research (DZL), University of Munich, LMU, Germany.

Pirfenidone demonstrated pleiotropic anti-inflammatory effects in various experimental and clinical settings. The aim of this study was to assess the impact of previous treatment with pirfenidone on short-term outcomes after single lung transplantation (SLTx). Therefore, patients with idiopathic pulmonary fibrosis (IPF) undergoing SLTx were retrospectively screened for previous use of pirfenidone and compared to respective controls. Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.15378
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http://dx.doi.org/10.1111/ajt.15378DOI Listing
April 2019
9 Reads

Synthetic Hemoglobin-Based Oxygen Carriers are an Acceptable Alternative for Packed Red Blood Cells in Normothermic Kidney Perfusion.

Am J Transplant 2019 Apr 2. Epub 2019 Apr 2.

Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Normothermic Machine Perfusion presents a novel platform for per-transplant assessment and reconditioning of kidney grafts. Maintaining the metabolic activity of a preserved graft at physiologic levels requires an adequate oxygen supply, typically delivered by crystalloid solutions supplemented with red blood cells. In this study, we explored the feasibility of using a synthetic hemoglobin-based oxygen carrier (HBOC) in human kidney normothermic perfusion. Read More

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http://dx.doi.org/10.1111/ajt.15375DOI Listing
April 2019
1 Read

The impact of donor and recipient common clinical and genetic variation on estimated glomerular filtration rate in a European renal transplant population.

Am J Transplant 2019 Feb 27. Epub 2019 Feb 27.

Department of Nephrology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.

Genetic variation across the human leukocyte antigen loci is known to influence renal-transplant outcome. However, the impact of genetic variation beyond the human leukocyte antigen loci is less clear. We tested the association of common genetic variation and clinical characteristics, from both the donor and recipient, with posttransplant eGFR at different time-points, out to 5 years posttransplantation. Read More

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http://dx.doi.org/10.1111/ajt.15326DOI Listing
February 2019

WNT pathway signaling is associated with microvascular injury and predicts kidney transplant failure.

Am J Transplant 2019 Mar 27. Epub 2019 Mar 27.

Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama.

Microvascular injury is associated with accelerated kidney transplant dysfunction and allograft failure. Molecular pathology can identify new mechanisms of microvascular injury while improving upon the diagnostic and prognostic capabilities of traditional histology. We conducted a case-control study of archived kidney biopsies stored up to 10 years with microvascular injury (n=50) compared to biopsies without histologic injury (n=45) of similar age, race, and sex. Read More

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http://dx.doi.org/10.1111/ajt.15372DOI Listing

Multiple myeloma derived from a kidney transplant donor who also developed myeloma after kidney donation.

Am J Transplant 2019 Mar 27. Epub 2019 Mar 27.

Division of Hematology, Jichi Medical University, Shimotuke, Japan.

Patients who undergo kidney transplantation are at increased risk of cancer due to the long-term use of immunosuppressive treatment. Postrenal transplant cancers usually originate from recipient cells, but donor-related cancers have been rarely reported. We report the case of 49-year-old woman who developed multiple myeloma of donor origin 7 years after kidney transplantation. Read More

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http://dx.doi.org/10.1111/ajt.15373DOI Listing
March 2019
1 Read

Improving our Mechanistic Understanding of the Indirect Effects of CMV Infection in Transplant Recipients.

Am J Transplant 2019 Mar 27. Epub 2019 Mar 27.

Transplant Infectious Diseases and Multi-Organ Transplant Program, University Health Network, Toronto, Canada.

CMV is an immunomodulatory virus that indirectly increases the risk for bacterial, fungal and viral infections. However, the pathogenesis of this phenomenon is poorly understood. We determined whether inflammatory responses to different Toll-like receptor (TLR) ligands are blunted during CMV infection in solid organ transplant (SOT) patients. Read More

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http://dx.doi.org/10.1111/ajt.15371DOI Listing

Small bowel and abdominal wall transplantation: A novel technique for synchronous revascularization.

Am J Transplant 2019 Mar 26. Epub 2019 Mar 26.

Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Abdominal wall transplantation (AWT) was introduced in 1999 in the context of reconstruction of complex abdominal wall defects in conjunction with visceral organ transplantation. As of recently, 38 cases of total AWT have been performed worldwide, about half of which were performed in the United States. While AWT is technically feasible, one of the major challenges presenting to the reconstructive surgeon is time to revascularization of the donor abdominal wall (AW), given the immediate proximity of the visceral organ and AWT. Read More

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http://dx.doi.org/10.1111/ajt.15370DOI Listing
March 2019
1 Read

Treg Respiration.

Am J Transplant 2019 Apr;19(4):969

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http://dx.doi.org/10.1111/ajt.15334DOI Listing

Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2019.

Am J Transplant 2019 Apr;19(4):1229-1231

Department of Pediatrics, University of California Los Angeles, Los Angeles, California.

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http://dx.doi.org/10.1111/ajt.15335DOI Listing

Pushing the envelope: Successful liver transplant using a donor graft with grade V liver injury.

Am J Transplant 2019 Apr;19(4):1236-1238

Department of Surgery, Division of Transplant Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1111/ajt.15288DOI Listing

Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older - United States, 2019.

Am J Transplant 2019 Apr;19(4):1232-1235

University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin.

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http://dx.doi.org/10.1111/ajt.15336DOI Listing

CMS Proposes New Quality Metric.

Authors:
Lara C Pullen

Am J Transplant 2019 Apr;19(4):967-968

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http://dx.doi.org/10.1111/ajt.15333DOI Listing

The neonatal Fc receptor: Key to homeostasic control of IgG and IgG-related biopharmaceuticals.

Am J Transplant 2019 Mar 23. Epub 2019 Mar 23.

Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.

IgG and albumin are the most abundant proteins in the circulation and have the longest half-lives. These properties are due to a unique receptor, the neonatal Fc receptor (FcRn). Although FcRn is named for its function of transferring IgG across the placenta from maternal to fetal circulation, FcRn functions throughout life to maintain IgG and albumin concentrations. Read More

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http://dx.doi.org/10.1111/ajt.15366DOI Listing

Erythropoietin, a multifaceted protein with innate and adaptive immune modulatory activity.

Am J Transplant 2019 Mar 23. Epub 2019 Mar 23.

Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.

Erythropoietin (EPO) is a glycoprotein mainly produced by the adult kidney in response to hypoxia and is the crucial regulator of red blood cell production. EPO receptors (EPORs), however, are not confined to erythroid cells, but are expressed by many organs including the heart, brain, retina, pancreas, and kidney, where they mediate EPO-induced, erythropoiesis-independent, tissue-protective effects. Some of these tissues do also produce and locally release small amounts of EPO in response to organ injury as a mechanism of self-repair. Read More

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http://dx.doi.org/10.1111/ajt.15369DOI Listing

Outstanding questions in transplantation: An introduction to this minireview series.

Am J Transplant 2019 Mar 23. Epub 2019 Mar 23.

Department of Medicine, The University of Chicago, Chicago, Illinois.

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http://dx.doi.org/10.1111/ajt.15367DOI Listing

The Changing Landscape of Live Kidney Donation in the United States From 2005 to 2017.

Am J Transplant 2019 Mar 23. Epub 2019 Mar 23.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

The number of live kidney donors has declined since 2005. This decline parallels the evolving knowledge of risk for biologically related, black, and younger donors. To responsibly promote donation, we sought to identify declining low-risk donor subgroups that might serve as targets for future interventions. Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.15368
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http://dx.doi.org/10.1111/ajt.15368DOI Listing
March 2019
5 Reads
5.683 Impact Factor

Secondary lymphoid tissue and costimulation-blockade resistant rejection: A nonhuman primate renal transplant study.

Am J Transplant 2019 Mar 20. Epub 2019 Mar 20.

Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Naïve T cell activation requires antigen presentation combined with costimulation through CD28, both of which optimally occur in secondary lymphoid tissues such as lymph nodes and the spleen. Belatacept impairs CD28 costimulation by binding its ligands, CD80 and CD86, and in doing so, impairs de novo alloimmune responses. However, in most patients belatacept is ineffective in preventing allograft rejection when used as a monotherapy, and adjuvant therapy is required for control of costimulation-blockade resistant rejection (CoBRR). Read More

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http://dx.doi.org/10.1111/ajt.15365DOI Listing
March 2019
1 Read

Donor Prone Positioning Protects Lungs from Injury During Warm Ischemia.

Am J Transplant 2019 Mar 19. Epub 2019 Mar 19.

Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada.

A large proportion of controlled donation after circulatory death (cDCD) donor lungs are declined because cardiac arrest does not occur in a suitable time after withdrawal of life-sustaining therapy. Improved strategies to preserve lungs after asystole may allow the recovery team to arrive after death actually occurs and enable the recovery of more lungs from cDCDs. The aim of this study was to determine the effect of donor positioning on the quality of lung preservation after cardiac arrest in a cDCD model. Read More

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http://dx.doi.org/10.1111/ajt.15363DOI Listing
March 2019
4 Reads

Safety and efficacy of eculizumab in the prevention of antibody-mediated rejection in living-donor kidney transplant recipients requiring desensitization therapy: A randomized trial.

Am J Transplant 2019 Mar 19. Epub 2019 Mar 19.

Paris Translational Research Center for Organ Transplantation, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche-S970, Paris, France.

We report results of a phase 2, randomized, multicenter, open-label, two-arm study evaluating the safety and efficacy of eculizumab in preventing acute antibody-mediated rejection (AMR) in sensitized recipients of living-donor kidney transplants requiring pretransplant desensitization (NCT01399593). In total, 102 patients underwent desensitization. Posttransplant, 51 patients received standard of care (SOC) and 51 received eculizumab. Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.15364
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http://dx.doi.org/10.1111/ajt.15364DOI Listing
March 2019
11 Reads

Beyond death and graft survival-Variation in outcomes after liver transplant. Results from the NSQIP transplant beta phase.

Am J Transplant 2019 Mar 18. Epub 2019 Mar 18.

Department of Surgery, University of California San Francisco, San Francisco, California.

The National Surgical Quality Program (NSQIP) Transplant program was designed by transplant surgeons from the ground up to track posttransplant outcomes beyond basic recipient and graft survival. After an initial pilot phase, the program has expanded to 29 participating sites and enrolled more than 4300 recipient-donor pairs into the database, including 1444 completed liver transplant cases. In this analysis, surgical site infection (SSI), urinary tract infection (UTI), and unplanned reoperation/intervention after liver transplantation were evaluated. Read More

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http://dx.doi.org/10.1111/ajt.15357DOI Listing

Agree on much, except it is time for change.

Am J Transplant 2019 Mar 18. Epub 2019 Mar 18.

University of Michigan, Ann Arbor, Michigan.

The imbalance between supply and demand of organs for transplant will not be fully solved by changes to the allocation system. Improved organ donation and utilization must be accomplished through critical reassessment of organ procurement organization (OPO) performance as a partnership between transplant centers, OPOs, and community hospitals. The continued discussion on changes to the organ distribution system should be based on patient-centeredness, enhanced transparency, improved models, and metrics. Read More

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http://dx.doi.org/10.1111/ajt.15362DOI Listing

Posttransplant lymphoproliferative disorder in pediatric patients: Survival rates according to primary sites of occurrence and a proposed clinical categorization.

Am J Transplant 2019 Mar 18. Epub 2019 Mar 18.

Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada.

Posttransplant lymphoproliferative disorder (PTLD) is a devastating complication of organ transplant. In a hospital-based registry, we identified biopsy-proven cases of PTLD among children during a 15-year period and reviewed trends in PTLD rates, the sites of involvement, and the associated survival rates. Cases that were included had at least 1 year of follow-up after the diagnosis of PTLD. Read More

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http://dx.doi.org/10.1111/ajt.15358DOI Listing
March 2019
2 Reads

Comparing everolimus-based immunosuppression with reduction or withdrawal of calcineurin inhibitor reduction from six months after heart transplantation: the randomized MANDELA study.

Am J Transplant 2019 Mar 18. Epub 2019 Mar 18.

Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.

In the 12-month, open-label MANDELA study, patients were randomized at month 6 after heart transplantation to (i) convert to calcineurin inhibitor (CNI)-free immunosuppression with everolimus (EVR), mycophenolic acid and steroids (CNI-free, n=71), or to (ii) continue reduced-exposure CNI, with EVR and steroids (EVR/redCNI, n=74). Tacrolimus was administered in 48.8% of EVR/redCNI patients and 52. Read More

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http://dx.doi.org/10.1111/ajt.15361DOI Listing
March 2019
1 Read

A donor risk index for graft loss in pediatric living donor kidney transplantation.

Am J Transplant 2019 Mar 15. Epub 2019 Mar 15.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Pediatric kidney transplant candidates often have multiple potential living donors (LDs); no evidence-based tool exists to compare potential LDs, or to decide between marginal LDs and deceased donor (DD) kidney transplantation (KT). We developed a pediatric living kidney donor profile index (P-LKDPI) on the same scale as the DD KDPI by using Cox regression to model the risk of all-cause graft loss as a function of living donor characteristics and DD KDPI. HLA-B mismatch (adjusted hazard ratio [aHR] per mismatch =  1. Read More

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http://dx.doi.org/10.1111/ajt.15360DOI Listing

Generating automated kidney transplant biopsy reports combining molecular measurements with ensembles of machine learning classifiers.

Am J Transplant 2019 Mar 13. Epub 2019 Mar 13.

Alberta Transplant Applied Genomics Centre, Alberta, Canada.

We previously reported a system for assessing rejection in kidney transplant biopsies using microarray-based gene expression data, the Molecular Microscope Diagnostic System (MMDx). The present study was designed to optimize the accuracy and stability of MMDx diagnoses by replacing single machine learning classifiers with ensembles of diverse classifier methods. We also examined the use of automated report sign-outs and the agreement between multiple human interpreters of the molecular results. Read More

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http://dx.doi.org/10.1111/ajt.15351DOI Listing

Reversal of secondary protein-losing enteropathy after surgical revision of a jejunal Roux-en-Y loop in a patient after liver transplantation.

Am J Transplant 2019 Mar 14. Epub 2019 Mar 14.

Department of Pediatric Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Secondary protein-losing enteropathy (PLE) is a rare complication following pediatric liver transplantation (LT), mostly related to venous outflow obstruction of the liver. Here, we discuss a thus far unknown cause of secondary PLE following pediatric LT. A 7-month-old boy underwent LT with biliary anastomosis using a Roux-en-Y jejunal loop. Read More

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http://dx.doi.org/10.1111/ajt.15354DOI Listing
March 2019
1 Read

Chronic pain following laparoscopic living-donor nephrectomy: Prevalence and impact on quality of life.

Am J Transplant 2019 Mar 14. Epub 2019 Mar 14.

Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

Chronic postsurgical pain (CPSP) following laparoscopic donor nephrectomy (LDN) is a disregarded topic. In this cross-sectional study, all consecutive patients who underwent an LDN at the Radboud University Medical Center (Radboudumc; 2003-2016) were approached for participation. Five hundred twelve living kidney donors were included and asked to complete two questionnaires, including the McGill Pain Questionnaire and the RAND Short Form-36 Health Status Inventory (RAND SF-36) regarding their health-related quality of life (HRQoL). Read More

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http://dx.doi.org/10.1111/ajt.15350DOI Listing
March 2019
1 Read

Hepatitis B and C virus infections transmitted through organ transplantation investigated by CDC, United States, 2014-2017.

Am J Transplant 2019 Mar 12. Epub 2019 Mar 12.

Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

We evaluated clinical outcomes among organ recipients with donor-derived hepatitis B virus (HBV) or hepatitis C virus (HCV) infections investigated by CDC from 2014-2017 in the United States. We characterized new HBV infections in organ recipients if donors tested negative for total anti-HBc, HBsAg and HBV DNA, and new recipient HCV infections if donors tested negative for anti-HCV and HCV RNA. Donor risk behaviors were abstracted from next-of-kin interviews and medical records. Read More

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http://dx.doi.org/10.1111/ajt.15352DOI Listing

Predictors of low risk for dropout from the liver transplant waiting list for hepatocellular carcinoma in long wait time regions: Implications for organ allocation.

Am J Transplant 2019 Mar 12. Epub 2019 Mar 12.

Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California.

All patients with hepatocellular carcinoma meeting United Network for Organ Sharing T2 criteria currently receive the same listing priority for liver transplant (LT). A previous study from our center identified a subgroup with a very low risk of waitlist dropout who may not derive immediate LT benefit. To evaluate this issue at a national level, we analyzed within the United Network for Organ Sharing database 2052 patients with T2 hepatocellular carcinoma receiving priority listing from 2011 to 2014 in long wait time regions 1, 5, and 9. Read More

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http://dx.doi.org/10.1111/ajt.15353DOI Listing

Center-level trends in utilization of HCV-exposed donors for HCV-uninfected kidney and liver transplant recipients in the United States.

Am J Transplant 2019 Mar 12. Epub 2019 Mar 12.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Several single-center reports of using HCV-viremic organs for HCV-uninfected (HCV-) recipients were recently published. We sought to characterize national utilization of HCV-exposed donors for HCV- recipients (HCV D+/R-) in kidney transplantation (KT) and liver transplantation (LT). Using SRTR data (April 1, 2015-December 2, 2018) and Gini coefficients, we studied center-level clustering of 1193 HCV D+/R- KTs and LTs. Read More

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http://dx.doi.org/10.1111/ajt.15355DOI Listing

Runaway powerhouse: Donor mitochondria promote rejection.

Authors:
Anna Valujskikh

Am J Transplant 2019 Mar 11. Epub 2019 Mar 11.

Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.

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http://dx.doi.org/10.1111/ajt.15349DOI Listing

Cotransplantation of preactivated mesenchymal stem cells improves intraportal engraftment of islets by inhibiting liver natural killer cells in mice.

Am J Transplant 2019 Mar 12. Epub 2019 Mar 12.

Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.

The activation of natural killer (NK) cells in the liver inhibits engraftment of intraportally transplanted islets. We attempted to modulate the activity of NK cells by cotransplanting mesenchymal stem cells (MSCs) with islets in mice. We first investigated the ability of MSCs to secrete prostaglandin E2 , a predominant inhibitor of NK cell function, in various combinations of inflammatory cytokines. Read More

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http://dx.doi.org/10.1111/ajt.15347DOI Listing

Restructuring or replacing? The untold story of the 2018 OPTN contract renewal.

Am J Transplant 2019 Mar 11. Epub 2019 Mar 11.

Organs for Life, Chapel Hill, North Carolina.

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http://dx.doi.org/10.1111/ajt.15348DOI Listing

Late intra-patient tacrolimus trough level variability as a major problem in kidney transplantation: A Collaborative Transplant Study Report.

Am J Transplant 2019 Mar 12. Epub 2019 Mar 12.

Institute of Immunology, Heidelberg University, Heidelberg, Germany.

Intra-patient variability (IPV) of tacrolimus trough level has been associated with poor outcome after kidney transplantation. These findings were derived from single-center analyses and restricted mainly to measurements early after transplantation. We analyzed in a multicenter effort whether high IPV of tacrolimus levels at posttransplant years 1, 2, and 3 was associated with impaired clinical outcome. Read More

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http://dx.doi.org/10.1111/ajt.15346DOI Listing

Bariatric surgery for obese donors: A letter to the editor re: Montgomery et al.

Am J Transplant 2019 Mar 10. Epub 2019 Mar 10.

University of Toledo College of Medicine and Life Sciences, Toledo, Ohio.

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http://dx.doi.org/10.1111/ajt.15344DOI Listing

Medicare immunosuppressive drug coverage bills-Can we afford them?

Authors:
Vanessa Grubbs

Am J Transplant 2019 Mar 8. Epub 2019 Mar 8.

Department of Medicine, University of California, San Francisco, San Francisco, California.

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http://dx.doi.org/10.1111/ajt.15345DOI Listing

Enteric conversion after bladder-drained pancreas transplantation is not associated with worse allograft survival.

Am J Transplant 2019 Mar 5. Epub 2019 Mar 5.

Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.

In the early experience of pancreas transplantation, bladder drainage was favored, but it often caused urologic, metabolic, and infectious complications that necessitated conversion to enteric drainage. Long-term graft survival after enteric conversion and the impact of time interval from transplantation to enteric conversion on graft survival is poorly understood. We studied all bladder-drained first-time pancreas transplantations performed at the University of Wisconsin from 1985 to 2000. Read More

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http://dx.doi.org/10.1111/ajt.15341DOI Listing
March 2019
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