1,229 results match your criteria Current Opinion in Organ Transplantation[Journal]


Current opinion in organ transplantation: lung transplantation.

Curr Opin Organ Transplant 2019 Apr 9. Epub 2019 Apr 9.

The Lung Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1097/MOT.0000000000000644DOI Listing
April 2019
1 Read

Assessing the outcome of organ allocation: choosing metrics.

Authors:
Jesse D Schold

Curr Opin Organ Transplant 2019 Apr 9. Epub 2019 Apr 9.

Department of Quantitative Health Sciences.

Purpose Of Review: Organ allocation is a highly complex process with significant impact on outcomes of donor organs and end-stage organ disease patients. Policies governing allocation must incorporate numerous factors to meet stated objective. There have been significant alterations and ongoing discussion about changes in allocation policy for all solid organs in the United States. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000637DOI Listing

Nonhuman leukocyte antigen antibodies that have impact in the heart transplant patient.

Curr Opin Organ Transplant 2019 Apr 9. Epub 2019 Apr 9.

The Department of Cardiovascular Medicine.

Purpose Of Review: Despite human leukocyte antigen (HLA) matching and monitoring for donor-specific HLA antibodies, antibody-mediated rejection and chronic rejection in the form of allograft vasculopathy and chronic graft dysfunction continue to occur. There has been increasing interest in non-HLA antibodies as mediators of these changes.

Recent Findings: In this review, we discuss the recent literature describing the importance of non-HLA antibodies in organ transplantation and summarize the literature evaluating such antibodies in heart transplantation. Read More

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http://Insights.ovid.com/crossref?an=00075200-900000000-9904
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http://dx.doi.org/10.1097/MOT.0000000000000642DOI Listing
April 2019
2 Reads

Desensitization for sensitized patients awaiting heart transplant.

Curr Opin Organ Transplant 2019 Apr 9. Epub 2019 Apr 9.

Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Purpose Of Review: This review summarizes contemporary desensitization strategies for patients awaiting cardiac transplantation in an era when specific management is still somewhat controversial.

Recent Findings: The number of sensitized patients awaiting heart transplantation is rising. Clinical assessment of antibody levels is mostly focused on human leukocyte antigen (HLA) antibodies. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000639DOI Listing
April 2019
1 Read

The clinical impact of donor-specific antibodies on antibody-mediated rejection and long-term prognosis after heart transplantation.

Curr Opin Organ Transplant 2019 Apr 9. Epub 2019 Apr 9.

Division of Cardiology, Department of Pediatrics.

Purpose Of Review: Outcomes after cardiac transplantation have improved over past decades, but long-term graft survival remains limited in part because of uncertainty regarding clinical implications of donor-specific antibodies (DSAs). The purpose of this review is to consolidate recent advances in knowledge on the topic of DSA and their potential to impact long-term prognosis after heart transplantation.

Recent Findings: The presence of persistent DSA increases the risk of poor outcome after heart transplantation, including development of antibody-mediated rejection (AMR), graft failure, cardiac allograft vasculopathy, and mortality. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000636DOI Listing
April 2019
1 Read

Pediatric lung transplantation: supply and demand.

Curr Opin Organ Transplant 2019 Apr 9. Epub 2019 Apr 9.

Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland.

Purpose Of Review: Lung transplantation has become an accepted therapy in infants, children, and adolescents suffering from end-stage lung diseases, an impaired quality of life and reduced life expectancy. The aim of this review is to highlight specific aspects of pediatric lung transplantation and to give an update on recent findings.

Recent Findings: Currently, over 100 lung transplant procedures are performed in children annually worldwide. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000630DOI Listing
April 2019
1 Read

Current practices in deceased organ donor management.

Curr Opin Organ Transplant 2019 Apr 5. Epub 2019 Apr 5.

Department of Surgery, Division of Transplant, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Purpose Of Review: Optimizing the management of deceased organ donors focuses on providing critical care that prevents, mitigates, or repairs the pathophysiologic sequelae of brain death. This review discusses protocol-based care; approaches to monitoring, resuscitation, hormone replacement therapy, and respiratory management; and the potential of various additional donor therapies.

Recent Findings: Protocol-based critical care after the determination of brain death has the potential to substantially increase the quantity and improve the quality of organs available for transplantation. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000638DOI Listing
April 2019
2 Reads

Lung donation after circulatory death.

Curr Opin Organ Transplant 2019 Apr 5. Epub 2019 Apr 5.

Department of Thoracic Surgery, University Hospitals Leuven.

Purpose Of Review: The current review presents a concise update on published literature on donation after circulatory death (DCD) and lung transplantation (LTx). Worldwide an increasing need for lungs is evident, however the utilization rate of DCD lung donors is still considerably low. In this summary article, we reviewed both the experimental background and international clinical experience. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000627DOI Listing
April 2019
1 Read

Impact of pretransplant antibodies on outcomes after heart transplantation.

Authors:
Shinichi Nunoda

Curr Opin Organ Transplant 2019 Apr 5. Epub 2019 Apr 5.

Department of Therapeutic Strategy for Severe Heart Failure, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan.

Purpose Of Review: Since the discovery of human leukocyte antigen (HLA) in the 1950s, there has been great interest in the role of antibodies in posttransplant rejection. The development of the lymphocyte toxicity test by Terasaki et al. in the 1960s was the first step toward understanding the role of antibodies in posttransplant rejection. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000629DOI Listing
April 2019
1 Read

The lung microbiome and transplantation.

Curr Opin Organ Transplant 2019 Apr 5. Epub 2019 Apr 5.

Molecular Biosciences, University of Technology Sydney.

Purpose Of Review: Lung transplantation survival is still limited compared with other solid organ transplant modalities, due to a range of factors that are continuing to be elucidated. However, new research is emerging which indicates that the microbiome of the lungs, and of other organs, may have important implications for immune response and mediating transplant outcomes. Pathogenic bacterial and viral species are known to have deleterious effects on the allograft, but taking a more global view, and considering the overall composition of the community of microbial species may undercover a greater understanding of the complex interplay involved in allograft dysfunction. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000631DOI Listing
April 2019
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When to intervene for donor-specific antibody after heart transplantation.

Curr Opin Organ Transplant 2019 Apr 3. Epub 2019 Apr 3.

Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Purpose Of Review: Posttransplant donor-specific human leukocyte antigen (HLA) antibodies (DSA) represent a complex area in heart transplantation with nonstandardized practice and paucity of clinical data to guide optimal management.

Recent Findings: De novo DSA after heart transplantation is common and associated with rejection, cardiac allograft vasculopathy, allograft failure, and mortality. Advances in methods for HLA antibody detection have enabled identification of DSA with high precision and sensitivity. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000634DOI Listing
April 2019
4 Reads

Crossing low-level donor-specific antibodies in heart transplantation.

Curr Opin Organ Transplant 2019 Apr 1. Epub 2019 Apr 1.

Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.

Purpose Of Review: Donor-specific antibodies (DSA) detected by solid-phase single-antigen bead (SAB) immunoassays have been associated with antibody-mediated rejection (AMR), cardiac allograft vasculopathy (CAV) and decreased survival after heart transplantation. The clinical relevance of low-level DSA is equivocal. This review examines the techniques used to define low-level DSA, the limitations of these techniques and recent clinical experience crossing low-level DSA. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000628DOI Listing
April 2019
2 Reads

Does the Canadian allocation system for highly sensitized patients work?

Curr Opin Organ Transplant 2019 Apr 1. Epub 2019 Apr 1.

Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

Purpose Of Review: The number of sensitized heart transplant candidates is rising. Highly sensitized patients are disadvantaged because they encounter longer waiting times to heart transplant. Strategies to reduce their waiting times include waitlist prioritization and desensitization therapies. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000635DOI Listing
April 2019
1 Read

Chronic lung allograft dysfunction: light at the end of the tunnel?

Curr Opin Organ Transplant 2019 Apr 1. Epub 2019 Apr 1.

Department of Chronic Diseases, Metabolism and Aging, KU Leuven.

Purpose Of Review: Chronic lung allograft dysfunction (CLAD) has been recently introduced as an umbrella-term encompassing all forms of chronic pulmonary function decline posttransplant with bronchiolitis obliterans syndrome and restrictive allograft syndrome as the most important subtypes. Differential diagnosis and management, however, remains complicated.

Recent Findings: Herein, we provide an overview of the different diagnostic criteria (pulmonary function, body plethysmography and radiology) used to differentiate bronchiolitis obliterans syndrome and restrictive allograft syndrome, their advantages and disadvantages as well as potential problems in making an accurate differential diagnosis. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000632DOI Listing
April 2019
7 Reads

Community-acquired respiratory viruses.

Authors:
Jens Gottlieb

Curr Opin Organ Transplant 2019 Apr 1. Epub 2019 Apr 1.

Department of Respiratory Medicine, Hannover Medical School, German Center of Lung Research (DZL), Hannover, Germany.

Purpose Of Review: Incidence of community-acquired respiratory viruses (CARVs) after lung transplantation (LTx) is 10-68 cases per 100 patient-years. Infected patients may develop graft failure and there seems to be an association between CARV infection and development of chronic lung allograft dysfunction (CLAD). This review summarizes the impact of CARV infection after LTx and potential treatment strategies. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000633DOI Listing
April 2019
6 Reads

Liver transplantation for colorectal liver metastasis.

Curr Opin Organ Transplant 2019 Apr;24(2):175-181

Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medicine.

Purpose Of Review: The aim of this review is to discuss existing data on liver transplantation for colorectal liver metastasis, emerging controversies, and future directions.

Recent Findings: Contemporary experience with transplanting patients with liver metastasis from colon cancer is mainly derived from European centers, with a large proportion being from a single institution (SECA study), made possible in part by a relatively high donor pool. The initial results prove to be encouraging by demonstrating an overall survival advantage over unresectable patients with liver-limited disease managed with chemotherapy only. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000623DOI Listing
April 2019
3 Reads

Current status of graft-versus-host disease after intestinal transplantation.

Curr Opin Organ Transplant 2019 Apr;24(2):199-206

Division of Pediatric Transplantation, Department of Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Thomas E. Starzl Transplant Institute, University of Pittsburgh School of Medicine, Pittsburgh, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000624DOI Listing
April 2019
14 Reads

Current status of lipid emulsions in the prevention of intestinal failure-associated liver disease.

Curr Opin Organ Transplant 2019 Apr;24(2):188-192

Department of Gastroenterology, Hepatology, and Nutrition, Children's Mercy.

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. Soybean-based lipid products are thought to be the biggest contributor to development of IFALD. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000620DOI Listing

Contemporary management of hepatoblastoma.

Curr Opin Organ Transplant 2019 Apr;24(2):113-117

Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000618DOI Listing
April 2019
4 Reads

Financial compensation for organ donors.

Curr Opin Organ Transplant 2019 Apr;24(2):182-187

Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000617DOI Listing
April 2019
1 Read

Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension.

Authors:
Sherif Kandil

Curr Opin Organ Transplant 2019 Apr;24(2):121-130

Department of Anesthesiology, Keck Medical School of USC, Los Angeles, California, USA.

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). Read More

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http://dx.doi.org/10.1097/MOT.0000000000000613DOI Listing
April 2019
2 Reads

Editorial: Advances in clinical liver transplantation: expanding indications and improving peri- and post-transplant care.

Curr Opin Organ Transplant 2019 Apr;24(2):111-112

Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

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http://dx.doi.org/10.1097/MOT.0000000000000626DOI Listing

Evolving swaps in transplantation: global exchange, vouchers, liver, and trans-organ paired exchange.

Curr Opin Organ Transplant 2019 Apr;24(2):161-166

Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000621DOI Listing

Donor-specific antibody management in intestine transplantation: hope for improving the long-term durability of the intestine allograft?

Curr Opin Organ Transplant 2019 Apr;24(2):212-218

MedStar Georgetown University Hospital, MedStar Georgetown Transplant Institute, Washington, DC.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000619DOI Listing
April 2019
2 Reads

The devil is in the detail: current management of perioperative surgical complications after liver transplantation.

Curr Opin Organ Transplant 2019 Apr;24(2):138-147

Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000616DOI Listing
April 2019
6 Reads

Living donor liver transplantation.

Curr Opin Organ Transplant 2019 Apr;24(2):131-137

Division of Abdominal Transplant Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000610DOI Listing
April 2019
2 Reads

Reassessing the role of liver transplantation for patients with metastatic colorectal cancer to the liver.

Curr Opin Organ Transplant 2019 Apr;24(2):118-120

Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000611DOI Listing
April 2019
1 Read

The finances of a liver transplant program.

Curr Opin Organ Transplant 2019 Apr;24(2):156-160

Vanderbilt University Medical Center, Nashville, Tennessee, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000612DOI Listing

The parallel paradigm between intestinal transplant inflammation and inflammatory bowel disease.

Curr Opin Organ Transplant 2019 Apr;24(2):207-211

MedStar Georgetown Transplant Institute, Georgetown University Hospital, Northwest, Washington, DC.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408947PMC
April 2019
3 Reads

Understanding and managing cardiovascular outcomes in liver transplant recipients.

Curr Opin Organ Transplant 2019 Apr;24(2):148-155

Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000614DOI Listing
April 2019
5 Reads

Laparoscopic right hepatectomy for living donor.

Curr Opin Organ Transplant 2019 Apr;24(2):167-174

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000609DOI Listing
April 2019
1 Read

Current outcomes after pediatric and adult intestinal transplantation.

Curr Opin Organ Transplant 2019 Apr;24(2):193-198

Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000608DOI Listing
April 2019
1 Read

Scientific Registry of Transplant Recipients program-specific reports: where we have been and where we are going.

Curr Opin Organ Transplant 2019 Feb;24(1):58-63

Hennepin Healthcare Research Institute, Scientific Registry of Transplant Recipients.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000597DOI Listing
February 2019
1 Read

Biomarkers of rejection in kidney transplantation.

Curr Opin Organ Transplant 2019 Feb;24(1):103-110

Division of Nephrology, Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA.

Purpose Of Review: To provide an update of the literature on the use of new biomarkers of rejection in kidney transplant recipients.

Recent Findings: The kidney allograft biopsy is currently considered the gold standard for the diagnosis of rejection. However, the kidney biopsy is invasive and could be indeterminate. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000606DOI Listing
February 2019
2 Reads

Complementary and integrative medicine in kidney transplantation.

Curr Opin Organ Transplant 2019 Feb;24(1):87-91

Division of Nephrology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA.

Purpose Of Review: Complementary and integrative medicine (CIM) use is widely prevalent in kidney transplant recipients but studies of efficacy or potential harm are sparse. This review examines prevalence of use of CIM and discusses potential beneficial and harmful aspects of CIM in renal transplant recipients.

Recent Findings: The prevalence of CIM use in kidney transplant patients varies from 12 to 45%. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000601DOI Listing
February 2019
3 Reads

Delayed graft function in kidney transplantation.

Curr Opin Organ Transplant 2019 Feb;24(1):82-86

Transplant Nephrology, Keck Hospital of USC, California, USA.

Purpose Of Review: Delayed graft function (DGF) has several long-term graft implications in the field of kidney transplantation and remains a challenge. The incidence of DGF is on the rise because of an increasing use of marginal kidneys in an era of organ shortage. Risk factors for DGF are numerous and stem from multiple sources in the transplant chain starting from the donor to its final allocation in the recipient. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000604DOI Listing
February 2019
3 Reads

Novel immunological and clinical insights in vascularized composite allotransplantation.

Curr Opin Organ Transplant 2019 Feb;24(1):42-48

Schuster Transplantation Research Center, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000592DOI Listing
February 2019
1 Read

Marginal kidney transplantation: the road less traveled.

Curr Opin Organ Transplant 2019 Feb;24(1):92-96

University of Southern California - Keck School of Medicine, Los Angeles, California, USA.

Purpose Of Review: Kidney transplantation indisputably confers a significant survival advantage and a better quality of life compared with dialysis, however, because of the increasing demand for kidney transplantation many patients continue to wait prolonged periods for kidney transplantation. The first step to alleviate the shortage is to reduce the discard rate by utilizing more marginal kidneys. This review studied the recent literature on marginal kidney transplantation. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000603DOI Listing
February 2019
1 Read

Tumor necrosis factor-driven cell death in donor organ as a barrier to immunological tolerance.

Curr Opin Organ Transplant 2019 Feb;24(1):12-19

Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, USA.

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. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000599DOI Listing
February 2019
1 Read

Measuring alloantibodies: a matter of quantity and quality.

Curr Opin Organ Transplant 2019 Feb;24(1):20-30

Regional HLA Laboratory, Laboratory Medicine Program, University Health Network.

Purpose Of Review: This review describes the utility and limitations of measure for assessing the presence, relative strength, and clinical impact of human leukocyte antigen (HLA) alloantibodies, as well as the other qualitative features of antibodies that are important considerations in assessing patient risk.

Recent Findings: Using MFI as a measure of antibody amount is limited for a variety of reasons. Standardized serum manipulations such as ethylene-diamine-tetra-acetic acid treatment or serum dilution results in better definition of relationships between MFI and antibody titer or complement activation, toward greater alignment in defining positivity. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000593DOI Listing
February 2019
5 Reads

Quality initiatives in pediatric transplantation.

Curr Opin Organ Transplant 2019 Feb;24(1):64-72

Department of Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Purpose Of Review: Pediatric transplantation faces unique challenges in implementing dynamic quality improvement measures because of proportionally smaller volumes compared to adults, logistics of being integrated successfully within larger or complex hospital systems, lack of adult-affiliated transplant centers, varying focus in prioritization of relevant outcome metrics, and potential lack of sufficient resources.

Recent Findings: To address these challenges, multiinstitutional collaborations have developed which have proven increasingly effective in driving awareness and quality improvement measures to supplement regulatory efforts in the pediatric population. Relevant work from the Pediatric Heart Transplant Society and Studies in Pediatric Liver Transplantation will be highlighted. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000595DOI Listing
February 2019
9 Reads

Why some organ allografts are tolerated better than others: new insights for an old question.

Curr Opin Organ Transplant 2019 Feb;24(1):49-57

Department of Surgery, Massachusetts General Hospital.

Purpose Of Review: There is great variability in how different organ allografts respond to the same tolerance induction protocol. Well known examples of this phenomenon include the protolerogenic nature of kidney and liver allografts as opposed to the tolerance-resistance of heart and lung allografts. This suggests there are organ-specific factors which differentially drive the immune response following transplantation. Read More

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http://Insights.ovid.com/crossref?an=00075200-900000000-9907
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http://dx.doi.org/10.1097/MOT.0000000000000594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467256PMC
February 2019
19 Reads

The Collaborative Improvement and Innovation Network project to drive quality improvement.

Curr Opin Organ Transplant 2019 Feb;24(1):73-81

Department of Organizational Excellence and Member Quality, United Network for Organ Sharing, Richmond, Virginia, USA.

Purpose Of Review: The purpose is to describe an approach for improvement using an organized collaborative improvement framework where participants learn, apply, and share improvement ideas supported through a 3-year Organ Procurement Transplant Network (OPTN) project called Collaborative Improvement and Innovation Network (COIIN). The COIIN project, proposed as an alternative approach to monitoring transplant performance, supported collaboration, and improvement in 58 transplant hospitals and partner organ procurement organizations. The aim was to increase transplantation with a focus on increasing the utilization of moderate-to-high (50-100%) Kidney Donor Profile Index (KDPI) kidneys. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000596DOI Listing
February 2019
23 Reads

Apolipoprotein L1 and kidney transplantation.

Curr Opin Organ Transplant 2019 Feb;24(1):97-102

Division of Nephrology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA.

Purpose Of Review: Consistent associations between variants of the apolipoprotein L1 (APOL1) gene and nondiabetic nephropathy have been reported in individuals of African descent. Donor APOL1 genotype has also been linked to shorter renal allograft survival. This review summarizes recent advances in understanding the biology of APOL1 and their implications to kidney donors and recipients. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000600DOI Listing
February 2019
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Editorial: New perspectives to increase transplant numbers and survival.

Authors:
Paolo Cravedi

Curr Opin Organ Transplant 2019 Feb;24(1):1-3

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

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http://dx.doi.org/10.1097/MOT.0000000000000602DOI Listing
February 2019
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Letter to the Editor: Current status and future direction of uterus transplantation.

Curr Opin Organ Transplant 2019 Feb;24(1)

Baylor University Medical Center, Simmons Transplant Institute, Dallas, Texas, USA.

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http://dx.doi.org/10.1097/MOT.0000000000000598DOI Listing
February 2019
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Xenogeneic transplantation and tolerance in the era of CRISPR-Cas9.

Curr Opin Organ Transplant 2019 Feb;24(1):5-11

Robinson Research Institute & Adelaide School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.

Purpose Of Review: The use of genetically modified donor pigs has been integral to recent major advances in xenograft survival in preclinical nonhuman primate models. CRISPR-Cas9 gene editing technology has dramatically accelerated the development of multimodified pigs. This review examines the current and projected impact of CRISPR-Cas9-mediated donor modification on preventing rejection and potentially promoting tolerance of porcine xenografts. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000589DOI Listing
February 2019
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Effector B cells in cardiac allograft vasculopathy.

Authors:
Emmanuel Zorn

Curr Opin Organ Transplant 2019 Feb;24(1):31-36

Columbia Center for Translational Immunology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.

Purpose Of Review: B cells have recently emerged as important immune players in solid organ rejection, especially in cardiac allograft vasculopathy (CAV), a chronic form of rejection following heart transplantation. B cells can exert either regulatory or effector functions. This review will provide an update on effector B cells in CAV. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000591DOI Listing
February 2019
13 Reads

Natural killer cells as modulators of alloimmune responses.

Curr Opin Organ Transplant 2019 Feb;24(1):37-41

Division of Abdominal Transplant, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.

Purpose Of Review: Natural killer (NK) cells are effector cells of the innate immune system that can lyse target cells without prior sensitization and are important in host defense to virally infected and transformed cells. Although the concept of 'missing-self' would suggest NK cells could target foreign allografts, the prevailing dogma has been that NK cells are not active participants in the rejection of solid organ allografts. This review summarizes recent studies that challenge this conclusion and instead suggest NK cells are important in outcomes posttransplant. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000590DOI Listing
February 2019
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Xenotransplantation tolerance: applications for recent advances in modified swine.

Curr Opin Organ Transplant 2018 Dec;23(6):642-648

Columbia Center for Translational Immunology, Columbia University College of Physicians and Surgeons.

Purpose Of Review: The aim of this study was to review the recent progress in xenotransplantation achieved through genetic engineering and discuss the potential of tolerance induction to overcome remaining barriers to extended xenograft survival.

Recent Findings: The success of life-saving allotransplantation has created a demand for organ transplantation that cannot be met by the supply of human organs. Xenotransplantation is one possible solution that would allow for a nearly unlimited supply of organs. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000585DOI Listing
December 2018
2 Reads