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Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities
Khan, Johann F. MBBS, MRCS, MMed1; Shah, Diana Mohd MBBS, MSc2; Sivapakiam, S. RN1; Mokhtar, Suryati MBBS, MMed1; Subramaniam, Manisekar MBBS, FRCS1; Raman, Krishnan MBBS, FRCS1; Singh, Harjit MBBS, FRCS1; Pillai, Mohanasundram MBBS, MRCS, MMed1; Sulaiman, Omar MBBS, MMed2
doi : 10.1097/TP.0000000000003591
December 2021 - Volume 105 - Issue 12 - p 2507-2512
Research Highlights
Lewik, Guido MD1; Issa, Fadi DPhil, FRCS(Plast)1
doi : 10.1097/TP.0000000000003979
December 2021 - Volume 105 - Issue 12 - p 2513-2514
Opportunities and Challenges of Targeting an Aging Immune System
Roesel, Maximilian J. Cand.med.1,2; Matsunaga, Tomohisa MD1,3; Tullius, Stefan G. MD, PhD1
doi : 10.1097/TP.0000000000003930
December 2021 - Volume 105 - Issue 12 - p 2515-2516
Continuous Distribution in Organ Allocation: Stepping Back From the Edge
Pavlakis, Martha MD1
doi : 10.1097/TP.0000000000003886
December 2021 - Volume 105 - Issue 12 - p 2517-2519
The Costs of Organ Procurement: Another Case of Efficiency Versus Equity
Howell, Martin PhD1,2
doi : 10.1097/TP.0000000000003668
December 2021 - Volume 105 - Issue 12 - p 2520-2521
The Challenge of Infection Outcomes in Clinical Trials
Avery, Robin MD1
doi : 10.1097/TP.0000000000003724
December 2021 - Volume 105 - Issue 12 - p 2522-2523
Chronic Diarrhea Secondary to Norovirus Infection in Kidney Transplant Recipients: Early Recognition Is Key
Belga, Sara MD1
doi : 10.1097/TP.0000000000003709
December 2021 - Volume 105 - Issue 12 - p 2524-2525
Measuring Long-term Outcomes of Pediatric Liver Transplantation: The Japanese Exemplar
Gondolesi, Gabriel E. MD, MAAC, FACS1
doi : 10.1097/TP.0000000000003611
December 2021 - Volume 105 - Issue 12 - p 2526-2527
COVID-19 Reinfection by the Gamma Variant in Kidney Transplant Recipients
Moschetta, Marina Oliboni MD1; Hadi, Riad Abdel MD1,2; Franco, Rodrigo Fontanive MD1,2; Wink, Priscila Lamb PhD3; Barth, Afonso Luis PhD3; Gonçalves, Luiz Felipe Santos MD, PhD1,2,4; Bauer, Andrea Carla MD, PhD1,2,4; Manfro, Roberto Ceratti MD, PhD1,2,4
doi : 10.1097/TP.0000000000003924
December 2021 - Volume 105 - Issue 12 - p e276-e277
SARS-CoV-2 Infection After Full Vaccination in Kidney Transplant Recipients
Montagud-Marrahi, Enrique MD1,2; Cucchiari, David MD, PhD1,2; Cuadrado-Payán, Elena MD1; Cofan, Frederic MD, PhD1; Torregrosa, Josep-Vicens MD1; Ventura-Aguiar, Pedro MD, PhD1,2,3; Revuelta, Ignacio MD, PhD1,2,3; Bodro, Marta MD, PhD4; Piñeiro, Gaston J. MD, PhD1,2,3; Esforzado, Nuria MD, PhD1; Campistol, Josep M. MD, PhD1,2,3; Oppenheimer, Federico MD, PhD1,2; Marcos, M. Ángeles MD, PhD5; Bayés, Beatriu MD, PhD1; Moreno, Asunción MD, PhD4; Diekmann, Fritz MD, PhD1,2,3
doi : 10.1097/TP.0000000000003927
December 2021 - Volume 105 - Issue 12 - p e278-e279
Antibody Response to a Fourth Dose of a SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Case Series
Alejo, Jennifer L. MD1; Mitchell, Jonathan MBBS1; Chiang, Teresa P.-Y. MD, MPH1; Abedon, Aura T. BS1; Boyarsky, Brian J. MD, PhD1; Avery, Robin K. MD2; Tobian, Aaron A.R. MD, PhD3; Levan, Macey L. JD, PhD1; Massie, Allan B. PhD1; Garonzik-Wang, Jacqueline M. MD, PhD1; Segev, Dorry L. MD, PhD1; Werbel, William A. MD2
doi : 10.1097/TP.0000000000003934
December 2021 - Volume 105 - Issue 12 - p e280-e281
The antibody response after 2 doses of an mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine is excellent in the general population but less robust in transplant patients.1 Severe breakthrough infections in solid organ transplant recipients (SOTRs) have prompted debate on how to protect these individuals.2,3 We previously reported improved antibody responses in ~50% of SOTRs after a third dose (D3) of vaccine.4 In this series, we studied antibody responses to a fourth dose (D4) of SARS-CoV-2 vaccine in 18 SOTRs from April 24, 2021, through June 16, 2021.
Preemptive Antibody Therapy for Vaccine Breakthrough SARS-CoV-2 Infection in Immunocompromised Patients
Catalano, Concetta MD1; Servais, Sophie MD, PhD2; Bonvoisin, Catherine MD2; Couturier, Bruno MD1; Hildebrand, Marc MD1; Etienne, Isabelle MD1; Meuris, Christelle MD2; Goffard, Jean-Christophe MD, PhD1; Wissing, Martin MD, PhD3; Goldman, Michel MD, PhD4; Le Moine, Alain MD, PhD1
doi : 10.1097/TP.0000000000003942
December 2021 - Volume 105 - Issue 12 - p e282
There is increasing evidence that COVID-19 vaccination regimens applied to the general population do not adequately protect a significant proportion of immunocompromised patients. Indeed, a recent study to be published in this journal reported a 82-fold higher risk of breakthrough infection in a large cohort of fully vaccinated solid organ transplant recipients.1 Even more strikingly, breakthrough infection in these patients was 485-fold more likely to lead to hospitalization or death.1 These impressive clinical data corroborate poor antibody and T-cell responses elicited by 2 mRNA vaccine doses in this population.2,3 Similarly, impaired antibody response to mRNA vaccination has been observed in patients with hematologic malignancies, those treated with anti-CD20 antibodies, and after stem cell transplantation.4 Although a third vaccine dose could help regain a better level of immunization in some of these immunocompromised individuals,2,3 there is a clear need to consider alternative strategies to protect this highly vulnerable patient population from developing severe COVID-19 disease.
Disappointing Immunization Rate After 2 Doses of the BNT162b2 Vaccine in a Belgian Cohort of Kidney Transplant Recipients
Georgery, Hélène MD1; Devresse, Arnaud PhD1,2; Yombi, Jean-Cyr MD2,3; Belkhir, Leila MD, PhD2,3; De Greef, Julien MD2,3; Darius, Tom MD, PhD2,4; Buemi, Antoine MD2,4; Scohy, Anais PharmD5; Kabamba, Benoit MD2,5; Goffin, Eric MD1,2; Kanaan, Nada MD1,2
doi : 10.1097/TP.0000000000003861
December 2021 - Volume 105 - Issue 12 - p e283-e284
Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is actively ongoing around the world to prevent coronavirus disease (COVID-19) infection that may be associated with dramatic outcomes, particularly in kidney transplant recipients (KTRs). We recently published a very low humoral response rate at 3.8% (n=3/78), 28 d after a single dose of the BNT162b2 vaccine (Pfizer-BioNTech).1
Crossmatch, Donor-specific Antibody Testing, and Immunosuppression in Simultaneous Liver and Kidney Transplantation: A Review
Das, Anushka MS1; Taner, Timucin MD, PhD2,3; Kim, Jim MD1,4; Emamaullee, Juliet MD, PhD, FRCSC, FACS1,4
doi : 10.1097/TP.0000000000003694
December 2021 - Volume 105 - Issue 12 - p e285-e291
Since the introduction of simultaneous liver-kidney transplantation (SLKT) in the 1960s, the potential for immunological protection from the liver allograft to a simultaneously transplanted kidney has been recognized. Due to expanded indications and changes in allocation policies, there has been increased utilization of SLKT. Despite growing experience, a lack of consensus exists regarding the extent of the immunological privilege of the liver the role for donor-specific HLA antibody (DSA) and crossmatch testing, and appropriateness of modern immunosuppression protocols in SLKT recipients. This review provides a detailed analysis of SLKT outcomes in the context of these factors, suggesting that although the liver can reduce the incidence of antibody-mediated rejection, attention should be given to liver allograft function, previous failed transplants, and other risk factors in pretransplant risk assessment. Current methods of DSA and crossmatch testing in SLKT are also discussed, and the role of specific DSA (high mean fluorescence intensity antibody, C1q+ binding) and their potential importance in posttransplant risk assessment are examined. Finally, trends in SLKT immunosuppression are discussed, including the use of nondepleting agents for induction and de-escalating use of steroids for maintenance immunosuppression. Ongoing research, including multicenter or randomized trials, will be necessary to optimize immune-related outcomes in SLKT recipients.
Psychosocial Evaluation of Candidates for Solid Organ Transplantation
Bailey, Pippa PhD1,2; Vergis, Nikhil PhD3,4; Allison, Michael PhD5; Riddell, Amy MB, BCh2,6; Massey, Emma PhD7
doi : 10.1097/TP.0000000000003732
December 2021 - Volume 105 - Issue 12 - p e292-e302
Transplant candidates should undergo an assessment of their mental health, social support, lifestyle, and behaviors. The primary aims of this “psychosocial evaluation” are to ensure that transplantation is of benefit to life expectancy and quality of life, and to allow optimization of the candidate and transplant outcomes. The content of psychosocial evaluations is informed by evidence regarding pretransplant psychosocial predictors of transplant outcomes. This review summarizes the current literature on pretransplant psychosocial predictors of transplant outcomes across differing solid organ transplants and discusses the limitations of existing research. Pretransplant depression, substance misuse, and nonadherence are associated with poorer posttransplant outcomes. Depression, smoking, and high levels of prescription opioid use are associated with reduced posttransplant survival. Pretransplant nonadherence is associated with posttransplant rejection, and nonadherence may mediate the effects of other psychosocial variables such as substance misuse. There is evidence to suggest that social support is associated with likelihood of substance misuse relapse after transplantation, but there is a lack of consistent evidence for an association between social support and posttransplant adherence, rejection, or survival across all organ transplant types.
Myeloid and Mesenchymal Stem Cell Therapies for Solid Organ Transplant Tolerance
Li, Jennifer MBBS, FRACP1,2; Thomson, Angus W. PhD, DSc, FRCPath3; Rogers, Natasha M. MBBS, PhD, FRACP1,2
doi : 10.1097/TP.0000000000003765
December 2021 - Volume 105 - Issue 12 - p e303-e321
Transplantation is now performed globally as a routine procedure. However, the increased demand for donor organs and consequent expansion of donor criteria has created an imperative to maximize the quality of these gains. The goal is to balance preservation of allograft function against patient quality-of-life, despite exposure to long-term immunosuppression. Elimination of immunosuppressive therapy to avoid drug toxicity, with concurrent acceptance of the allograft—so-called operational tolerance—has proven elusive. The lack of recent advances in immunomodulatory drug development, together with advances in immunotherapy in oncology, has prompted interest in cell-based therapies to control the alloimmune response. Extensive experimental work in animals has characterized regulatory immune cell populations that can induce and maintain tolerance, demonstrating that their adoptive transfer can promote donor-specific tolerance. An extension of this large body of work has resulted in protocols for manufacture, as well as early-phase safety and feasibility trials for many regulatory cell types. Despite the excitement generated by early clinical trials in autoimmune diseases and organ transplantation, there is as yet no clinically validated, approved regulatory cell therapy for transplantation. In this review, we summarize recent advances in this field, with a focus on myeloid and mesenchymal cell therapies, including current understanding of the mechanisms of action of regulatory immune cells, and clinical trials in organ transplantation using these cells as therapeutics.
Innate (and Innate-like) Lymphoid Cells: Emerging Immune Subsets With Multiple Roles Along Transplant Life
Charmetant, Xavier MD1; Bachelet, Thomas MD, PhD2,3; Déchanet-Merville, Julie PhD4; Walzer, Thierry PhD1; Thaunat, Olivier MD, PhD1,5,6
doi : 10.1097/TP.0000000000003782
December 2021 - Volume 105 - Issue 12 - p e322-e336
Transplant immunology is currently largely focused on conventional adaptive immunity, particularly T and B lymphocytes, which have long been considered as the only cells capable of allorecognition. In this vision, except for the initial phase of ischemia/reperfusion, during which the role of innate immune effectors is well established, the latter are largely considered as “passive” players, recruited secondarily to amplify graft destruction processes during rejection. Challenging this prevalent dogma, the recent progresses in basic immunology have unraveled the complexity of the innate immune system and identified different subsets of innate (and innate-like) lymphoid cells. As most of these cells are tissue-resident, they are overrepresented among passenger leukocytes. Beyond their role in ischemia/reperfusion, some of these subsets have been shown to be capable of allorecognition and/or of regulating alloreactive adaptive responses, suggesting that these emerging immune players are actively involved in most of the life phases of the grafts and their recipients. Drawing upon the inventory of the literature, this review synthesizes the current state of knowledge of the role of the different innate (and innate-like) lymphoid cell subsets during ischemia/reperfusion, allorecognition, and graft rejection. How these subsets also contribute to graft tolerance and the protection of chronically immunosuppressed patients against infectious and cancerous complications is also examined.
Antemortem Heparin in Organ Donation After Circulatory Death Determination: A Systematic Review of the Literature
Honarmand, Kimia MD, MSc1; Alshamsi, Fayez MD2; Foroutan, Farid PhD3; Rochwerg, Bram MD, MSc4,5; Belley-Cote, Emilie MD, PhD4,5,6,7; Mclure, Graham MD, MSc5; D’Aragon, Frederick MD, MSc8; Ball, Ian M. MD, MSc1,9; Sener, Alp MD, PhD10; Selzner, Markus MD11; Guyatt, Gordon MD, MSc5,12; Meade, Maureen O. MD, MSc4,5
doi : 10.1097/TP.0000000000003793
December 2021 - Volume 105 - Issue 12 - p e337-e346
Donation after circulatory death determination frequently involves antemortem heparin administration to mitigate peri-arrest microvascular thrombosis. We systematically reviewed the literature to: (1) describe heparin administration practices and (2) explore the effects on transplant outcomes. We searched MEDLINE and EMBASE for studies reporting donation after circulatory death determination heparin practices including use, dosage, and timing (objective 1). To explore associations between antemortem heparin and transplant outcomes (objective 2), we (1) summarized within-study comparisons and (2) used meta-regression analyses to examine associations between proportions of donors that received heparin and transplant outcomes. We assessed risk of bias using the Newcastle Ottawa Scale and applied the GRADE methodology to determine certainty in the evidence. For objective 1, among 55 eligible studies, 48 reported heparin administration to at least some donors (range: 15.8%–100%) at variable doses (up to 1000 units/kg) and times relative to withdrawal of life-sustaining therapy. For objective 2, 7 studies that directly compared liver transplants with and without antemortem heparin reported lower rates of primary nonfunction, hepatic artery thrombosis, graft failure at 5 y, or recipient mortality (low certainty of evidence). In contrast, meta-regression analysis of 32 liver transplant studies detected no associations between the proportion of donors that received heparin and rates of early allograft dysfunction, primary nonfunction, hepatic artery thrombosis, biliary ischemia, graft failure, retransplantation, or patient survival (very low certainty of evidence). In conclusion, antemortem heparin practices vary substantially with an uncertain effect on transplant outcomes. Given the controversies surrounding antemortem heparin, clinical trials may be warranted.
Secondary Endothelial Keratoplasty—A Narrative Review of the Outcomes of Secondary Corneal Endothelial Allografts
Moura-Coelho, Nuno MD, MMed1,2,3; Cunha, João Paulo MD, PhD4,5; Morral, Merce MD, PhD6,7; Gris, Oscar MD, PhD6,7; Manero, Felicidad MD6,7; Güell, José Luis MD, PhD6,7
doi : 10.1097/TP.0000000000003735
December 2021 - Volume 105 - Issue 12 - p e347-e365
We review the literature on the efficacy and safety outcomes of secondary Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK).
Recommendations and Guidance on Nutritional Supplementation in the Liver Transplant Setting
Campos-Varela, Isabel MD1,2; Gómez-Gavara, Concepción MD3; Augustin, Salvador MD1,2
doi : 10.1097/TP.0000000000003736
December 2021 - Volume 105 - Issue 12 - p 2528-2537
Malnutrition is a frequent complication in patients with cirrhosis and liver transplant (LT) candidates. It is highly related to sarcopenia, and their implications in morbidity and mortality go beyond the waiting list period throughout the post-LT. However, there are no specific interventions defined by guidelines regarding the kind or the timing of the nutritional intervention to improve LT outcomes. Results from studies developed in the LT setting and evaluating their impact on the LT candidates or recipients are discussed in this review, and new research lines are presented.
Antifungal Prophylaxis After Lung Transplantation: Where Are We Now?
De Mol, Wim MD1; Bos, Saskia MD2; Beeckmans, Hanne MD1; Lagrou, Katrien MD, PhD3,4; Spriet, Isabel MSc, PhD5,6; Verleden, Geert M. MD, PhD2,7; Vos, Robin MD, PhD2,7
doi : 10.1097/TP.0000000000003717
December 2021 - Volume 105 - Issue 12 - p 2538-2545
Lung transplantation is an important treatment option for various end-stage lung diseases. However, survival remains limited due to graft rejection and infections. Despite that fungal infections are frequent and carry a bad prognosis, there is currently no consensus on efficacy, optimal drug, route, or duration of antifungal prophylaxis. This narrative review summarizes current strategies for antifungal prophylaxis after lung transplantation.
High-resolution Metatranscriptomic Characterization of the Pulmonary RNA Virome After Lung Transplantation
Mitchell, Alicia B. BMedSci (Hons), PhD1; Li, Ci-Xiu PhD2; Oliver, Brian G.G. PhD3; Holmes, Edward C. PhD, FAA, FRS2; Glanville, Allan R. MD4
doi : 10.1097/TP.0000000000003713
December 2021 - Volume 105 - Issue 12 - p 2546-2553
Lung transplantation provides a unique opportunity to investigate the constituents and temporal dynamics of the human pulmonary microbiome after lung transplantation. For methodological reasons, prior studies using metagenomics have detected DNA viruses but not demonstrated the presence of RNA viruses, including those that are common community acquired. In this proof-of-concept study, we aimed to further characterize the pulmonary microbiome after lung transplantation by using metagenomic next-generation sequencing (mNGS), with a particular focus on the RNA virome.
Undernutrition and Hypoleptinemia Modulate Alloimmunity and CMV-specific Viral Immunity in Transplantation
David, Emeraghi MS1; Zhu, Minghua PhD2; Bennett, Braden C. BS3; Cheng, Daniel1; Schroder, Paul MD, PhD3; Nichols, Amanda BS1; Parker, William PhD3; Kirk, Allan D. MD, PhD1,3; MacIver, Nancie MD, PhD1; Chambers, Eileen T. MD1,3
doi : 10.1097/TP.0000000000003743
December 2021 - Volume 105 - Issue 12 - p 2554-2563
Immunological mechanisms linking undernutrition to infection and the alloimmune response are poorly understood in transplantation. We aimed to determine how undernutrition and hypoleptinemia impact T-cell allospecific and cytomegalovirus (CMV) viral-specific immunity in a murine model.
Impact of Advanced Renal Dysfunction on Posttransplant Outcomes After Living Donor Liver Transplantation in the United States
Bittermann, Therese MD1,2; Abt, Peter L. MD3; Olthoff, Kim M. MD3; Kaur, Navpreet MD4; Heimbach, Julie K. MD5; Emamaullee, Juliet MD, PhD, FRCSC, FACS4
doi : 10.1097/TP.0000000000003728
December 2021 - Volume 105 - Issue 12 - p 2564-2570
Survival after living donor liver transplantation (LDLT) in the United States is excellent. However, the significance of pretransplant kidney disease on outcomes in this population is poorly understood.
Incidence and Risk Factors for Fatal Graft-versus-host Disease After Liver Transplantation
Kitajima, Toshihiro PhD1; Henry, Matthew1; Ivanics, Tommy MD1; Yeddula, Sirisha MS1; Collins, Kelly MD1; Rizzari, Michael MD1; Yoshida, Atsushi MD1; Abouljoud, Marwan S. MD1; Nagai, Shunji PhD1; Moonka, Dilip MD2
doi : 10.1097/TP.0000000000003607
December 2021 - Volume 105 - Issue 12 - p 2571-2578
Graft-versus-host disease (GVHD) after liver transplantation (LT) is a rare but serious complication. The aim of this study is to identify risk factors, including immunosuppressive regimens, for mortality due to GVHD (fatal GVHD).
Postrecurrence Survival After Liver Transplantation for Liver Metastases From Neuroendocrine Tumors
Sposito, Carlo MD1,2; Rossi, Roberta Elisa MD1,3; Monteleone, Michela MD1; Coppa, Jorgelina MD1; Bongini, Marco MD1; Milione, Massimo MD4; Bhoori, Sherrie MD1; Mazzaferro, Vincenzo MD, PhD1,2
doi : 10.1097/TP.0000000000003802
December 2021 - Volume 105 - Issue 12 - p 2579-2586
Liver metastases from neuroendocrine tumors (NETs) are an accepted indication for liver transplantation (LT). Despite strict patient selection, post-LT recurrence is observed in 30%–50% of cases. Postrecurrence survival is poorly investigated as well as factors influencing postrecurrence outcomes.
Outcomes of Pediatric Liver Transplantation in Japan: A Report from the Registry of the Japanese Liver Transplantation Society
Kasahara, Mureo MD, PhD1; Umeshita, Koji MD, PhD2; Eguchi, Susumu MD, PhD3; Eguchi, Hidetoshi MD, PhD2; Sakamoto, Seisuke MD, PhD1; Fukuda, Akinari MD, PhD1; Egawa, Hiroto MD, PhD4; Haga, Hironori MD, PhD5; Kokudo, Norihiro MD, PhD6; Sakisaka, Shotaro MD, PhD7; Takada, Yasutsugu MD, PhD8; Tanaka, Eiji MD, PhD9; Uemoto, Shinji MD, PhD10; Ohdan, Hideki MD, PhD11
doi : 10.1097/TP.0000000000003610
December 2021 - Volume 105 - Issue 12 - p 2587-2595
The Japanese Liver Transplantation Society (JLTS), a cooperative research consortium, was established in 1980 to characterize and follow trends in patient characteristics and graft survival among all liver transplant patients in Japan. This study analyzed factors that may affect the current outcomes of pediatric patients who undergo liver transplantation (LT) by evaluating one of the largest pediatric LT cohorts in the world.
CT-measured Cortical Volume Ratio Is an Accurate Alternative to Nuclear Medicine Split Scan Ratio Among Living Kidney Donors
Montgomery, John R. MD, MSc1,2; Brown, Craig S. MD, MSc1,2; Zondlak, Allyse N. BS3; Walsh, Kevin W. BS3; Kozlowski, Julia E. BS3; Pinsky, Alexa M. BS3; Herriman, Emily A. ANP-BC1; Sussman, Jeremy MD, MS4; Lu, Yee MD5; Stein, Erica B. MD6; Shankar, Prasad R. MD6,7; Sung, Randall S. MD1; Woodside, Kenneth J. MD1
doi : 10.1097/TP.0000000000003676
December 2021 - Volume 105 - Issue 12 - p 2596-2605
The 125I-iothalamate clearance and 99mTc diethylenetriamine-pentaacetic acid (99mTc-DTPA) split scan nuclear medicine studies are used among living kidney donor candidates to determine measured glomerular filtration rate (mGFR) and split scan ratio (SSR). The computerized tomography–derived cortical volume ratio (CVR) is a novel measurement of split kidney function and can be combined with predonation estimated GFR (eGFR) or mGFR to predict postdonation kidney function. Whether predonation SSR predicts postdonation kidney function better than predonation CVR and whether predonation mGFR provides additional information beyond predonation eGFR are unknown.
Association Between Treatment of Secondary Hyperparathyroidism and Posttransplant Outcomes
Mathur, Aarti MD1; Sutton, Whitney MD1; Ahn, JiYoon B. KMD, MPH1; Prescott, Jason D. MD, PhD1; Zeiger, Martha A. MD2; Segev, Dorry L. MD, PhD1,3; McAdams-DeMarco, Mara PhD1,3
doi : 10.1097/TP.0000000000003653
December 2021 - Volume 105 - Issue 12 - p e366-e374
Secondary hyperparathyroidism (SHPT) affects nearly all patients on maintenance dialysis therapy. SHPT treatment options have considerably evolved over the past 2 decades but vary in degree of improvement in SHPT. Therefore, we hypothesize that the risks of adverse outcomes after kidney transplantation (KT) may differ by SHPT treatment.
Toxoplasmosis Among 38 751 Hematopoietic Stem-cell Transplant Recipients: A Systematic Review of Disease Prevalence and a Compilation of Imaging and Autopsy Findings
Contopoulos-Ioannidis, Despina G. MD1,2; Cho, Stephanie M. MS3; Bertaina, Alice MD, PhD4; Leung, Ann N. MD5; Fischbein, Nancy MD6; Lanzman, Bryan MD6; Schwenk, Hayden T. MD, MPH1; Montoya, Jose G. MD2
doi : 10.1097/TP.0000000000003662
December 2021 - Volume 105 - Issue 12 - p e375-e386
Toxoplasmosis in hematopoietic stem-cell transplant (HSCT) recipients can be life threatening if not promptly diagnosed and treated.
Wages, Travel, and Lodging Reimbursement by the National Kidney Registry: An Important Step Toward Financial Neutrality for Living Kidney Donors in the United States
Garg, Neetika MD1; Waterman, Amy D. PhD2,3; Ranasinghe, Omesh MPH2; Warnke, Leza RN4; Morris, Jonathan RN5; Cooper, Matthew MD6; Mandelbrot, Didier A. MD1
doi : 10.1097/TP.0000000000003721
December 2021 - Volume 105 - Issue 12 - p 2606-2611
Since 2007, the National Living Donor Assistance Center has provided the most financial support to US living donors meeting specific income criteria by reimbursing travel, meal, and lodging expenses. In 2019, the National Kidney Registry started providing lost wages, travel, and lodging reimbursement via their Donor Shield program. Donor Shield is automatically provided to donors who participate in kidney paired donation through the National Kidney Registry or who donate at a Donor Shield Direct center, without any income restrictions.
Cost Structures of US Organ Procurement Organizations
Held, Philip J. PhD1; Bragg-Gresham, Jennifer L. PhD2; Peters, Thomas G. MD3; McCormick, Frank PhD4; Chertow, Glenn MD, MPH1; Vaughan, William P. BS5; Roberts, John P. MD6
doi : 10.1097/TP.0000000000003667
December 2021 - Volume 105 - Issue 12 - p 2612-2619
The goal is to provide a national analysis of organ procurement organization (OPO) costs.
Overcoming the Limits of Reconditioning: Seventeen Hours of EVLP With Successful Transplantation From Uncontrolled Circulatory Death Donor
Palleschi, Alessandro MD1,2; Rosso, Lorenzo MD, PhD1,2; Ruggeri, Giulia Maria MD3; Croci, Giorgio Alberto MD2,4; Rossetti, Valeria MD5; Citerio, Giuseppe MD6,7; Grasselli, Giacomo MD2,3; Nosotti, Mario MD1,2; Zanella, Alberto MD2,3
doi : 10.1097/TP.0000000000003646
December 2021 - Volume 105 - Issue 12 - p 2620-2624
Uncontrolled donation after circulatory death (DCD) donors are an extraordinary resource to increase the number of lungs available for transplantation. However, the risk of the warm ischemia resulting from cardiac arrest to irreversibly damage the organs is considerable. Moreover, graft preservation issues and organizational problems often worsen the dangerous effects of warm ischemia. Ex vivo lung perfusion (EVLP) enables us to evaluate and recondition lungs whose functionality is doubtful, as well as to overcome the difficulties related to time and logistics.
Evolution of Recipient Characteristics Over 3 Decades and Impact on Survival After Lung Transplantation
Elgharably, Haytham MD1,2; Ayyat, Kamal S. MD, PhD1,2; Okamoto, Toshihiro MD, PhD1,2; Thuita, Lucy MS3; Unai, Shinya MD1; Bribriesco, Alejandro C. MD1; Yun, James J. MD, PhD1; Johnston, Douglas R. MD1; Ahmad, Usman MD1; Murthy, Sudish C. MD, PhD1; Budev, Marie M. DO, MPH4; Pettersson, Gosta B. MD, PhD1; McCurry, Kenneth R. MD1,2
doi : 10.1097/TP.0000000000003756
December 2021 - Volume 105 - Issue 12 - p e387-e394
Lung transplantation (LTx) is a definitive treatment for end-stage lung disease. Herein, we reviewed our center experience over 3 decades to examine the evolution of recipient characteristics and contemporary predictors of survival for LTx.
Human Metapneumovirus and Parainfluenza Virus Infections in Lung Transplant Recipients: The Effects on Lung Allograft and Clinical Outcomes
Permpalung, Nitipong MD, MPH1,2; Sait, Afrah S. MD1; Bazemore, Katrina MPH3; Avery, Robin K. MD1; Mathew, Joby DPT3; Shah, Pali D. MD3
doi : 10.1097/TP.0000000000003645
December 2021 - Volume 105 - Issue 12 - p 2625-2631
Human metapneumovirus (HMPVi) and parainfluenza virus (PIVi) infections are common community-acquired infections in lung transplant recipients (LTRs), but data are extremely limited.
Range and Consistency of Infection Outcomes Reported in Trials Conducted in Kidney Transplant Recipients: A Systematic Review
Chan, Samuel FRACP1,2,3; Au, Eric FRACP4,5; Johnson, David W. PhD1,2,3; Hawley, Carmel M. M Med Sci1,2,3; Tong, Allison PhD4,5; Pascoe, Elaine M. M Biostat1,2; Craig, Jonathan C. PhD6; Sautenet, Benedicte MD5,7; Blumberg, Emily A. MD8; Brennan, Daniel MD9; Campbell, Scott B. PhD1,2,3; Cao, Christopher MD1; Francis, Ross S. PhD1,2; Huuskes, Brooke PhD10; Isbel, Nicole M. PhD1,2; Knoll, Greg MD11; Kotton, Camille N. MD12; Mamode, Nizam MD13; Muller, Elmi PhD14; An Ha Phan, Hai MD15; Tedesco-Silva, Helio MD16; White, David M. MD17; Wolley, Martin J. PhD2,18; Viecelli, Andrea K. PhD1,2,3
doi : 10.1097/TP.0000000000003723
December 2021 - Volume 105 - Issue 12 - p 2632-2638
Infection remains a leading cause of death in kidney transplant recipients. This study aimed to assess the scope and consistency of infection outcomes reported in contemporary trials conducted in kidney transplant recipients.
Center-level Utilization of Hepatitis C Virus–positive Donors for Orthotopic Heart Transplantation
Huckaby, Lauren V. MD, MS1; Seese, Laura M. MD, MS2; Handzel, Robert MD, MS3; Wang, Yisi MPH2; Hickey, Gavin MD4; Kilic, Arman MD2
doi : 10.1097/TP.0000000000003674
December 2021 - Volume 105 - Issue 12 - p 2639-2645
The use of hepatitis C virus–positive (HCV+) donors has expanded the donor pool for orthotopic heart transplantation (OHT). This study evaluated center-level trends and utilization of HCV+ donors for OHT.
Automated En Masse Machine Learning Model Generation Shows Comparable Performance as Classic Regression Models for Predicting Delayed Graft Function in Renal Allografts
Jen, Kuang-Yu MD, PhD1; Albahra, Samer MD1; Yen, Felicia BS1; Sageshima, Junichiro MD2; Chen, Ling-Xin MD, MS3; Tran, Nam PhD1; Rashidi, Hooman H. MD1
doi : 10.1097/TP.0000000000003640
December 2021 - Volume 105 - Issue 12 - p 2646-2654
Several groups have previously developed logistic regression models for predicting delayed graft function (DGF). In this study, we used an automated machine learning (ML) modeling pipeline to generate and optimize DGF prediction models en masse.
Norovirus Infections in Kidney Transplant Recipients
Gäckler, Anja MD1; Struve, Christoph MD2; Mülling, Nils MD1; Eisenberger, Ute MD1; Korth, Johannes MD1; Babel, Nina MD3; Kribben, Andreas MD1; Fiedler, Melanie MD4; Witzke, Oliver MD2; Rohn, Hana MD2
doi : 10.1097/TP.0000000000003708
December 2021 - Volume 105 - Issue 12 - p 2655-2660
Norovirus (NoV) infection frequently progresses to chronic disease after kidney transplant (KTx). This study aims to assess potential risk factors helping to determine patients at risk of chronic NoV infection and to analyze the effect of NoV on allograft outcome. Additionally, we assessed the effectiveness of intravenous immunoglobulin (IVIg) therapy for chronic NoV infection.
Operative Technique of Donor Organ Procurement for En Bloc Heart-liver Transplantation
Elde, Stefan MD1; Brubaker, Aleah L. MD, PhD2; Than, Peter A. MD2; Rinewalt, Daniel MD3; MacArthur, John W. MD1; Alassar, Aiman MD, PhD1; Bonham, Clark A. MD2; Esquivel, Carlos O. MD, PhD2; Shudo, Yasuhiro MD, PhD1; Concepcion, Waldo MD2; Woo, Y. Joseph MD1
doi : 10.1097/TP.0000000000003697
December 2021 - Volume 105 - Issue 12 - p 2661-2665
Combined heart-liver transplant is an emerging option for patients with indications for heart transplantation and otherwise prohibitive hepatic dysfunction. Heart-liver transplantation is particularly relevant for patients with single ventricle physiology who often develop Fontan-associated liver disease and fibrosis. Although only performed at a limited number of centers, several approaches to combined heart-liver transplantation have been described. The en bloc technique offers several potential advantages over the traditional sequential technique. Specifically, en bloc heart-liver transplantation may allow improved hemodynamics, decreased bleeding, reduced liver allograft ischemic time, and may result in reduced rates of graft dysfunction. Here we describe our center’s en bloc heart-liver procurement technique in detail, with the aim of allowing broader use and standardization of this technique.
Belatacept in Kidney Transplant Recipients With Failed Allografts for the Prevention of Humoral Sensitization: A Pilot Randomized Controlled Trial
Badell, I. Raul MD1; Bray, Robert A. PhD2; Elbein, Rivka1; Chami, Ashtar S. MD1; Easley, Kirk A. MS3; Pastan, Stephen O. MD1; Guasch, Antonio MD1; Gebel, Howard M. PhD2; Adams, Andrew B. MD, PhD1; Larsen, Christian P. MD, PhD1
doi : 10.1097/TP.0000000000003852
December 2021 - Volume 105 - Issue 12 - p e395-e396
Letter to the Editor
Ison, Michael G. MD, MS1; Hirsch, Hans H. MD, MS2
doi : 10.1097/TP.0000000000003853
December 2021 - Volume 105 - Issue 12 - p e397
Durvalumab as a Successful Downstaging Therapy for Liver Transplantation in Hepatocellular Carcinoma: The Importance of a Washout Period
Sogbe, Miguel MD1; López-Guerra, Diego MD, PhD2; Blanco-Fernández, Gerardo MD, PhD2; Sangro, Bruno MD, PhD1,3; Narváez-Rodriguez, Isidoro MD4
doi : 10.1097/TP.0000000000003855
December 2021 - Volume 105 - Issue 12 - p e398-e400
Peribiliary Intravascular Fibrin Occlusions and Bile Duct Necrosis in DCD Livers During Ex Situ Perfusion: Prevention With Tissue Plasminogen Activator and Fresh Frozen Plasma
Watson, Christopher J.E. MD1,2,3,4; Brais, Rebecca BAMB1,5; Gaurav, Rohit MS4; Swift, Lisa4; Fear, Corrina4; Foukaneli, Theodora MD1,6; Butler, Andrew J. MChir1,2,3,4
doi : 10.1097/TP.0000000000003864
December 2021 - Volume 105 - Issue 12 - p e401-e402
Regulations and Procurement Surgery in DCD Liver Transplantation: The Custodial Role of Professional Societies in the DCD and Liver Perfusion Revolution
Hessheimer, Amelia J. MD, PhD1; Polak, Wojciech MD, PhD2; Antoine, Corinne MD3; Dondero Pozzo, Federica MD4; Maluf, Daniel G. MD5; Monbaliu, Diethard MD, PhD6; Oniscu, Gabriel C. MD7
doi : 10.1097/TP.0000000000003869
December 2021 - Volume 105 - Issue 12 - p e403-e404
Comments on “Regulations and Procurement Surgery in DCD Liver Transplantation: Expert Consensus Guidance From the International Liver Transplantation Society”
Choubey, Ankur P. MD, MPH1; Ortiz, Jorge MD2
doi : 10.1097/TP.0000000000003868
December 2021 - Volume 105 - Issue 12 - p e405-e406
The Abundance of Antigalactose-deficient IgA1 Autoantibodies Results in Glomerular Deposition and IgA Nephropathy Recurrence After Renal Transplantation
Nakamura, Tsukasa MD, PhD1; Shirouzu, Takayuki PhD2; Harada, Shumpei MD, PhD1; Sugimoto, Ryusuke MD1; Nobori, Shuji MD, PhD1; Yoshikawa, Mikiko MD1; Ushigome, Hidetaka MD, PhD1; Kawai, Shintaro PhD2
doi : 10.1097/TP.0000000000003879
December 2021 - Volume 105 - Issue 12 - p e407-e408
Pancreatic Islets Quality and Potency Cannot be Verified as Required for Drugs: Reflection on the FDA Review of a Biological License Application for Human Islets
Witkowski, Piotr MD, PhD1; Anteby, Roi MD2,3; Olaitan, Oyedolamu K. MD4; Forbes, Racheal C. MD5; Niederhaus, Silke MD6; Ricordi, Camilo MD7; Fair, Jeffrey H. MD8; Harland, Robert C. MD9
doi : 10.1097/TP.0000000000003880
December 2021 - Volume 105 - Issue 12 - p e409-e410
