Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Current opinion in organ transplantation [journal]
- Editorial introductions. [Journal Article]
- Curr Opin Organ Transplant 2014 Oct; 19(5):v.
- Terminal heart failure: who should be transplanted and who should have mechanical circulatory support? [Journal Article]
- Curr Opin Organ Transplant 2014 Oct; 19(5):486-93.
Permanent long-term mechanical circulatory support (MCS) is currently reserved for patients who are transplant ineligible. In light of improved outcomes with current continuous flow devices, increased interest has focused on the potential extension of MCS therapy to ambulatory advanced heart failure patients and as an alternative to cardiac transplantation.Average 1-year and 2-year survival with heart transplantation is about 85 and 80%, and with MCS therapy, it is 85 and 70% (with censoring at transplant). Specific subsets of destination therapy patients enjoy survival out to 2 years, which is comparable with transplant survival. Risk factor analyses identify similar risk profiles for each therapy. Life satisfaction after each is highly dependent on the frequency and severity of adverse events, which are quite different for these interventions. Patients with long expected waiting times will likely be the initial group for triage off the transplant wait list to MCS therapy.MCS has progressively improved and may become a reasonable alternative to transplantation for highly selected patients with long expected waiting time. More routine extension of MCS therapy to the transplant population awaits further reduction of major adverse events, miniaturized devices, and less invasive implant techniques.
- Current techniques for pediatric liver transplantation. [Journal Article]
- Curr Opin Organ Transplant 2014 Oct; 19(5):468-73.
Orthotopic liver transplantation in the pediatric population is a technically challenging undertaking, requiring highly specialized surgical techniques unique to this group. This review describes the most current method of transplantation for these patients.Pediatric liver transplantation employs multiple modifications of standard transplant technique, including alternative methods of vascular and biliary anastomoses as well as technical variant grafts. We herein describe how these methods are employed in procurement, back-table preparation, hepatectomy, and allograft implantation.This review provides concise direction of surgical technique for pediatric liver transplant recipients.
- Donation after cardiac death for lung transplantation: a review of current clinical practice. [Journal Article]
- Curr Opin Organ Transplant 2014 Oct; 19(5):455-9.
This review presents a concise update on clinical donation after cardiac death (DCD or DDCD) lung transplantation. Lung allografts have predominantly been procured from donors after determination of neurologic death but will not meet the existing demand. A steadily increasing need for lungs is evident worldwide, especially in an era of improved outcomes for recipients. Other solid organ utilization from donors after determination of cardiac death has markedly increased internationally, but the utilization rate of lungs from such donors is still considerably less. The multifaceted reasons for this discrepancy are considered, and the recent evidence available supporting DCD for lung transplantation in clinical practice is presented in context. The recent experimental research studies are not within the remit of this appraisal.The more recent and markedly increased lung recipient cohorts showed very satisfactory survival outcomes for DCD transplantation in several programs. The overall utilization rate, however, remains low. The background and the rationale of lung donor allograft expansion to proactively include DCD allografts from controlled (Maastricht category III donors) is re-emphasized in this review. The feasibility of other DCD categories for lung transplantation is considered. This is particularly prudent with the advent of the ex-vivo lung perfusion modality in pulmonary procurement.Despite evidence for adequate survival outcomes and reported favorable primary graft dysfunction rates, DCD lung transplantation remains underutilized in most countries. Waiting times could be notably reduced and mortality of lung candidates arguably decreased by a more decided and appropriate implementation of proven DCD lung transplant strategies.
- Medical management of children after liver transplantation. [JOURNAL ARTICLE]
- Curr Opin Organ Transplant 2014 Aug 27.
Successful outcomes in patient, graft survival, and quality of life depend on the prevention, early detection, and treatment of possible complications. The aim of the study was to highlight the common outcomes focusing on the unique features in children. Medical follow-up of children after liver transplantation includes monitoring of surgical complications: biliary and vascular, rejection, infections, posttransplant lymphoproliferative disease, other malignancies, recurrent disease, graft function, hypertension, diabetes, renal failure, among other conditions. The goal is to maintain normal graft function on minimal immunosuppression to avoid medication-induced side-effects.Recent findings include the importance of meticulous follow-up of Epstein-Barr virus and Cytomegalic virus viral load, leading to early diagnosis and improved prognosis, increased prevalence of renal toxicity, cognitive dysfunction, autoimmune, atopic and eosinophilic disease, oral hygiene and chronic hepatitis, and fibrosis of allografts.Caring for children after liver transplantation is extremely rewarding; however, careful attention must be paid to a variety of systems with understanding of the distinctiveness of pediatrics to assure optimal outcomes.
- Lung transplantation. [Journal Article]
- Curr Opin Organ Transplant 2014 Oct; 19(5):453-4.
- High-risk donors: extending our criteria in times of organ shortage. [Journal Article]
- Curr Opin Organ Transplant 2014 Oct; 19(5):494-9.
Increasing waiting lists and declining transplant numbers due to organ shortage are a global problem that needs a multimodal approach to overcome this situation. Extending the criteria for transplantation may be one part of the solution.There are political efforts to increase the donor rate and change the listing criteria and the allocation process. Recently, the cardiac allocation score was introduced enhancing the factor urgency to the allocation process. Marginal donor organs can be accepted using ex-vivo perfusion strategies. Experimental approaches, such as donation after circulatory death and xenotransplantation, need to be further developed to be applied to humans and increase the pool of available transplant organs.Organ shortage needs new approaches to overcome the discrepancy between the number of patients on the wait list and performed heart transplantations, reduce wait list mortality and improve long-term outcomes after transplantation.
- Long-term care of the heart transplant recipient. [Journal Article]
- Curr Opin Organ Transplant 2014 Oct; 19(5):515-24.
This article will review the long-term care of the heart transplant recipient, focusing on the major causes of mortality and morbidity after transplantation.The major causes of mortality include rejection, infection, malignancy, and transplant coronary artery disease. The major causes of morbidity include renal dysfunction, hypertension, diabetes, dyslipidemia, gout, and osteoporosis. Strategies for prevention and management of these complications include advances in noninvasive monitoring assays. These assays, including the AlloMap gene expression profile for monitoring of rejection and the Cylex immune monitoring score for monitoring of over-immunosuppression, will allow better assessment of rejection and the level of immune response.Newer advances in rejection surveillance and immune monitoring will allow clinicians to tailor current therapies to the needs of individual heart transplant recipients to maximize benefit and minimize toxicity.
- Experimental models of cardiac transplantation: design determines relevance. [Journal Article]
- Curr Opin Organ Transplant 2014 Oct; 19(5):525-30.
Experimental models have contributed enormously to basic immunology. However, the use of reductionist experiments has produced results that are not always successfully translated into the clinic. Recently, incorporation of more realistic clinical parameters in experimental designs has produced new insights relevant to cardiac transplantation.Experiments in mice have provided crucial insights into the concept that T cell responses to pathogens generate memory cells with cross-reactive specificities for histocompatibility antigens. These memory T cells are resistant to current immunosuppressive strategies. Memory T cells infiltrate grafts within hours after transplantation, and grafts subjected to clinically relevant periods of cold ischemia are more susceptible to injury by this cellular infiltrate. Early immune responses now can be investigated with improved 'humanized' mice. Mice with multiple knock-in genes for human cytokines support development of human monocytes, macrophages and natural killer cells in increased numbers and with better function.Better and more clinically relevant experimental designs are providing animal models tailored to address clinic exigencies.
- Immunosuppression-state-of-the-art: anything new in the pipeline? [JOURNAL ARTICLE]
- Curr Opin Organ Transplant 2014 Aug 23.
Cardiac transplantation has been the therapy for advanced heart failure that is associated with the best and most durable outcomes. This has been a result of improvements in immunosuppression, specifically the widespread adoption of more potent immunosuppressive agents such as tacrolimus and mycophenolate mofetil in place of cyclosporine and azathioprine and more protocol-driven immunosuppressive regimens which minimize both rejection and complications of immunosuppression such as infections and nephrotoxicity. The rejection rates have fallen over the past 2 decades as posttransplant survival has improved. Despite these successes, long-term survival is limited by cardiac allograft vasculopathy and malignancies. The purpose of this review is to discuss new approaches to immunosuppression, which may address the long-term outcomes after transplant.Recent findings in clinical trials have shown that proliferation signal inhibitors or mammalian target of rapamycin inhibitors can reduce the incidence and severity of cardiac allograft vasculopathy and are used in higher doses as anticancer agents, but their uses are associated with side-effects.Consequently, there is considerable interest in developing newer immunosuppressive agents that will be more effective in treating and preventing these long-term complications with fewer side-effects. At present, there are no new agents other than Rituximab, which are being studied, in clinical trials.