Longer Term Follow-up on Acuity Circle Allocation Strategies in Liver Transplantation
AbstractPurpose of ReviewThis review summarizes longer term follow-up of acuity circle –based distribution for livers, which was implemented on February 4, 2020.Recent FindingsAfter 2 years of policy implementation, the likelihood of transplant increased, while removals for death or being too sick decreased. The median transplant score was unchanged, and the variance in the median MELD at transplant decreased for OPTN regions, DSA, and state. Concurrently, median distance from donor to transplant hospital and cold ischemia times increased. A slight increase in liver non-use rate and decrease in liver utilization rate h...
Source: Current Transplantation Reports - April 24, 2024 Category: Transplant Surgery Source Type: research
Psychometric Analysis for a Standardized Approach When Evaluating Liver Transplant Candidates with Acute Alcohol-Related Hepatitis
AbstractPurpose of ReviewTo summarize the role of psychometric instruments in the evaluation and management of patients with acute alcoholic hepatitis (AAH) evaluated for liver transplantation (LT).Recent FindingsPsychometrics can inform the care of patients with AAH in the transplantation setting by enhancing diagnostic accuracy and allowing a more precise understanding of the patient ’s mental health status. The predictive value of the psychometric scale in LT candidates with AAH remains low and controversial.SummaryCombining psychometrics with clinical judgment and other diagnostic tools ensures a more comprehensive a...
Source: Current Transplantation Reports - April 24, 2024 Category: Transplant Surgery Source Type: research
Clinical Application of Frailty in the Evaluation of Solid Organ Transplant Patients
AbstractPurpose of reviewFrailty is increasingly recognized as an important predictor of mortality and morbidity in patients across various medical subspecialties. The purpose of this review is to assess how frailty and markers of functional status are viewed within the field of transplant and incorporated into patient evaluations.Recent FindingsFrailty has been shown to influence patient and graft outcomes and many centers incorporate some form of frailty assessment during transplant candidacy evaluation. However, the optimal methods for assessing frailty have not been defined for solid organ transplant populations, and t...
Source: Current Transplantation Reports - April 23, 2024 Category: Transplant Surgery Source Type: research
Trends, Outcomes, and Evaluation of the Older Living Kidney Donor
AbstractPurpose of ReviewWe aim to review trends, donor and recipient outcomes, and considerations in the evaluation of older living kidney donors (LD).Recent FindingsOlder donors comprise a small but growing proportion of LDs. Aging is associated with nephrosclerosis, nephron loss, and a physiologic decline in kidney function. Importantly, living donor outcomes are favorable, with older LDs having similar mortality to age-matched healthy older non-donors, a lower lifetime risk of ESKD than younger LDs, and preserved quality of life. Allograft survival of LDKT from older LDs is also acceptable, and recipient survival is be...
Source: Current Transplantation Reports - April 19, 2024 Category: Transplant Surgery Source Type: research
The Ripple Effects of Delayed Graft Function
AbstractPurpose of ReviewThe number of people with end-stage kidney disease requiring renal replacement therapy is growing at a faster rate than the number of kidneys available for transplant. Additional options for deceased donor kidney transplant will increase risk for delayed graft function, which has expansive clinical, performance, and financial implications. The purpose of this paper is to discuss how delayed graft function impacts different domains.Recent FindingsGiven that most kidney transplants in the USA are performed with deceased donors, expanding the deceased donor pool is likely to be of the highest impact. ...
Source: Current Transplantation Reports - April 11, 2024 Category: Transplant Surgery Source Type: research
The Current Status of Organ Recovery Surgeon Remuneration in the United States
AbstractPurpose of ReviewRemuneration for surgeons who procure organs for transplantation from deceased donors is highly variable throughout the country and not standardized by the Centers for Medicare& Medicaid Services (CMS). CMS does not grant formal relative value units (RVUs) for organ recoveries but some transplant centers award “non-standardized” RVUs in an ad hoc fashion.Recent FindingsA REDCap survey was sent out by the Business Practice Committee of the American Society of Transplant Surgeons to understand the practices of individual transplant centers regarding payment for transplant-related procedures. ...
Source: Current Transplantation Reports - April 6, 2024 Category: Transplant Surgery Source Type: research
Nutrition Evaluation and Counseling for Potential Living Kidney Donors: An Opportunity for Lifelong Change
AbstractPurpose of ReviewIn this review, we discuss the importance of nutrition evaluation and counseling for living kidney donor candidates (LKDCs) and the roles of the dietitian and transplant physician.Recent FindingsIn the past decades, living kidney donors are becoming older and have higher rates of obesity and glucose intolerance. Like all adult populations, living kidney donors are at risk for developing diabetes, obesity, hypertension, and kidney disease post-donation, and risks may rise as these chronic diseases rise in the general population. Further, implications may be more serious for individuals living with o...
Source: Current Transplantation Reports - April 3, 2024 Category: Transplant Surgery Source Type: research
Inflammation in Brain-Dead Donor Organs and Therapeutic Approaches to It
AbstractPurpose of ReviewThe increasing number of patients on the waiting list for organ transplantation and organ shortage require the improvement of organ yield and graft quality from brain-dead donors. In addition to hemodynamic and metabolic disturbance, inflammatory responses might cause tissue damage and increase the risk of allograft dysfunction and rejection. Herein, we have summarized the evidence of inflammation in brain-dead organs and the therapeutic approaches to resolve it.Recent FindingsSome novel approaches, for instance, mesenchymal stem cell therapy, senolytics, calcineurin inhibitors, carbamylated erythr...
Source: Current Transplantation Reports - March 16, 2024 Category: Transplant Surgery Source Type: research
Updated Comparison of Robotic Versus Laparoscopic Donor Nephrectomy
This article reviews recent literature regarding the use of robotic versus laparoscopic donor nephrectomies over the past 3 years. There have been several comparisons between the robotic and laparoscopic approach assessing operative time, learning curve, costs, and safety. Some robotic benefits are more intangible than what is available in comparisons specifically those related to ergonomics, visualization, and trainin g of future transplant surgeons. Importantly, both techniques are safe for both the donor and recipient, and both techniques are useful tools especially in an environment where access to the robotic platfo...
Source: Current Transplantation Reports - February 14, 2024 Category: Transplant Surgery Source Type: research
The Carbon Footprint of Organ Transplantation in the USA
AbstractPurpose of ReviewThe purpose of this review is to evaluate the available literature on the environmental impact of healthcare, focusing specifically on solid organ transplantation.Recent FindingsLittle has been written on the environmental impact of solid organ transplantation, but there are several studies on the carbon footprint of operating rooms and hemodialysis, which help provide some context for the potential impact of solid organ transplantation.SummaryThe field of climate science as related to the provision of healthcare is new and requires dedicated research to build out a comprehensive understanding of t...
Source: Current Transplantation Reports - February 8, 2024 Category: Transplant Surgery Source Type: research
Continuously Balancing the Ethics of Organ Allocation
AbstractPurpose of ReviewIn 2018, the US Organ Procurement and Transplantation Network (OPTN) approved a continuous distribution model as a framework for developing future organ allocation policy. This review assesses the ethical underpinnings and implications of the OPTN ’s transition to the continuous distribution of organs.Recent FindingsContinuous distribution is as much a change in how organs are allocated as it is a change in how organ allocation policies are developed. The OPTN is transitioning all organ allocation systems to this new framework.SummaryThe OPTN changed its policy development process to distinguish ...
Source: Current Transplantation Reports - January 23, 2024 Category: Transplant Surgery Source Type: research
Outcomes of Entecavir Prophylaxis in Hepatitis B Immune Patients Receiving Hepatitis B Infected Kidneys: A Single Center Experience
AbstractPurpose of ReviewHepatitis B (HBV) vaccinated patients have mixed responses with regard to antibody titers and subsequent level of immunity. This review aims to examine the diverse strategies employed by transplant centers for infection prevention when utilizing HBV-infected kidneys, including our own center ’s practice.Recent FindingsTransplant centers have implemented varied prophylaxis approaches based on recipients ’ anti-HB titers for utilizing HBV-infected kidneys. We retrospectively reviewed ten recipients who received kidneys from HBV-positive donors at our center. Recipients with anti-HBs titers above ...
Source: Current Transplantation Reports - January 10, 2024 Category: Transplant Surgery Source Type: research
Have a Heart: Tie It Off — Update on Recommendations Regarding Vascular Access Ligation After Successful Renal Transplant
AbstractPurpose of ReviewArteriovenous fistulas (AVF) are invaluable for patients undergoing hemodialysis (HD), but for patients with a functioning kidney transplant (KT), the complications and negative physiologic effects potentially outweigh the benefit. Following successful KT, surveillance of complications of HD access is limited and the true incidence is unknown.Recent FindingsMultiple authors have demonstrated that fistula ligation results in decreased left ventricular mass and cardiac output without increased creatinine. Additional literature has shown improvement of symptoms of right heart failure. Current research...
Source: Current Transplantation Reports - December 13, 2023 Category: Transplant Surgery Source Type: research
Innate Immune Responses in Transplant Immunity
AbstractPurpose of ReviewDespite a significant decrease in the rate of acute rejection, long-term solid organ allotransplant success is limited by chronic rejection. Transplant research has historically focused on adaptive immune responses. However, there is a growing appreciation that the innate immune system is a potential contributor to short- and long-term graft injuries. We seek to provide an overview of the current literature on innate immunity in transplantation, discussing both innate na ïve and memory immune responses, mechanisms by which innate cells recognize allogeneic signals, specific subsets of innate cells...
Source: Current Transplantation Reports - November 27, 2023 Category: Transplant Surgery Source Type: research
Outcomes, Attitudes, and Updated Ethical Analysis of Early Liver Transplantation for Severe Alcoholic Hepatitis
Discussions of post-transplant sobriety are becoming more nuanced, with not all alcohol use being seen as equally problematic. Nevertheless, there continues to be controversy around ELT.SummaryData continues to show that the 6-month rule does not further the goal of promoting patient and graft survival. Instead, it perpetuates stigma toward those who consume alcohol and inappropriately singles out ALD as morally exceptional. Further work in transplant should focus on promoting the health and well-being of all transplant patients, including those who consume alcohol, supporting the transplant teams who take on this responsi...
Source: Current Transplantation Reports - November 24, 2023 Category: Transplant Surgery Source Type: research
