Intestinal Bioengineering.
Authors: Dunn JCY
Abstract
This review summarizes bioengineering innovations in the treatment of patients with short bowel syndrome. Bioengineering approaches aim to increase the overall intestinal tissue mass. While the morphology of the intestine is clearly altered by these interventions, it remains to be shown that the overall function of the intestine is improved. Continued innovations will likely bring about new therapeutic options for patients with short bowel syndrome. Careful evaluations of the impact of these interventions await controlled clinical trials.
PMID: 28564517 [PubMed - in proce...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Long-term Outcomes in Intestinal Rehabilitation in Children.
Authors: Wendel D, Horslen SP
Abstract
Long-term outcomes for pediatric patients with intestinal failure have significantly improved with advances in management of parenteral nutrition and the associated comorbidities. These changes have been driven by the development of multidisciplinary intestinal rehabilitation teams. Overall survival and transplant-free survival rates have increased while the introduction of new management strategies has decreased complications such as central line infections and intestinal failure associated liver disease. Factors have been identified that aid in prediction of duratio...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Donor-Specific HLA Antibodies: A Review of Data Published in 2016.
Authors: Idica A, Everly MJ
Abstract
The results from continued research regarding the role of anti-human leukocyte antigen (anti-HLA) antibodies and donor-specific antibodies (DSA) in transplantation has strengthened the association between DSA and allograft rejection. The formation of de novo DSAs is particularly detrimental to allograft function and survival. Paradoxically, grafts of patients without DSA may fail and patients with DSA may continue to have extended post-transplant graft function. An explanation for this inconsistency in outcomes must be found to utilize anti-HLA DSA as a biomarker of all...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Cytokines as Biomarkers for Renal Transplant Recipients: What is New?
Authors: Kawakita S, Everly MJ
Abstract
Poor long-term graft survival remains a major problem in the field of organ transplantation. This could be attributed at least in part, to the lack of reliable biomarkers that allow for accurate, noninvasive monitoring of graft status and individualized immunosuppressive therapy. To this end, cytokines and chemokines have been investigated in a number of studies to evaluate their potential to serve as diagnostic and prognostic markers for kidney transplantation. Based on our review of recent publications, urinary chemokine C-C motif ligand 2, chemokine C-XC motif lig...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
The Clinical Impact of Non-HLA Antibodies in Solid Organ Transplantation.
Authors: Freischlag K, Pearl MH, Chambers ET
Abstract
Antibody-mediated rejection in solid organ transplantation is associated with significant organ dysfunction and allograft loss. Donor-specific antibodies against human leukocyte antigens (HLAs) have been a major focus for research, clinical testing, and therapies. Recently, non-HLA autoantibodies to various endothelial antigens including angiotensin II type 1 receptor, endothelin-1 type A receptor, Major Histocompatibility Complex Class 1-Related Chain A, perlecan, and collagen V are emerging as both potential mediators of allograft dysfunction and targ...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Non-HLA Antibodies in Clinical Transplantation.
Authors: Chan-On C, Sarwal M
Abstract
Organ transplantation overcomes conservative therapy to improve patient longevity. Despite the improvement of donor-recipient compatibility tests and intensified immunosuppressive agents, long-term graft survival remains poor because of acute and chronic injury driven by immunologic and non-immunologic factors. The significant immunological barrier for graft longevity is antibody-mediated rejection. Antibodies reactive to donor-specific human leukocyte antigens (HLA) have been shown to have adverse effects on the transplanted organ. However, there is minimal or controv...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
HLA Epitopes - Are We Ready for Clinical Prime Time? Historic Perspective and Future Needs.
Authors: Dvorai RH, Pinelli DF, Tambur AR
Abstract
A significant barrier to long-term transplant success is the development of de novo donor-specific human leukocyte antigen (HLA) antibodies. The best approach to minimize the risk of developing such antibodies is an HLA identical transplant, but the likelihood of finding such an organ is very low. The alternative is to identify "permissible mismatches" - HLA antigen mismatches that are less likely to induce an immune response. In the past few years, it has become clear that matching at the "epitope level" is the likely solution; however, we are still strug...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
HLA Epitopes and Shared Molecular Eplet Characterization and Their Implication on Transplant Outcome: The Experience of One Center.
We report three interesting cases concerning antibody-mediated rejection (AMR), associated or not with anti-donor-specific antibodies, and detection of implicated molecular epitopes. The first report presents a case of intra-allele sensitization. The second case presents an interesting case concerning Luminex mean fluorescence intensity (MFI) levels considered to be low risk antibodies (<1000), but producing AMR. The third case occurred after a second kidney transplantation mediated by antibodies directed against HLA-C antigens (MFI<1000) in the previous transplantation (which was considered to be an indicator of low...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Acute Rejection, Kidney Allograft Function, and Graft Survival in Patients with Circulating Pre-Transplant IgG Antibodies Directed Against Donor HLA-A, -B, or -C Locus Determined Antigens.
Authors: Abuhelaiqa E, Friedlander R, Aull M, Putheti P, Sharma V, Suthanthiran M, Dadhania D
Abstract
The relationship between circulating pre-transplant immunoglobulin G (IgG) antibodies to donor human leukocyte antigen (HLA) -C locus determined antigens alone and acute rejection, kidney allograft function, and graft survival is not fully defined. Also, the impact of circulating pre-transplant IgG antibodies to donor HLA-C locus antigens alone on these outcomes has not been compared with the impact of circulating pre-transplant IgG antibodies to donor HLA-A or -B locus antigens. We conducted a retrospect...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Pre-empting Antibody-Mediated Rejection: A Program of DSA Monitoring and Treatment Can Effectively Prevent Antibody Mediated Rejection.
In conclusion, a program of universal risk-stratified DSA testing in kidney transplant patients can dramatically reduce rates of AMR and virtually eliminate graft loss due to AMR.
PMID: 28564526 [PubMed - in process] (Source: Clinical Transplants)
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Incidence and Factors Associated with De Novo DSA After BK Viremia in Renal Transplant Recipients.
In conclusion, despite being considered a result of over-immunosuppression, BKV can still be followed by dnDSA in a substantial proportion of patients. Monitoring for dnDSA in patients being managed for BKV may be warranted.
PMID: 28564527 [PubMed - in process] (Source: Clinical Transplants)
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Late Antibody-Mediated Rejection in Kidney Transplant Recipients: Outcomes after Intravenous Immunoglobulin Therapy.
Authors: Agarwal G, Diskin CD, Williams TA, Kumar V
Abstract
Development of acute antibody-mediated rejection (AMR) is associated with graft loss and can occur both early (<3 months) and late (>3 months) post-transplant. Treatment and prognosis differ in early and late AMR. Herein, we present a single-center experience using high-dose intravenous immunoglobulin (IVIg) (2g/kg) for the treatment of late AMR. All kidney recipients with negative T- and B-cell flow crossmatch at transplant and biopsy-proven late AMR were included (2009-2013, n=126). All patients were treated with IVIg at 2g/kg over divide...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Outcomes in Simultaneous Liver Kidney Transplants in the Setting of a Positive Crossmatch: A Single Center Experience.
In conclusion, in patients with very strongly +FCXM with high MFI DSA, proceeding with the transplantation leads to poor outcomes.
PMID: 28564529 [PubMed - in process] (Source: Clinical Transplants)
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
C1q Donor-Specific Antibody Associates with Post-transplant Biopsy Findings in Highly- Sensitized Kidney Transplant Recipients.
Authors: Kuppachi S, Holanda D, Gallegos S, Field EH
Abstract
Donor-specific anti-human leukocyte antigen antibodies (DSA) are associated with antibody-mediated rejection (AMR) in kidney transplantation, but the spectrum of graft injury seen in patients with DSA ranges from no damage to florid rejection. Since immunoglobulin G (IgG) antibodies with cytotoxic potential can be distinguished by their binding complement fraction C1q, the level of C1q-binding IgG (C1q+) DSA may be useful for stratifying risk or diagnosing AMR. We therefore investigated the value of IgG and C1q+ DSA in predicting pathologic feat...
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Acute Rejection in 6-Antigen HLA-Matched Kidney Transplant Recipients: Risk Factors and Outcomes from the Wisconsin Allograft Recipient Database (WisARD).
In conclusion, acute cellular and antibody-mediated rejection are infrequent in HLA-matched kidney transplant recipients. Nonadherence appears to be relatively common among those experiencing rejection. Acute rejection was not associated with higher graft loss or death. The pathogenesis of acute rejection in HLA-matched recipients remains to be determined.
PMID: 28564531 [PubMed - in process] (Source: Clinical Transplants)
Source: Clinical Transplants - June 2, 2017 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
