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

Clinical Genetic Testing in Kidney Disease and Transplantation: Logistical, Ethical, Legal, and Social Considerations
AbstractPurpose of ReviewThe role of genetics in renal disorders is being increasingly recognized, prompting the need to describe and address barriers to meaningful implementation of genetic testing in clinical care.Recent FindingsThe rapid expansion in accessibility and decreased cost of sequencing technologies has prompted increased identification of monogenic contributors to kidney disease and demonstration of the high yield of genetic testing in renal cohorts. Genetic testing in kidney disease and transplantation offers meaningful applications, including those relating to diagnosis, prognosis, management, and implicati...
Source: Current Transplantation Reports - November 23, 2023 Category: Transplant Surgery Source Type: research

Approaches to Mitigate Longer Cold Ischemic Times and Increased Rates of Delayed Graft Function Associated With the Revised Kidney Allocation System
AbstractPurpose of ReviewA new geographic distance-based allocation system was unveiled across the USA in 2021 to increase the efficiency and equity of kidney transplant allocations. Modeled after a similar change to the allocation system for lung transplants in 2017, the Organ Procurement and Transplantation Network utilized rigorous methods and statistical modeling to devise a system that would not only increase transplant rates but also improve access for marginalized groups.Recent FindingsNow, approximately 2  years post-implementation, the new allocation system has proven to significantly increase access to transplan...
Source: Current Transplantation Reports - November 18, 2023 Category: Transplant Surgery Source Type: research

Statistical Confounding in Observational Research and Center Performance Evaluations in Organ Transplantation
AbstractPurpose of ReviewTo describe statistical confounding and the impact of observational research in transplantation. Further, to evaluate potential confounding factors that are common in transplant research with particular focus on the impact on evaluating transplant center performance.Recent FindingsThere are numerous studies documenting evidence of factors that impact outcomes of transplant patients that are not consistently available for risk adjustment in observational transplant research studies. These factors may vary between patient groups and transplant centers and as such, potential confounders affected accur...
Source: Current Transplantation Reports - November 15, 2023 Category: Transplant Surgery Source Type: research

Designing the Ideal Transplant Surgery Fellowship
AbstractPurpose of ReviewThe purpose of this review is to summarize the current literature on abdominal transplant surgery fellowship training and to describe the characteristics of an ideal transplant surgery fellowship.Recent FindingsThere is a growing body of literature on how fellows develop technical competency during training. Autonomy is a key factor in the development of competency. The use of competency-based evaluations is one promising strategy for more accurate evaluation of a fellow ’s readiness to practice independently. We also review the evidence on well-being during fellowship and discuss ways to improve...
Source: Current Transplantation Reports - November 11, 2023 Category: Transplant Surgery Source Type: research

Incorporating Translational Data into Immunosuppression Decisions During COVID-19
AbstractPurpose of ReviewCOVID-19 outcomes are worse in solid organ transplant recipients. How to manage immunosuppressants in transplant recipients is not well studied. Incorporating translational data can aid in making immunosuppression decisions.Recent FindingsBoth the adaptive and innate immune system play a role in SARS CoV2 clearance and mortality, while a dysregulated innate immune system can lead to cytokine storm and poor outcomes.SummaryThis review focuses on the immunology of COVID-19, including early mild disease to severe COVID-19, including cytokine storm and death. It summarizes the mechanisms of transplant ...
Source: Current Transplantation Reports - November 7, 2023 Category: Transplant Surgery Source Type: research

Defiance of Occam ’s Razor: Recent Changes in US Kidney Allocation and Impact on Efficiency and Marginal Kidney Outcomes
AbstractPurpose of ReviewRecent changes in US kidney allocation policy have created concerns regarding negative effects on allocation efficiency secondary to increasing complexity. The purpose of this review is to examine available data on the impact of circle-based allocation policies on kidney transplant outcomes and lessons learned following similar changes in liver allocation.Recent FindingsChanges to circle-based allocation policy have exponentially increased organ offer burden and negatively influenced cold ischemia times (CIT) and travel logistics. For liver allocation, which proceeded kidney allocation changes, the...
Source: Current Transplantation Reports - October 11, 2023 Category: Transplant Surgery Source Type: research

Exosomes as Modulators and Biomarkers of Transplant Immunity
AbstractPurpose of ReviewExosomes have garnered increasing interest due to their involvement in a wide array of biological processes, including immunity and regeneration. In this review, we outline our current understanding of the role of exosomes in modulating transplant immune responses and as biomarkers of allograft function or rejection.Recent FindingsThe exosomal effect on post-transplant immunity is heterogeneous and context dependent. They are critical for priming anti-donor T cell immunity via semi-direct presentation but have also been shown to promote tolerance to graft-expressed non-inherited maternal antigens. ...
Source: Current Transplantation Reports - October 4, 2023 Category: Transplant Surgery Source Type: research