Immune responses to self-antigens (autoimmunity) in allograft rejection.
Authors: Ramachandran S, Subramanian V, Mohanakumar T
Abstract
Many lung, heart, and kidney transplant recipients with clinically as well as pathologically diagnosed chronic rejection don't have detectable antibodies directed to the mismatched donor HLA in their sera. This has led to the hypothesis that antibody responses to other tissue-restricted antigens may contribute to the development of chronic rejection. Development of immune responses to self-antigens has been described following all solid organ transplantations. Studies have further presented evidence for a significant cross talk between the allo...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Understanding trends and predictors of outcome in elderly renal transplant recipients: an analysis of the UNOS registry.
This report aims to give an actual overview of outcomes in deceased donor transplantation of advanced age recipients, by comparing graft and patient survival of transplants recorded in the United Network for Organ Sharing registry from 2000 to 2012, between three age groups: 70-84, 50-69, and 35-49 years of age. Subsequently, risk factors for graft failure and death were analyzed for elderly (70-84 years) recipients and their mortality compared to young (35-49 years) recipients. Elderly recipients showed higher death-censored graft survival and lower patient survival (log-rank p<0.001). Graft failure was highly associat...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Donor risk factors in orthotopic liver transplant: analysis of the OPTN/UNOS registry.
This study of the United Network for Organ Sharing registry data analyzed reputed donor factors using the post-MELD data and evaluated them further in HCV positive and HCV negative recipients with hepatic cirrhosis to develop a modified DRI (mDRI). We found that HCV negative cirrhotic recipients have generally higher tolerance against inferior qualities of donors than HCV positive cirrhotic patients. In addition, the results revealed the post-MELD prognostic factors that should be considered in the donor procurement processes. The group of "all recipients" and the subset of HCV positive cirrhotic recipients showed a simila...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Causes of graft failure in simultaneous pancreas-kidney transplantation by various time periods.
Authors: Wakil K, Sugawara Y, Kokudo N, Kadowaki T
Abstract
Data collected by the United Network for Organ Sharing from all approved United States transplant programs was analyzed. The data included 26,572 adult diabetic patients who received a primary pancreas transplant between January 1987 and December 2012. Simultaneous pancreas-kidney (SPK) transplantation was the major therapeutic option for diabetes patients. SPK had better graft survival than pancreas transplant alone (PTA) or pancreas-after-kidney (PAK) or pancreas-with-kidney (from a living donor, PWK). The 5-year pancreas graft survival rates fo...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Heart transplantation in an aging society: an analysis of 25 years of the OPTN/UNOS registry.
Authors: Hörmann M, Everly MJ
Abstract
The annual number of adult heart transplantations in the United States is still low due to a lack of donor organs. Median long-term survival has been improved by about 1.7 years over the last 12 years. The aging of society is reflected in the United Network for Organ Sharing data, with more patients older than 70 years old receiving cardiac transplantation. The rate of acute rejection is higher in the group of younger patients, whereas older patients suffer from renal failure. They die more often from infection and malignancies, most likely due to immunosuppression. ...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Kidney failure requiring kidney transplantation after pancreas transplant alone.
In conclusion, KF/KT after PTA was not uncommon (9.7% at 5 years), and prospective PTA recipients should be aware of the risks of kidney failure after transplantation.
PMID: 25095491 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Report from the Japan Registry of Pancreas Transplantation (2000-2012): outcomes of pancreas transplantation from marginal donors.
Authors: Ito T, Gotoh M
Abstract
One hundred forty-eight pancreas transplants [119 simultaneous pancreas and kidney transplantations (SPK), 20 pancreas after kidney transplantations, 9 pancreas transplants alone] from deceased donors were performed in Japan during the period from 2000 to 2012. According to Kapur's criteria, 108 out of 148 (73.0%) cases involved marginal donors. Of importance, when total cold ischemic time was more than 12 hours, early pancreas graft loss (first 3 months posttransplantation) significantly increased. Other donor-related risk factors such as donor age, obesity, cause of death...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
2013 annual literature review of donor-specific HLA antibodies after organ transplantation.
Authors: Kaneku H
Abstract
1. There is still a need to better differentiate clinically relevant from irrelevant DSA in all organs. Modified bead assay testing for different immunoglobulin (Ig) G characteristics (Clq-fixing DSA, C4d-fixing DSA, IgG subclasses, or IgM) often improve the predictive value for rejection and failure compared to standard IgG DSA. A new approach looking for intragraft DSA instead of serum DSA represents a very interesting attempt. The relevance of DSA may not solely be determined by antibody characteristics, but may be in the capacity of an antibody to bind specific antigens on th...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Progress and outcomes of the first high-volume pediatric liver transplantation program in Saudi Arabia.
Authors: Fayyad A, Shagrani M, AlGoufi T, ElSheikh Y, Murray J, Elgohary A, AlSebayel M, Burdelski M, Broering DC
Abstract
In 2010, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, established a dedicated Organ Transplant Center to overcome the inadequacy in transplantation care in the region. Due to the high need for solid organ transplantation in children, this center focused on pediatric transplantation. Between 2011 and 2013, a total of 112 pediatric liver transplantations have been performed in our center, mostly from living donors (n=103, 92%). Eight percent of transplants w...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Excellent outcomes with expanded criteria donor kidneys: the role of the recipient's age.
Authors: Serur D, Kapur S, Saal S, Leeser D, Gerber LM, Wang J, Hartono C, Lee J, Dadhania D, Kim K, Muthukumar T, Lee J, Seshan S, Chiu YL, Levine D, Parker T, Riggio R, Smith B, Cheigh J
Abstract
At the present time, the number of deceased donor kidney transplants performed annually has remained unchanged for 4 years. Desire for standard criteria donor (SCD) kidneys by recipients, coupled with high discard rates of donor kidneys, contributes to a lack of procedures being performed. A subgroup of recipients, those under age 50, may fare as well with an expanded criteria donor (ECD) allograft as those who ...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Reduction of HLA class I expression by ribonucleic acid interference mitigates allogenicity of human primary and Immortalized cells.
Authors: Lemp NA, Haga K, Hacke K, Treger JA, Bogan BT, Faure-Kumar E, Logg CR, Kruse CA, Cicciarelli JC, Kasahara N
Abstract
Unmatched human leukocyte antigens (HLA) expressed by allogeneic donor cells are the major target for immunological rejection. In order to reduce the immunogenicity of allograft cells, we have developed lentiviral vectors for delivery of short hairpin ribonucleic acid (shRNA) against Class I HLA. This approach was evaluated in both an established human embryonic kidney cell line and primary human CD34+ hematopoietic stem/progenitor cells. Target cells transduced with lentiviral vect...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Fifty years later.
Authors: Mangan TL, Benedetti KA, Starzl TE
Abstract
That concludes my remarks. If I have not made my purpose clear, let me summarize simply. I, like all others gathered here, have come to pay homage to Paul Terasaki, a man who bent in the winds of his time but never broke. Over the last 50 years, I have worked with many people. No collaboration has been dearer than that with Paul (Fig. 7).
PMID: 25095497 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Gene and stem cell therapy for diabetes.
Authors: Calne RY, Ghoneim MA, Lee KO, Uin GS
Abstract
Gene and stem cell therapy has been on the scientific agenda in many laboratories for more than 20 years. The literature is enormous, but practical applications have been few. Recently advances in stem cell biology and gene therapy are clarifying some of the issues. I have made a few observations concerning our own studies on bone marrow mesenchymal stem cells cultured to produce a small percentage of insulin-producing cells and human insulin gene engineered into Lenti and AA viruses. The aim of clinical application would still seem to be several years...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
Fifteen years later: main lessons from composite tissue allografts.
Authors: Dubernard JM, Sirigu A, Seulin C, Morelon E, Petruzzo P
Abstract
Composite tissue allografts (CTA) are also called "reconstructive transplantation" as they are a valid alternative approach to repairing complex tissue defects. These procedures are still considered "experimental" and their therapeutic value remains to be validated. An immunosuppressive treatment similar to that used in solid organ transplantation allows CTA survival and function despite a high rate of acute rejection (AR) episodes. Clinical experience seems to confirm that skin is the most antigenic tissue and the first target of AR...
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
HLA matching and kidney transplantation: beyond graft survival.
Authors: Opelz G, Döhler B
Abstract
Analysis of data from the international Collaborative Transplant Study has revealed striking relationships between human leukocyte antigen mismatching and graft survival, the incidence of death from cardiovascular disease or infection, the occurrence of non-Hodgkin lymphoma, and onset of post-transplant osteoporosis and bone fracture following kidney transplantation from a deceased donor.
PMID: 25095500 [PubMed - indexed for MEDLINE] (Source: Clinical Transplants)
Source: Clinical Transplants - November 20, 2015 Category: Transplant Surgery Tags: Clin Transpl Source Type: research
