Rabbit antithymocyte globulin and donor-specific antibodies in kidney transplantation – a review
The mode of action of rabbit antithymocyte globulin (rATG) includes preferential inhibition of pre-existing donor-reactive memory T-cell reconstitution and possibly apoptosis of plasma cells, the source of donor specific antibodies (DSA). In kidney transplant patients with low-strength preformed DSA, non-comparative data have shown a low incidence of antibody-mediated rejection (ABMR) and graft survival using rATG even without desensitization procedures. For high strengths of preformed DSA, rATG induction with more aggressive desensitization appears effective, with mixed results concerning the addition of B-cell specific a...
Source: Transplantation Reviews - February 18, 2016 Category: Transplant Surgery Authors: Julio Pascual, Andreas Zuckermann, Arjang Djamali, Alexandre Hertig, Maarten Naesens Source Type: research
Current state of clinical end-points assessment in transplant: key points
Solid organ transplantation is the treatment of choice for patients with end-stage organ disease. However, organ transplantation can stress the cardiovascular system and decrease immune surveillance, leading to early mortality and graft loss due to multiple underlying comorbidities. Clinical end-points in transplant include death and graft failure. Thus, generating accurate predictive models through regression models is crucial to test for definitive clinical post-transplantation end-points. Survival predictive models should assemble efficient surrogate markers or prognostic factors to generate a minimal set of variables d...
Source: Transplantation Reviews - February 18, 2016 Category: Transplant Surgery Authors: Domingo Hernández, Alfonso Muriel, Víctor Abraira Source Type: research
Immunological risk assessment: The key to individualized immunosuppression after kidney transplantation
The wide range of immunosuppressive therapies and protocols permits tailored planning of the initial regimen according to the immunological risk status of individual patients. Pre-transplant risk assessment can include many factors, but there is no clear consensus on which parameters to take into account, and their relative importance. In general younger patients are known to be at higher risk for acute rejection, compounded by higher rates of non-adherence in adolescents. Donor age and recipient gender do not appear to exert a meaningful effect on risk of rejection per se, but black recipient ethnicity remains a well-esta...
Source: Transplantation Reviews - February 18, 2016 Category: Transplant Surgery Authors: Johann Pratschke, Duska Dragun, Ingeborg A. Hauser, Sabine Horn, Thomas F. Mueller, Peter Schemmer, Friedrich Thaiss Source Type: research
Modulation of Human Allogeneic and Syngeneic Pluripotent Stem Cells and Immunological Implications for Transplantation
Tissues derived from induced pluripotent stem cells (iPSCs) are a promising source of cells for building various regenerative medicine therapies; from simply transplanting cells to reseeding decellularized organs to reconstructing multicellular tissues. Although reprogramming strategies for producing iPSCs have improved, the clinical use of iPSCs is limited by the presence of unique human leukocyte antigen (HLA) genes, the main immunologic barrier to transplantation. In order to overcome the immunological hurdles associated with allogeneic tissues and organs, the generation of patient-histocompatible iPSCs (autologous or H...
Source: Transplantation Reviews - February 10, 2016 Category: Transplant Surgery Authors: S.D. Sackett, M.E. Brown, D.M. Tremmel, T. Ellis, W.J. Burlingham, J.S. Odorico Source Type: research
A commercial transplant network's perspective of value in solid organ transplantation: Strategizing for value in transplant care
Solid organ transplantation has been an area of great interest to commercial payers ever since it moved into mainstream medical care beginning in the 1980's. Over the years a system of evaluating transplant program performance based on volume and one year graft and patient survival has developed. While this system has served its purpose, there is an increasing realization from payers that a need exists for a more sophisticated way to evaluate quality and cost-effectiveness of these complex procedures. (Source: Transplantation Reviews)
Source: Transplantation Reviews - January 8, 2016 Category: Transplant Surgery Authors: Frank D. Irwin, Charlotte Wu, Wade M. Bannister, Anthony F. Bonagura, Bart Laihinen, David A. Axelrod, Mark A. Schnitzler Source Type: research
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Source: Transplantation Reviews - December 18, 2015 Category: Transplant Surgery Source Type: research
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Source: Transplantation Reviews - December 18, 2015 Category: Transplant Surgery Source Type: research
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Source: Transplantation Reviews - December 18, 2015 Category: Transplant Surgery Source Type: research
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Source: Transplantation Reviews - December 18, 2015 Category: Transplant Surgery Source Type: research
Maximizing the benefit of liver transplantation: Implications for organ allocation and clinical practice
Benefit in medicine refers to the incremental gain in health status derived from a medical intervention. It can be conceptualized as follows:where Hw denotes health status with treatment, and Hwo denotes health status without treatment. In other words, benefit combines both need and outcome. “Health status” can be broadly divided into two categories: quality of life and quantity of life. Therefore, “beneficial” medical interventions are those which improve quality or quantity of life (or both). Value is simply Benefit*Cost, so medical interventions that create significant benefit at low cost are termed “high valu...
Source: Transplantation Reviews - December 18, 2015 Category: Transplant Surgery Authors: Michael L. Volk Source Type: research
Intestinal Transplantation: The Anesthesia Perspective
Intestinal transplantation is a complex and challenging surgery. It is very effective for treating intestinal failure, especially for those patients who cannot tolerate parenteral nutrition or have extensive abdominal disease. Chronic parental nutrition can induce intestinal failure associated liver disease (IFALD). According to United Network for Organ Sharing (UNOS) data, children with intestinal failure affected by liver disease secondary to parenteral nutrition have the highest mortality on a waiting list when compared with all candidates for solid organ transplantation. (Source: Transplantation Reviews)
Source: Transplantation Reviews - November 13, 2015 Category: Transplant Surgery Authors: Aparna Dalal Source Type: research
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Source: Transplantation Reviews - October 1, 2015 Category: Transplant Surgery Source Type: research
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Source: Transplantation Reviews - October 1, 2015 Category: Transplant Surgery Source Type: research
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Source: Transplantation Reviews - October 1, 2015 Category: Transplant Surgery Source Type: research
