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Current Opinion in Organ Transplantation Aug 2020Machine learning techniques play an important role in organ transplantation. Analysing the main tasks for which they are being applied, together with the advantages and... (Review)
Review
PURPOSE OF REVIEW
Machine learning techniques play an important role in organ transplantation. Analysing the main tasks for which they are being applied, together with the advantages and disadvantages of their use, can be of crucial interest for clinical practitioners.
RECENT FINDINGS
In the last 10 years, there has been an explosion of interest in the application of machine-learning techniques to organ transplantation. Several approaches have been proposed in the literature aiming to find universal models by considering multicenter cohorts or from different countries. Moreover, recently, deep learning has also been applied demonstrating a notable ability when dealing with a vast amount of information.
SUMMARY
Organ transplantation can benefit from machine learning in such a way to improve the current procedures for donor--recipient matching or to improve standard scores. However, a correct preprocessing is needed to provide consistent and high quality databases for machine-learning algorithms, aiming to robust and fair approaches to support expert decision-making systems.
Topics: Donor Selection; Humans; Machine Learning; Organ Transplantation; Tissue Donors; Tissue and Organ Procurement
PubMed: 32618714
DOI: 10.1097/MOT.0000000000000774 -
Transplant International : Official... Nov 2014Recipient's iron status is an important determinant of clinical outcome in transplantation medicine. This review addresses iron metabolism in solid organ... (Review)
Review
Recipient's iron status is an important determinant of clinical outcome in transplantation medicine. This review addresses iron metabolism in solid organ transplantation, where the role of iron as a mediator of ischemia-reperfusion injury, as an immune-modulatory element, and as a determinant of organ and graft function is discussed. Although iron chelators reduce ischemia-reperfusion injury in cell and animal models, these benefits have not yet been implemented into clinical practice. Iron deficiency and iron overload are associated with reduced immune activation, whose molecular mechanisms are reviewed in detail. Furthermore, iron overload and hyperferritinemia are associated with poor prognosis in end-stage organ failure in patients awaiting kidney, or liver transplantation. This negative prognostic impact of iron overload appears to persist after transplantation, which highlights the need for optimizing iron management before and after solid organ transplantation. In contrast, iron deficiency and anemia are also associated with poor prognosis in patients with end-stage heart failure. Intravenous iron supplementation should be managed carefully because parenterally induced iron overload could persist after successful transplantation. In conclusion, current evidence shows that iron overload and iron deficiency are important risk factors before and after solid organ transplantation. Iron status should therefore be actively managed in patients on the waiting list and after transplantation.
Topics: Allografts; Animals; Heart Transplantation; Humans; Iron; Iron Chelating Agents; Kidney Transplantation; Liver Transplantation; Lung Transplantation; Lymphocyte Activation; Organ Preservation; Organ Transplantation; Prognosis; T-Lymphocytes; Tissue and Organ Procurement; Transplantation Immunology
PubMed: 24964028
DOI: 10.1111/tri.12374 -
Current Opinion in Organ Transplantation Aug 2020Classifiers based on artificial intelligence have emerged in all areas of medicine. Although very subtle, many decisions in organ transplantation can now be addressed in... (Review)
Review
PURPOSE OF REVIEW
Classifiers based on artificial intelligence have emerged in all areas of medicine. Although very subtle, many decisions in organ transplantation can now be addressed in a more concisely manner with the support of these classifiers.
RECENT FINDINGS
Any aspect of organ transplantation (image processing, prediction of results, diagnostic proposals, therapeutic algorithms or precision treatments) consists of a set of input variables and a set of output variables. Artificial intelligence classifiers differ in the way they establish relationships between the input variables, how they select the data groups to train patterns and how they are able to predict the possible options of the output variables. There are hundreds of classifiers to achieve this goal. The most appropriate classifiers to address the different aspects of organ transplantation are Artificial Neural Networks, Decision Tree classifiers, Random Forest, and Naïve Bayes classification models. There are hundreds of examples of the usefulness of artificial intelligence in organ transplantation, especially in image processing, organ allocation, D-R matching, precision pathology, real-time immunosuppression, transplant oncology, and predictive analysis.
SUMMARY
In the coming years, clinical transplant experts will increasingly use Deep Learning-based models to support their decisions, specially in those cases where subjectivity is common.
Topics: Artificial Intelligence; Bayes Theorem; Humans; Neural Networks, Computer; Organ Transplantation
PubMed: 32487888
DOI: 10.1097/MOT.0000000000000775 -
Acta Biochimica Polonica 2018Organ injury during ischemia is one of the clinical problems of today's transplantation. It occurs during warm ischemia time (WIT) when the blood flow is cut off and... (Review)
Review
Organ injury during ischemia is one of the clinical problems of today's transplantation. It occurs during warm ischemia time (WIT) when the blood flow is cut off and during cold ischemia when a graft is chilled in situ until the circulation is restored to the recipient organism. Fast cooling of the organ slows down metabolism and activates intracellular enzymes, which minimizes the effects of warm ischemia. Unfortunately, hypothermia also results in inhibition of ATP synthesis, cell swelling and intracellular acidity. That is why research is continually being conducted to develop new fluids for rinsing and storing organs, as well as to optimize the composition of those that are already in use, which will allow for longer and more effective graft storage and restoration of their optimal functions after transplantation. This article provides current information on rinsing and storage fluids available on the global market. It also discusses tips for the fluid modifications with hormones and micronutrients.
Topics: Humans; Organ Preservation Solutions; Organ Transplantation; Reperfusion Injury; Temperature
PubMed: 29352749
DOI: 10.18388/abp.2017_2312 -
Transplant International : Official... 2024
Topics: Humans; Tissue and Organ Procurement; Organ Transplantation; Tissue Donors
PubMed: 38655205
DOI: 10.3389/ti.2024.13011 -
Pediatric Transplantation May 2023Organ transplantation is limited by access to suitable organs. Infant recipient waitlist mortality is increased due to the scarcity of size-matched organs. Neonatal... (Review)
Review
Organ transplantation is limited by access to suitable organs. Infant recipient waitlist mortality is increased due to the scarcity of size-matched organs. Neonatal organ donors have been proposed as an underutilized source of donor organs. However, the literature on the actual prevalence and outcome of neonatal organ donation and transplantation is fragmented and not well analyzed. This literature review aims to summarize the available literature on the potential of neonatal organ donation and to analyze published cases of neonatal organ transplantation. A systematic search of the Medline and Cochrane databases yielded 2964 articles, which were screened for eligibility. In total, 86 articles were considered eligible, of which 34 were included in the literature review: 8 articles describing the potential of neonatal organ donation programs, and 26 articles describing clinical transplantation. Current evidence suggests there is a large pool of potential neonatal organ donors. In contrast, the literature on neonatal organ donor utilization is sparse. However, case series of successful kidney, heart, liver, hepatocyte, and multivisceral transplantation using organs from neonatal donors are summarized. Although good posttransplant organ function was achieved, the use of neonatal organs is associated with increased risk of thrombosis in both kidney and liver transplantation. Neonatal organ donation is a promising alternative for expanding the current donor pool. Experience is limited, but reported patient and graft survival are acceptable and more research on the subject is warranted.
Topics: Infant; Infant, Newborn; Humans; Organ Transplantation; Tissue and Organ Procurement; Tissue Donors; Liver Transplantation; Kidney
PubMed: 36792069
DOI: 10.1111/petr.14486 -
Clinics in Liver Disease Aug 2014Intestinal transplantation is the definitive therapy for patients with irreversible intestinal failure and can be combined with transplantation of other abdominal... (Review)
Review
Intestinal transplantation is the definitive therapy for patients with irreversible intestinal failure and can be combined with transplantation of other abdominal organs, such as stomach, spleen, and pancreas with or without liver. There is an increasing trend in the volume of intestinal and multivisceral transplantation in the past few decades and there is also increasing trend in patient and graft survival primarily due to improved patient selection, advances in immunosuppression, and improved perioperative management. This review summarizes the various key elements in patient selection, types of grafts, and updates in the perioperative management involved in multivisceral transplantation.
Topics: Contraindications; Cytomegalovirus Infections; Graft Rejection; Graft vs Host Disease; Humans; Immunosuppression Therapy; Intestinal Diseases; Intestines; Liver Transplantation; Lymphoproliferative Disorders; Organ Transplantation; Pancreas Transplantation; Patient Selection; Stomach
PubMed: 25017082
DOI: 10.1016/j.cld.2014.05.008 -
Seminars in Cardiothoracic and Vascular... Jun 2020In the year 2019, we identified and screened over 400 peer-reviewed publications on pancreatic transplantation, over 200 on intestinal transplantation, and over 1900 on... (Review)
Review
In the year 2019, we identified and screened over 400 peer-reviewed publications on pancreatic transplantation, over 200 on intestinal transplantation, and over 1900 on kidney transplantation. The liver transplantation section focuses on and features selected articles among 70 clinical trials published in 2019. This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We explore a broad range of topics, including risks for and prediction of perioperative complications, updated indications for transplantation, recommendations on perioperative management, including Enhanced Recovery After Surgery programs, and topics relevant to optimization of patient and graft outcomes and survival.
Topics: Enhanced Recovery After Surgery; Fluid Therapy; Graft Survival; Humans; Intestines; Kidney Transplantation; Liver Transplantation; Organ Transplantation; Pain Management; Pancreas Transplantation; Tissue Donors
PubMed: 32342763
DOI: 10.1177/1089253220920497 -
Arquivos de Neuro-psiquiatria Oct 2017Solid organ transplantation is a significant development in the treatment of chronic kidney, liver, heart and lung diseases. This therapeutic approach has increased... (Review)
Review
Solid organ transplantation is a significant development in the treatment of chronic kidney, liver, heart and lung diseases. This therapeutic approach has increased patient survival and improved quality of life. New surgical techniques and immunosuppressive drugs have been developed to achieve better outcomes. However, the variety of neurological complications following solid organ transplantation is broad and carries prognostic significance. Patients may have involvement of the central or peripheral nervous system due to multiple causes that can vary depending on time of onset after the surgical procedure, the transplanted organ, and the intensity and type of immunosuppressive therapy. Neurological manifestations following solid organ transplantation pose a diagnostic challenge to medical specialists despite extensive investigation. This review aimed to provide a practical approach to help neurologists and clinicians assess and manage solid organ transplant patients presenting with acute or chronic neurological manifestations.
Topics: Humans; Nervous System Diseases; Organ Transplantation
PubMed: 29166466
DOI: 10.1590/0004-282X20170132 -
Transplantation Jul 2019
Topics: Diffusion of Innovation; Government Regulation; History, 20th Century; History, 21st Century; Humans; Lithuania; Organ Transplantation; Policy Making; Tissue and Organ Procurement
PubMed: 31241549
DOI: 10.1097/TP.0000000000002575