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Transplantation Jun 2018Despite recent advances, cytomegalovirus (CMV) infections remain one of the most common complications affecting solid organ transplant recipients, conveying higher risks... (Review)
Review
Despite recent advances, cytomegalovirus (CMV) infections remain one of the most common complications affecting solid organ transplant recipients, conveying higher risks of complications, graft loss, morbidity, and mortality. Research in the field and development of prior consensus guidelines supported by The Transplantation Society has allowed a more standardized approach to CMV management. An international multidisciplinary panel of experts was convened to expand and revise evidence and expert opinion-based consensus guidelines on CMV management including prevention, treatment, diagnostics, immunology, drug resistance, and pediatric issues. Highlights include advances in molecular and immunologic diagnostics, improved understanding of diagnostic thresholds, optimized methods of prevention, advances in the use of novel antiviral therapies and certain immunosuppressive agents, and more savvy approaches to treatment resistant/refractory disease. The following report summarizes the updated recommendations.
Topics: Antiviral Agents; Consensus; Cytomegalovirus Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Opportunistic Infections; Organ Transplantation; Risk Factors; Treatment Outcome
PubMed: 29596116
DOI: 10.1097/TP.0000000000002191 -
Best Practice & Research. Clinical... 2021The innate and adaptive immune systems work as a complex interplay between different cell types, involving cytokines and chemokines mediating extracellular and paracrine... (Review)
Review
The innate and adaptive immune systems work as a complex interplay between different cell types, involving cytokines and chemokines mediating extracellular and paracrine effects. At the intracellular level, the inflammatory cascade is mediated by multifaceted processes that have been better described in the last 10 years. Immunosuppressive agents available in clinical practice act at different points of those cascades at the intracellular or extracellular level. Those drugs can mediate their effects on one or more cell types finally limiting inflammation and immune responses to antigens. Every immunosuppressive agent is characterized by intrinsic toxicity and side effects that may be due to the same therapeutic pathways or to off-target secondary effect of each molecule. We will here review the mechanisms of action of the most widely used immunosuppressive agents in the field of solid organ transplantation and autoimmune disorders, describing the mechanisms underlying both the therapeutic and secondary effects.
Topics: Autoimmune Diseases; Humans; Immune System; Immunosuppressive Agents; Organ Transplantation; Pharmaceutical Preparations
PubMed: 34874841
DOI: 10.1016/j.bpg.2021.101757 -
Nature Reviews. Nephrology Aug 2021Although overall donation and transplantation activity is higher in Europe than on other continents, differences between European countries in almost every aspect of... (Review)
Review
Although overall donation and transplantation activity is higher in Europe than on other continents, differences between European countries in almost every aspect of transplantation activity (for example, in the number of transplantations, the number of people with a functioning graft, in rates of living versus deceased donation, and in the use of expanded criteria donors) suggest that there is ample room for improvement. Herein we review the policy and clinical measures that should be considered to increase access to transplantation and improve post-transplantation outcomes. This Roadmap, generated by a group of major European stakeholders collaborating within a Thematic Network, presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation. This framework can be adopted by countries and institutions that are interested in advancing transplantation, both within and outside the European Union. Within this framework, a priority ranking of initiatives is suggested that could serve as the basis for a new European Union Action Plan on Organ Donation and Transplantation.
Topics: Europe; European Union; Humans; Kidney Transplantation; Organ Transplantation; Stakeholder Participation; Tissue and Organ Procurement; Waiting Lists
PubMed: 33953367
DOI: 10.1038/s41581-021-00425-3 -
BMC Anesthesiology Mar 2019
Topics: Anesthesiology; Animals; Humans; Organ Transplantation; Specialization
PubMed: 30832567
DOI: 10.1186/s12871-019-0704-z -
Viruses Apr 2021As guest editors, we are pleased to present this Special Issue on BK virus (BKV) and transplantation with the intention of exploring some aspects related to...
As guest editors, we are pleased to present this Special Issue on BK virus (BKV) and transplantation with the intention of exploring some aspects related to BKV-associated diseases in transplant recipients, since they are still unclear [...].
Topics: BK Virus; Disease Susceptibility; Humans; Kidney Transplantation; Organ Transplantation; Polyomavirus Infections; Transplant Recipients; Tumor Virus Infections
PubMed: 33922350
DOI: 10.3390/v13050733 -
Intensive Care Medicine May 2019Prognosis of solid organ transplant (SOT) recipients has improved, mainly because of better prevention of rejection by immunosuppressive therapies. However, SOT... (Review)
Review
PURPOSE
Prognosis of solid organ transplant (SOT) recipients has improved, mainly because of better prevention of rejection by immunosuppressive therapies. However, SOT recipients are highly susceptible to conventional and opportunistic infections, which represent a major cause of morbidity, graft dysfunction and mortality.
METHODS
Narrative review.
RESULTS
We cover the current epidemiology and main aspects of infections in SOT recipients including risk factors such as postoperative risks and specific risks for different transplant recipients, key points on anti-infective prophylaxis as well as diagnostic and therapeutic approaches. We provide an up-to-date guide for management of the main syndromes that can be encountered in SOT recipients including acute respiratory failure, sepsis or septic shock, and central nervous system infections as well as bacterial infections with multidrug-resistant strains, invasive fungal diseases, viral infections and less common pathogens that may impact this patient population.
CONCLUSION
We provide state-of the art review of available knowledge of critically ill SOT patients with infections.
Topics: Anti-Bacterial Agents; Communicable Diseases; Humans; Immunocompromised Host; Organ Transplantation; Transplant Recipients
PubMed: 30911807
DOI: 10.1007/s00134-019-05597-y -
Advances in Chronic Kidney Disease Nov 2021Diabetes mellitus (DM) is one of the most common complications after kidney transplantation and is associated with unfavorable outcomes including death. DM can be... (Review)
Review
Diabetes mellitus (DM) is one of the most common complications after kidney transplantation and is associated with unfavorable outcomes including death. DM can be present before transplant but post-transplant DM (PTDM) refers to diabetes that is diagnosed after solid organ transplantation. Despite its high prevalence, optimal treatment to prevent complications of PTDM is unknown. Medical therapy of pre-existent DM or PTDM after transplant is challenging because of frequent interactions between antidiabetic and immunosuppressive agents. There is also frequent need for medication dose adjustments due to residual kidney disease and a higher risk of medication side effects in patients treated with immunosuppressive agents. Sodium-glucose cotransporter 2 inhibitors have demonstrated a favorable cardio-renal profile in patients with DM without a transplant and hence hold great promise in this patient population although there is concern about the higher risk of urinary tract infections. The significant gaps in our understanding of the pathophysiology, diagnosis, and management of DM after kidney transplantation need to be urgently addressed.
Topics: Diabetes Mellitus; Humans; Hypoglycemic Agents; Immunosuppressive Agents; Kidney Transplantation; Organ Transplantation
PubMed: 35367028
DOI: 10.1053/j.ackd.2021.10.004 -
Mechanisms of Ageing and Development Dec 2021Older organs provide a substantial unrealized potential with the capacity to close the gap between demand and supply in organ transplantation. The potential of... (Review)
Review
Older organs provide a substantial unrealized potential with the capacity to close the gap between demand and supply in organ transplantation. The potential of senolytics in improving age-related conditions has been shown in various experimental studies and early clinical trials. Those encouraging data may also be of relevance for transplantation. As age-differences between donor and recipients are not uncommon, aging may be accelerated in recipients when transplanting older organs; young organs may, at least in theory, have the potential to 'rejuvenate' old recipients. Here, we review the relevance of senescent cells and the effects of senolytics on organ quality, alloimmune responses and outcomes in solid organ transplantation. This article is part of the Special Issue - Senolytics - Edited by Joao Passos and Diana Jurk.
Topics: Aging, Premature; Cellular Senescence; Humans; Organ Transplantation; Senotherapeutics; Tissue Survival
PubMed: 34606875
DOI: 10.1016/j.mad.2021.111582 -
Transplantation Sep 2017
Topics: Belgium; Delivery of Health Care, Integrated; Diffusion of Innovation; Forecasting; Health Policy; History, 20th Century; History, 21st Century; Humans; Models, Organizational; Organ Transplantation; Policy Making; Time Factors; Tissue Donors; Tissue and Organ Procurement; Waiting Lists
PubMed: 28832443
DOI: 10.1097/TP.0000000000001866 -
American Journal of Transplantation :... Dec 2020
Topics: Animals; Mice; Models, Theoretical; Organ Transplantation; Urinary Bladder; Vascularized Composite Allotransplantation
PubMed: 32406153
DOI: 10.1111/ajt.16008