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Current Opinion in Organ Transplantation Aug 2019Respiratory viruses are common in solid organ transplant (SOT) recipients and recognized as a significant cause of mortality and morbidity. This review examines the... (Review)
Review
PURPOSE OF REVIEW
Respiratory viruses are common in solid organ transplant (SOT) recipients and recognized as a significant cause of mortality and morbidity. This review examines the literature on influenza and noninfluenza viruses in the SOT recipient.
RECENT FINDINGS
Advances in immunosuppression and antimicrobial prophylaxis have led to improved patient and graft survival, yet respiratory viruses continue to be a common cause of disease in this population. Influenza viruses have received top priority regarding prevention and treatment, whereas advances in molecular diagnostic tests detecting an array of other respiratory viruses have expanded our knowledge about the epidemiology and impact of these viruses in both the general population and SOT patients. Effective treatment and prevention for noninfluenza respiratory viruses are only emerging.
SUMMARY
Respiratory viruses can contribute to a wide array of symptoms in SOT, particularly in lung transplant recipients. The clinical manifestations, diagnosis, and treatment options for influenza and noninfluenza viruses in SOT patients are reviewed. PCR and related molecular techniques represent the most sensitive diagnostic modalities for detection of respiratory viruses. Early therapy is associated with improved outcomes. Newer classes of antivirals and antibodies are under continuous development for many of these community acquired respiratory viruses.
Topics: Humans; Organ Transplantation; Respiratory Tract Infections
PubMed: 31145157
DOI: 10.1097/MOT.0000000000000663 -
Frontiers in Immunology 2021In transplantation, donor and recipients frequently differ in age. Senescent cells accumulate in donor organs with aging and have the potential to promote senescence in... (Review)
Review
In transplantation, donor and recipients frequently differ in age. Senescent cells accumulate in donor organs with aging and have the potential to promote senescence in adjacent cells when transferred into recipient animals. Characteristically, senescent cells secrete a myriad of pro-inflammatory, soluble molecules as part of their distinct secretory phenotype that have been shown to drive senescence and age-related co-morbidities. Preliminary own data show that the transplantation of old organs limits the physical reserve of recipient animals. Here, we review how organ age may affect transplant recipients and discuss the potential of accelerated aging.
Topics: Age Factors; Aging; Animals; Cellular Senescence; Humans; Immunosenescence; Organ Transplantation
PubMed: 33995411
DOI: 10.3389/fimmu.2021.671479 -
Acta Neurochirurgica Dec 2016Since the turn of the last century, the prospect of head transplantation has captured the imagination of scientists and the general public. Recently, head transplant has... (Review)
Review
BACKGROUND
Since the turn of the last century, the prospect of head transplantation has captured the imagination of scientists and the general public. Recently, head transplant has regained attention in popular media, as neurosurgeons have proposed performing this procedure in 2017. Given the potential impact of such a procedure, we were interested in learning the history of the technical hurdles that need to be overcome, and determine if it is even technically possible to perform such a procedure on humans today.
METHOD
We conducted a historical review of available literature on the technical challenges and developments of head transplantation. The many social, psychological, ethical, religious, cultural, and legal questions of head transplantation were beyond the scope of this review.
RESULTS
Our historical review identified the following important technical considerations related to performing a head transplant: maintenance of blood flow to an isolated brain via vessel anastomosis; availability of immunosuppressive agents; spinal anastomosis and fusion following cord transfection; pain control in the recipient. Several animal studies have demonstrated success in maintaining recipient cerebral perfusion and achieving immunosuppression. However, there is currently sparse evidence in favor of successful spinal anastomosis and fusion after transection. While recent publications by an Italian group offer novel approaches to this challenge, research on this topic has been sparse and hinges on procedures performed in animal models in the 1970s. How transferrable these older methods are to the human nervous system is unclear and warrants further exploration.
CONCLUSIONS
Our review identified several important considerations related to performing a viable head transplantation. Besides the technical challenges that remain, there are important ethical issues to consider, such as exploitation of vulnerable patients and informed consent. Thus, besides the remaining technical challenges, these ethical issues will also need to be addressed before moving these studies to the clinic.
Topics: Animals; Head; History, 20th Century; History, 21st Century; Humans; Organ Transplantation
PubMed: 27738901
DOI: 10.1007/s00701-016-2984-0 -
Current Opinion in Organ Transplantation Oct 2022Older donors have the potential to close the gap between demand and supply in solid organs transplantation. Utilizing older organs, at the same time, has been associated... (Review)
Review
PURPOSE OF REVIEW
Older donors have the potential to close the gap between demand and supply in solid organs transplantation. Utilizing older organs, at the same time, has been associated with worse short- and long-term outcomes. Here, we introduce potential mechanisms on how treatments during machine perfusion (MP) may safely improve the utilization of older organs.
RECENT FINDINGS
Consequences of ischemia reperfusion injury (IRI), a process of acute, sterile inflammation leading to organ injury are more prominent in older organs. Of relevance, organ age and IRI seem to act synergistically, leading to an increase of damage associated molecular patterns that trigger innate and adaptive immune responses. While cold storage has traditionally been considered the standard of care in organ preservation, accumulating data support that both hypothermic and normothermic MP improve organ quality, particularly in older organs. Furthermore, MP provides the opportunity to assess the quality of organs while adding therapeutic agents. Experimental data have already demonstrated the potential of applying treatments during MP. New experimental show that the depletion of senescent cells that accumulate in old organs improves organ quality and transplant outcomes.
SUMMARY
As the importance of expanding the donor pool is increasing, MP and novel treatments bear the potential to assess and regenerate older organs, narrowing the gap between demand and supply.
Topics: Aged; Humans; Organ Preservation; Organ Transplantation; Perfusion; Senotherapeutics; Tissue Donors
PubMed: 35950886
DOI: 10.1097/MOT.0000000000001019 -
American Journal of Transplantation :... Jan 2022Kalil and Florescu discuss the growing evidence related to survival outcomes of solid organ transplant patients who are hospitalized due to COVID-19 and place this...
Kalil and Florescu discuss the growing evidence related to survival outcomes of solid organ transplant patients who are hospitalized due to COVID-19 and place this evidence within the context of other post-transplant infections. See Heldman et al. (page 279).
Topics: COVID-19; Hospitalization; Humans; Organ Transplantation; SARS-CoV-2; Transplant Recipients
PubMed: 34738312
DOI: 10.1111/ajt.16885 -
Ear, Nose, & Throat Journal 2019
Topics: China; Humans; Organ Transplantation; Periodicals as Topic; Prisoners; Publishing; Tissue and Organ Harvesting
PubMed: 31056941
DOI: 10.1177/0145561319843031 -
Nephron 2017Following transplantation (TX) of both renal and non-renal organs, a large proportion of patients have renal dysfunction. There are multiple causes for this. Chronic... (Review)
Review
Following transplantation (TX) of both renal and non-renal organs, a large proportion of patients have renal dysfunction. There are multiple causes for this. Chronic nephrotoxicity and high doses of calcineurin inhibitors are important factors. Preoperative and perioperative factors like hypertension, hypotension, drugs and infections may play a causative role as well. Organ-specific causes include hepatorenal syndrome, cirrhosis, low cardiac function, low respiratory function and diabetes developed both before and after TX. It is important to be able to perform precise and valid measurements or estimates of renal function in these patients, in order to accurately and safely dose immunosuppressive medication and perform and adjust the treatment and prophylaxis of renal dysfunction. This is a short overview and discussion of relevant studies and possible caveats of estimated glomerular filtration rate methods for use in renal and non-renal TX.
Topics: Glomerular Filtration Rate; Humans; Kidney Diseases; Kidney Transplantation; Organ Transplantation
PubMed: 27388425
DOI: 10.1159/000447673 -
Current Opinion in Organ Transplantation Aug 2019Manipulating costimulatory signals has been shown to alter T cell responses and prolong graft survival in solid organ transplantation. Our understanding of and ability... (Review)
Review
PURPOSE OF REVIEW
Manipulating costimulatory signals has been shown to alter T cell responses and prolong graft survival in solid organ transplantation. Our understanding of and ability to target various costimulation pathways continues to evolve.
RECENT FINDINGS
Since the approval of belatacept in kidney transplantation, many additional biologics have been developed targeting clinically relevant costimulation signaling axes including CD40-CD40L, inducible costimulator-inducible costimulator ligand (ICOS-ICOSL), and OX40-OX40L. Currently, the effects of costimulation blockade on posttransplant humoral responses, tolerance induction, and xenotransplantation are under active investigation. Here, we will discuss these pathways as well as preclinical and clinical outcomes of biologics targeting these pathways in organ transplantation.
SUMMARY
Targeting costimultion is a promising approach for not only controlling T cell but also B cell responses. Consequently, costimulation blockade shows considerable potential for improving outcomes in antibody-mediated rejection and xenotransplantation.
Topics: Abatacept; Animals; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Organ Transplantation; Swine; Transplantation, Heterologous
PubMed: 31157670
DOI: 10.1097/MOT.0000000000000656 -
American Heart Journal Oct 2021The epidemiology, and outcome of infective endocarditis (IE) among solid organ transplant (SOT) recipients is unknown.
BACKGROUND
The epidemiology, and outcome of infective endocarditis (IE) among solid organ transplant (SOT) recipients is unknown.
METHODS
We used data from the 2013-2018 Nationwide Readmissions Database (NRD). IE- and SOT-associated hospitalizations were identified using diagnosis and procedure codes. Outcomes included inpatient mortality, length of stay, and inpatient costs. Adjusted analyses were performed using weighted regression models.
RESULTS
A total of 99,052 IE-associated hospitalizations, corresponding to a weighted national estimate of 193,164, were included for analysis. Of these, 794 (weighted n = 1,574) were associated with transplant history (SOT-IE). Mortality was not significantly different between SOT-IE and non-SOT-IE (17.2% vs. 15.8%, adjusted relative risk [aRR]: 0.86, 95% confidence interval [CI] [0.71, 1.03]), and fewer SOT-IE patients underwent valve repair or replacement than non-SOT-IE (12.5% vs. 16.2%, aRR 0.82, 95% CI [0.71, 0.95]). We then compared outcomes of patients diagnosed with IE during their index transplant hospitalization (index-SOT-IE) to patients without IE during their transplant hospitalization (index-SOT). Index-SOT-IE occurred most frequently among heart transplant recipients (45.1%), and was associated with greater mortality (27.1% vs. 2.3%, aRR 6.07, 95% CI [3.32, 11.11]).
CONCLUSION
Dual diagnosis of SOT and IE was associated with worse outcomes among SOT recipients during index hospitalization, but not overall among patients with IE.
Topics: Databases, Factual; Endocarditis; Female; Hospital Costs; Hospital Mortality; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Organ Transplantation; Postoperative Complications; Regression Analysis; Retrospective Studies; Risk Factors; Treatment Outcome; United States
PubMed: 34157299
DOI: 10.1016/j.ahj.2021.06.007 -
Military Medical Research Aug 2021Single-cell RNA sequencing (scRNA-seq) is a comprehensive technical tool to analyze intracellular and intercellular interaction data by whole transcriptional profile... (Review)
Review
Single-cell RNA sequencing (scRNA-seq) is a comprehensive technical tool to analyze intracellular and intercellular interaction data by whole transcriptional profile analysis. Here, we describe the application in biomedical research, focusing on the immune system during organ transplantation and rejection. Unlike conventional transcriptome analysis, this method provides a full map of multiple cell populations in one specific tissue and presents a dynamic and transient unbiased method to explore the progression of allograft dysfunction, starting from the stress response to final graft failure. This promising sequencing technology remarkably improves individualized organ rejection treatment by identifying decisive cellular subgroups and cell-specific interactions.
Topics: Gene Expression Profiling; Humans; Organ Transplantation; Sequence Analysis, RNA; Single-Cell Analysis
PubMed: 34389057
DOI: 10.1186/s40779-021-00336-1