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Critical Care Nursing Clinics of North... Mar 2017Solid organ transplantation has become a well-established standard of care for end-organ failure, and the nurse in the intensive care unit may be exposed to these... (Review)
Review
Solid organ transplantation has become a well-established standard of care for end-organ failure, and the nurse in the intensive care unit may be exposed to these patients at any stage in the care continuum of pretransplant or posttransplant care. Knowledge of risk factors, timing, and treatments for infections may help to enhance clinical practices and optimize patient safety and clinical outcomes.
Topics: Bacterial Infections; Continuity of Patient Care; Critical Care Nursing; Humans; Immunocompromised Host; Intensive Care Units; Organ Transplantation; Postoperative Complications; Risk Factors; Wound Infection
PubMed: 28160960
DOI: 10.1016/j.cnc.2016.09.002 -
Experimental and Clinical... Jan 2019In Jordan, the history of organ transplantation started in 1972 with a kidney transplant from a deceased donor. At present, Jordan is in a good position with regard to... (Review)
Review
In Jordan, the history of organ transplantation started in 1972 with a kidney transplant from a deceased donor. At present, Jordan is in a good position with regard to organ transplantation among developing countries. It remains important to follow through with some decisions and enact laws that would increase the percentage of legal organ donations and transplant procedures. This has involved the expansion of relative degree donation. Until 2013, most relative degree donations involved 1st-degree and 2nd-degree relatives. The degree of genetical and legal relatives in living organ donation was then expanded to allow 4th- and 5th-degree relatives. This expansion to a 5th-degree relative came about when it was realized that the percentage of organ transplants in 2nd-degree relatives was high. Therefore, the idea of organ donation in these degrees may be beneficial, as it can lead to significantly higher numbers of organ donations.
Topics: Family; Health Policy; History, 20th Century; History, 21st Century; Humans; Islam; Jordan; Living Donors; Organ Transplantation; Pedigree; Policy Making; Religion and Medicine
PubMed: 30777517
DOI: 10.6002/ect.MESOT2018.L24 -
Experimental and Clinical... Feb 2019Hand transplantation is the most common form of modern composite tissue allotransplantation, with 89 cases reported worldwide since 1998. The procedure is a treatment... (Review)
Review
Hand transplantation is the most common form of modern composite tissue allotransplantation, with 89 cases reported worldwide since 1998. The procedure is a treatment option for complex injuries that leave patients with structural, functional, and aesthetic deficits that cannot be addressed by other means. Successful application of this technology requires a multidisciplinary approach, incorporating not only skilled hand surgeons, transplant surgeons, and transplant immunologists, but also hand therapists, psychiatrists, medical specialists, anesthesiologists, and so on. Its long-term results depend on proper patient selection, a technically successful operation, postoperative rehabilitation, and an immunotherapy protocol that prevents rejection. Recent advances in transplant immunology are shifting the focus from immunosuppression to immunoregulation. Despite the enormous antigen load associated with composite tissue allografts, hand transplant has become a clinical reality, with immunosuppression comparable to that of solid-organ transplants. Our understanding of hand transplantation is still evolving, and ongoing research is needed to improve functional outcomes and to decrease the morbidity associated with long-term immunosuppression. This review discusses the current protocols for upper extremity donation, transplant receipt, surgical techniques, postoperative rehabilitation and immunosuppression, nerve regeneration, functional outcomes, ethical issues, and financial considerations.
Topics: Amputation, Surgical; Clinical Decision-Making; Graft Rejection; Graft Survival; Hand; Humans; Immunosuppressive Agents; Organ Transplantation; Patient Selection; Recovery of Function; Risk Factors; Time Factors; Treatment Outcome
PubMed: 30719955
DOI: 10.6002/ect.2018.0163 -
Annals of Transplantation Jul 2020Augmented reality (AR) delivers virtual information or some of its elements to the real world. This technology, which has been used primarily for entertainment and... (Review)
Review
Augmented reality (AR) delivers virtual information or some of its elements to the real world. This technology, which has been used primarily for entertainment and military applications, has vigorously entered medicine, especially in radiology and surgery, yet has never been used in organ transplantation. AR could be useful in training transplant surgeons, promoting organ donations, graft retrieval and allocation, and microscopic diagnosis of rejection, treatment of complications, and post-transplantation neoplasms. The availability of AR display tools such as Smartphone screens and head-mounted goggles, accessibility of software for automated image segmentation and 3-dimensional reconstruction, and algorithms allowing registration, make augmented reality an attractive tool for surgery including transplantation. The shortage of hospital IT specialists and insufficient investments from medical equipment manufacturers into the development of AR technology remain the most significant obstacles in its broader application.
Topics: Augmented Reality; Humans; Organ Transplantation; Surgery, Computer-Assisted
PubMed: 32732862
DOI: 10.12659/AOT.923597 -
International Journal of Molecular... Mar 2021CRISPR/Cas (clustered regularly interspaced short palindromic repeats linked to Cas nuclease) technology has revolutionized many aspects of genetic engineering research.... (Review)
Review
CRISPR/Cas (clustered regularly interspaced short palindromic repeats linked to Cas nuclease) technology has revolutionized many aspects of genetic engineering research. Thanks to it, it became possible to study the functions and mechanisms of biology with greater precision, as well as to obtain genetically modified organisms, both prokaryotic and eukaryotic. The changes introduced by the CRISPR/Cas system are based on the repair paths of the single or double strand DNA breaks that cause insertions, deletions, or precise integrations of donor DNA. These changes are crucial for many fields of science, one of which is the use of animals (pigs) as a reservoir of tissues and organs for xenotransplantation into humans. Non-genetically modified animals cannot be used to save human life and health due to acute immunological reactions resulting from the phylogenetic distance of these two species. This review is intended to collect and summarize the advantages as well as achievements of the CRISPR/Cas system in pig-to-human xenotransplantation research. In addition, it demonstrates barriers and limitations that require careful evaluation before attempting to experiment with this technology.
Topics: Animals; CRISPR-Cas Systems; DNA Breaks, Double-Stranded; DNA Repair; Gene Editing; Genetic Engineering; Graft Rejection; Graft Survival; Heterografts; Humans; Models, Animal; Organ Transplantation; Swine; Transplantation, Heterologous
PubMed: 33801123
DOI: 10.3390/ijms22063196 -
Transplant International : Official... Jun 2019
Topics: Animals; Bioengineering; Biomedical Research; Humans; Organ Preservation; Organ Transplantation; Perfusion; Pluripotent Stem Cells; Tissue and Organ Procurement
PubMed: 31209951
DOI: 10.1111/tri.13419 -
The Journal of Nursing Research : JNR Nov 2020Organ transplantation was one of the greatest achievements of medical science during the 20th century. Knowledge, education, and culture all play prominent roles in...
BACKGROUND
Organ transplantation was one of the greatest achievements of medical science during the 20th century. Knowledge, education, and culture all play prominent roles in transplantation because of the complexity of the process from donation to transplantation.
PURPOSE
The aim of this research was to determine and analyze the knowledge and attitudes about organ donation and transplantation among the general population in Limassol, Cyprus.
METHODS
A quantitative research approach was followed, and a questionnaire consisting of closed-ended questions was completed by adults from the general population in Limassol.
RESULTS
One thousand two hundred adults out of the 1,346 adults who were contacted responded to the survey (response rate: 89%) and were included as participants. Of the participants, 93.4% (p < .05) considered organ donation to be lifesaving, 57% expressed interest (and 39.8% expressed disinterest) in becoming organ donors, 80.6% (p < .05) expressed awareness of there being a waiting list for people in need of organ transplantation, 50.4% agreed that brain death must be confirmed before organ removal for transplantation, and 47% recalled having been informed about organ donation through the media, with 31.5% stating that they had never been informed about organ donation.
CONCLUSIONS
The participants demonstrated limited awareness regarding the organ donation system in Cyprus. Furthermore, a significant percentage stated that they lacked a source for obtaining related information. The Cypriot society should be informed and encouraged to participate in organ donation to increase the rate of organ transplantation.
Topics: Adult; Cyprus; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Organ Transplantation; Patient Acceptance of Health Care; Surveys and Questionnaires; Tissue Donors
PubMed: 33156139
DOI: 10.1097/jnr.0000000000000409 -
Frontiers in Immunology 2022The human microbiota heavily influences most vital aspects of human physiology including organ transplantation outcomes and transplant rejection risk. A variety of organ... (Review)
Review
The human microbiota heavily influences most vital aspects of human physiology including organ transplantation outcomes and transplant rejection risk. A variety of organ transplantation scenarios such as lung and heart transplantation as well as hematopoietic stem cell transplantation is heavily influenced by the human microbiotas. The human microbiota refers to a rich, diverse, and complex ecosystem of bacteria, fungi, archaea, helminths, protozoans, parasites, and viruses. Research accumulating over the past decade has established the existence of complex cross-species, cross-kingdom interactions between the residents of the various human microbiotas and the human body. Since the gut microbiota is the densest, most popular, and most studied human microbiota, the impact of other human microbiotas such as the oral, lung, urinary, and genital microbiotas is often overshadowed. However, these microbiotas also provide critical and unique insights pertaining to transplantation success, rejection risk, and overall host health, across multiple different transplantation scenarios. Organ transplantation as well as the pre-, peri-, and post-transplant pharmacological regimens patients undergo is known to adversely impact the microbiotas, thereby increasing the risk of adverse patient outcomes. Over the past decade, holistic approaches to post-transplant patient care such as the administration of clinical and dietary interventions aiming at restoring deranged microbiota community structures have been gaining momentum. Examples of these include prebiotic and probiotic administration, fecal microbial transplantation, and bacteriophage-mediated multidrug-resistant bacterial decolonization. This review will discuss these perspectives and explore the role of different human microbiotas in the context of various transplantation scenarios.
Topics: Fecal Microbiota Transplantation; Gastrointestinal Microbiome; Hematopoietic Stem Cells; Humans; Microbiota; Organ Transplantation
PubMed: 35874759
DOI: 10.3389/fimmu.2022.932228 -
Transplant Immunology Aug 2023Biological aging is the accumulation of cellular and molecular damage within an individual over time. The biological age of a donor organ is known to influence clinical... (Review)
Review
INTRODUCTION
Biological aging is the accumulation of cellular and molecular damage within an individual over time. The biological age of a donor organ is known to influence clinical outcomes of solid organ transplantation, including delayed graft function and frequency of rejection episodes. While much research has focused on the biological age of donor organs, the recipient's biological age may also influence transplantation outcomes. The aim of this scoping review was to identify and provide an overview of the existing evidence regarding biological aging in solid organ transplant recipients and the impact on patient outcomes post-transplant.
METHODS
Literature searches were carried out on PubMed, Web of Science, Google Scholar, Embase and TRIP using the phrases 'solid organ transplant', 'cell senescence', 'cell aging' and 'outcomes', using boolean 'and/or' phrases and MeSH terms. Duplicates were removed and abstracts were reviewed by two independent reviewers. Full papers were then screened for inclusion by two reviewers. Data extraction was carried out using a standardised proforma agreed on prior to starting.
RESULTS
32 studies, including data on a total of 7760 patients, were identified for inclusion in this review; 23 relating to kidney transplant recipients, three to liver transplant, five to lung transplant and one to heart transplantation. A wide range of biomarkers of biological aging have been assessed in kidney transplant recipients, whereas studies of liver, lung and heart transplant have predominantly assessed recipient telomere length. The most robust associations with clinical outcomes are observed in kidney transplant recipients, possibly influenced by the larger number of studies and the use of a wider range of biomarkers of biological aging. In kidney transplant recipients reduced thymic function and accumulation of terminally differentiated T cell populations was associated with reduced risk of acute rejection but increased risk of infection and mortality.
CONCLUSION
Studies to date on biological aging in transplant recipients have been heavily biased to kidney transplant recipients. The results from these studies suggest recipient biological age can influence clinical outcomes and future research is needed to prioritise robust biomarkers of biological aging in transplant recipients.
Topics: Humans; Organ Transplantation; Heart Transplantation; Liver Transplantation; Lung Transplantation; Transplant Recipients; Aging; Graft Rejection
PubMed: 37182719
DOI: 10.1016/j.trim.2023.101851 -
Current Opinion in Organ Transplantation Feb 2020To summarise recently published studies of donor pretreatment and machine perfusion strategies in kidney transplantation. (Review)
Review
PURPOSE OF REVIEW
To summarise recently published studies of donor pretreatment and machine perfusion strategies in kidney transplantation.
RECENT FINDINGS
The sparsity of donor pretreatment trials has resulted in the re-analysis of already existing data, and RCTs are urgently needed to reinvigorate this aspect of donor research. Uncontrolled donation after circulatory death kidney transplantation has the highest risk of delayed graft function and graft failure, and recent studies have reported that normothermic regional perfusion improves graft function and survival in this setting. Hypothermic machine perfusion reduces delayed graft function following deceased donor kidney transplantation across donor types but unanswered questions still remain regarding its use. The use of oxygenated hypothermic machine perfusion appears to improve graft function in controlled donation after circulatory death mediated by a reduction in acute rejection. Ex-situ normothermic perfusion is emerging and while technically challenging it may facilitate the delivery of pretreatments.
SUMMARY
RCTs are urgently needed to reinvigorate research into donor pretreatment and to establish the place of specific preservation techniques in deceased donor kidney transplantation.
Topics: Humans; Organ Preservation; Organ Transplantation; Perfusion; Tissue Donors
PubMed: 31834008
DOI: 10.1097/MOT.0000000000000725