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Frontiers in Pharmacology 2021Ameliorating graft injury induced by ischemia and hypoxia, expanding the donor pool, and improving graft quality and recipient prognosis are still goals pursued by the... (Review)
Review
Ameliorating graft injury induced by ischemia and hypoxia, expanding the donor pool, and improving graft quality and recipient prognosis are still goals pursued by the transplant community. The preservation of organs during this process from donor to recipient is critical to the prognosis of both the graft and the recipient. At present, static cold storage, which is most widely used in clinical practice, not only reduces cell metabolism and oxygen demand through low temperature but also prevents cell edema and resists apoptosis through the application of traditional preservation solutions, but these do not improve hypoxia and increase oxygenation of the donor organ. In recent years, improving the ischemia and hypoxia of grafts during preservation and repairing the quality of marginal donor organs have been of great concern. Hemoglobin-based oxygen carriers (HBOCs) are "made of" natural hemoglobins that were originally developed as blood substitutes but have been extended to a variety of hypoxic clinical situations due to their ability to release oxygen. Compared with traditional preservation protocols, the addition of HBOCs to traditional preservation protocols provides more oxygen to organs to meet their energy metabolic needs, prolong preservation time, reduce ischemia-reperfusion injury to grafts, improve graft quality, and even increase the number of transplantable donors. The focus of the present study was to review the potential applications of HBOCs in solid organ preservation and provide new approaches to understanding the mechanism of the promising strategies for organ preservation.
PubMed: 34916938
DOI: 10.3389/fphar.2021.760215 -
Infectious Diseases of Poverty Aug 2018Rabies, for which the mortality rate is almost 100%, is a zoonotic viral disease that can be transmitted via solid organs or tissue allotransplantation. Dozens of deaths... (Review)
Review
BACKGROUND
Rabies, for which the mortality rate is almost 100%, is a zoonotic viral disease that can be transmitted via solid organs or tissue allotransplantation. Dozens of deaths from rabies via solid organs or tissues allotransplantation (ROTA) have been documented during the last decades. In 2015 and 2016, two cases of rabies virus transmission via solid organs or tissue allotransplantation were reported in China, which further underscore the risk and importance of this special type of rabies for organ transplant recipients.
MAIN TEXT
From 1978 to 2017, at least 13 cases of ROTA, causing dozens of deaths, have been reported worldwide, whether in the high-risk or low-risk countries of rabies. The reported incubation period of ROTA ranges from 11 days to more than 17 months, while the historical incubation period of rabies is generally considered to range from ~ 1 week to several years. The pathogenesis of ROTA is not clear, but the use of post-exposure prophylaxis (PEP) can play a protective role in the transplant recipients. We also summarize reports about ROTA in China, combined with the actual situation regarding work on rabies surveillance and elimination, and suggest countermeasures for the prevention and control of ROTA in the future.
CONCLUSIONS
Understanding the significance of ROTA, screening the suspected organs, assessing the risk and protecting the related population will be effective way to prevent and control further occurrence of ROTA.
Topics: China; Female; Humans; Male; Organ Transplantation; Post-Exposure Prophylaxis; Rabies; Rabies Vaccines; Rabies virus; Survival Analysis; Tissue Transplantation; Transplantation, Homologous; Vaccination
PubMed: 30107857
DOI: 10.1186/s40249-018-0467-7 -
JAMA Network Open Oct 2023In 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating the Organ Procurement Organization (OPO) Conditions for Coverage. This rule...
IMPORTANCE
In 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating the Organ Procurement Organization (OPO) Conditions for Coverage. This rule evaluates OPO performance based on an unadjusted donation rate and an age-adjusted transplant rate; however, neither considers other underlying population differences.
OBJECTIVE
To evaluate whether adjusting for age and/or area deprivation index yields the same tier assignments as the cause, age, and location consistent (CALC) tier used by CMS.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cross-sectional study examined the performance of 58 OPOs from 2018 to 2020 across the entire US. A total of 12 041 778 death records were examined from the 2017 to 2020 National Center for Health Statistics' Restricted Vital Statistics Detailed Multiple Cause of Death files; 399 530 of these met the definition of potential deceased donor. Information about 42 572 solid organ donors from the Scientific Registry of Transplant Recipients was also used. Statistical analysis was performed from January 2017 to December 2020.
EXPOSURE
Area deprivation of donation service areas and age of potential donors.
MAIN OUTCOME AND MEASURES
OPO performance as measured by donation and transplant rates.
RESULTS
A total of 399 530 potential deceased donors and 42 572 actual solid donor organs were assigned to 1 of 58 OPOs. Age and ADI adjustment resulted in 19.0% (11 of 58) to 31.0% (18 of 58) reclassification of tier ratings for the OPOs, with 46.6% of OPOs (27 of 58) changing tier ranking at least once during the 3-year period. Between 6.9% (4 of 58) and 12.1% (7 of 58) moved into tier 1 and up to 8.6% (5 of 58) moved into tier 3.
CONCLUSIONS AND RELEVANCE
This cross-sectional study of population characteristics and OPO performance metrics found that adjusting for area deprivation and age significantly changed OPO measured performance and tier classifications. These findings suggest that underlying population characteristics may alter processes of care and characterize donation and transplant rates independent of OPO performance. Risk adjustment accounting for population characteristics warrants consideration in prospective policy and further evaluation of quality metrics.
Topics: Humans; Aged; United States; Retrospective Studies; Cross-Sectional Studies; Prospective Studies; Medicare; Tissue and Organ Procurement
PubMed: 37787992
DOI: 10.1001/jamanetworkopen.2023.36749 -
Cells Feb 2020Extracellular vesicles (EVs) play an important role in cell-to-cell communication by delivering coding and non-coding RNA species and proteins to target cells. Recently,... (Review)
Review
Extracellular vesicles (EVs) play an important role in cell-to-cell communication by delivering coding and non-coding RNA species and proteins to target cells. Recently, the therapeutic potential of EVs has been shown to extend to the field of solid organ transplantations. Mesenchymal stromal cell-derived EVs (MSC-EVs) in particular have been proposed as a new tool to improve graft survival, thanks to the modulation of tolerance toward the graft, and to their anti-fibrotic and pro-angiogenic effects. Moreover, MSC-EVs may reduce ischemia reperfusion injury, improving the recovery from acute damage. In addition, EVs currently considered helpful tools for preserving donor organs when administered before transplant in the context of hypothermic or normothermic perfusion machines. The addition of EVs to the perfusion solution, recently proposed for kidney, lung, and liver grafts, resulted in the amelioration of donor organ viability and functionality. EVs may therefore be of therapeutic interest in different aspects of the transplantation process for increasing the number of available organs and improving their long-term survival.
Topics: Animals; Extracellular Vesicles; Graft vs Host Disease; Humans; Organ Transplantation; Perfusion; Regenerative Medicine; Stem Cells
PubMed: 32033489
DOI: 10.3390/cells9020369 -
Transplant International : Official... Jul 2021Utilization of pancreases for transplantation remains inferior to that of other organs. Herein, we analysed UK pancreas discards to identify the reasons for the low... (Review)
Review
Utilization of pancreases for transplantation remains inferior to that of other organs. Herein, we analysed UK pancreas discards to identify the reasons for the low utilization rates. Data on all pancreases offered first for solid organ transplantation between 1st January 2005 and 31st December 2015 were extracted from the UK Transplant Registry. The number of organs discarded, reasons and the time point of discard were analysed. A centre specific comparison was also undertaken. 7367 pancreases were offered first for solid organ transplantation. 35% were donors after circulatory death (DCD). 3668 (49.7%) organs were not retrieved. Of the 3699 pancreases retrieved, 38% were initially accepted but subsequently discarded. 2145 (29%) grafts offered were transplanted as simultaneous pancreas-kidney or solitary pancreas. 1177 (55%) were transplanted on the first offer whilst the remaining 968 were transplanted after a median of three offers. 52% DBD pancreases were accepted and transplanted on the first offer compared with 68% DCD grafts. There were significant differences in discard rates between centres (30-80% for DBD and 3-78% for DCD, P < 0.001). A significant number of solid pancreases are discarded. Better graft assessment at retrieval could minimize unnecessary organ travel and discards. Closer links with islet programmes may allow for better utilization of discarded grafts.
Topics: Graft Survival; Humans; Organ Transplantation; Pancreas; Pancreas Transplantation; Tissue Donors; Tissue and Organ Procurement; United Kingdom
PubMed: 33794037
DOI: 10.1111/tri.13876 -
Journal of Medical Toxicology :... Dec 2018The gap between the number of patients on transplant waiting lists and patients receiving transplants is growing. Use of organs from donors who have died following... (Review)
Review
INTRODUCTION
The gap between the number of patients on transplant waiting lists and patients receiving transplants is growing. Use of organs from donors who have died following pesticide exposure remains controversial. This study reviews the literature related to transplantation from this group.
METHODS
A literature search was undertaken on PubMed using the following keywords: 'insecticide', 'pesticide', 'rodenticide', 'organophosphate', 'carbamate', 'paraquat', 'poisoning', 'toxicity', 'overdose', 'intoxication', 'ingestion', 'organ donation or procurement', 'transplant', 'allograft transplant', and 'expanded criteria organ donation'; 21 specific pesticides/insecticides were also added to the search; the indexes for EAPCCT/NACCT meeting abstracts 2008-2017 were also searched. Identified publications were reviewed and if described human donation/transplantation of ≥ 1 solid organ(s), the following was extracted: (i) compound(s) ingested; (ii) donor demographics; (iii) organ(s) transplanted; and (iv) graft function at follow-up.
RESULTS
Ten papers were identified describing 20 fatalities (1999-2017) related to the following pesticide exposures: organophosphate, 8 cases; aldicarb, 4; paraquat, 3; parathion, 1; malathion, 1; carbofuran/carbamate, 1; carbamate, 1; and brodifacoum, 1 and no further cases were identified from EAPCCT/NACCT abstracts. Donors were aged 12-50 (25.9 ± 11.9) years. Forty-four organs were transplanted: 28 kidneys, 7 livers, 6 corneas, and 3 hearts. Forty recipients had outcome reported: 3 (7.5%) patients died, 3 (7.5%) had graft failure/dysfunction and 34 (85.0%) had good graft function. Overall survival with good function was 96%, 71%, 83%, and 67% for kidneys, livers, corneas and hearts respectively.
CONCLUSION
Review of the published literature suggests that solid organ donation following exposure to a pesticide is associated with good short-to-medium-term graft organ function following transplantation, particularly for transplanted kidneys and corneas.
Topics: Humans; Organ Transplantation; Pesticides; Tissue Donors; Treatment Outcome
PubMed: 29987646
DOI: 10.1007/s13181-018-0673-5 -
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 -
Journal of Research in Medical Sciences... Dec 2014Cytomegalovirus (CMV), a problematic virus in solid organ transplant recipients (SOTR) such as liver, can worsen overall mortality and transplant outcome, so its... (Review)
Review
BACKGROUND
Cytomegalovirus (CMV), a problematic virus in solid organ transplant recipients (SOTR) such as liver, can worsen overall mortality and transplant outcome, so its prevention and treatment is a key of success in such patients. This study is aimed to compare the efficacy of ganciclovir (GCV) and valganciclovir (VGC) for prevention and treatment of infection with CMV.
MATERIALS AND METHODS
After sensitive and systematic search in PubMed, EMBASE, Cochrane and other available databases, both prospective and retrospective studies on effect of VGC and GCV in prevention and treatment of CMV disease among SOTR, which had our study criteria, were included. The pooled risk estimates were calculated using random-effects models.
RESULTS
Among 1324 title, 19 studies were included. In 11 prophylactic studies (2368 patients), the pooled risk of CMV disease (VGC relative to GCV) was 1.16, 95% confidence interval (CI): 0.91-1.49 and in studies of liver transplant recipients, 1.53, 95% CI: 0.86-2.70. Rate of viremia eradication in VGC to GCV was 1.05, 95% CI: 0.97-1.13. In 3 treatment studies (422 patients), rate of successful treatment in VGC to GCV was 0.98, 95% CI: 0.91-1.06 and viremia eradication 0.95, CI 95% 0.77-1.16. All these values did not show statistically significantly differences between GCV and VGC.
CONCLUSION
It can be concluded that VGC as an alternative to GCV can be used with equal efficacy in prevention and treatment of CMV disease in SOTR.
PubMed: 25709661
DOI: No ID Found -
BMJ Open Jan 2023After solid-organ transplantation (SOTx), recipients must adhere to a lifelong medical regimen, change their lifestyle and cope with physiological and psychosocial...
INTRODUCTION
After solid-organ transplantation (SOTx), recipients must adhere to a lifelong medical regimen, change their lifestyle and cope with physiological and psychosocial challenges. This requires active participation in their care and self-management abilities. The concept of self-management after SOTx has only been described regarding specific organs and focused on adherence to medical treatment. A comprehensive conceptualisation of self-management entailing all solid organs and beyond medical aspects does not exist. This might lead to unmet self-management support needs of SOTx recipients and hinder a more holistic and integrative approach in self-management support. Therefore, a better understanding of the concept of self-management after SOTx is needed to facilitate a comprehensive evidence base for healthcare providers and researchers. The purpose of this scoping review is to explore existing evidence on self-management in adults after SOTx.
METHODS AND ANALYSIS
To identify relevant evidence, six electronic databases and three study registers will be searched, supplemented by handsearches, reference checking and expert recommendations. Screening and selection of available evidence will be carried out in a two-step process by two independent reviewers. International evidence published in English or German reporting on adults after heart, lung, liver, pancreas, kidney or small bowel transplantation will be considered. To meet inclusion criteria, articles have to focus on either: self-management, self-management support or recipients' or healthcare providers' perspectives of challenges and needs potentially addressable by self-management. Data extraction will be performed by two reviewers independently using a structured form. Data will be analysed descriptively and using content analysis procedures. Findings will be summarised narratively and presented in tabular format.
ETHICS AND DISSEMINATION
The consultation and approval of an ethics committee is not required for this scoping review. Findings of the scoping review will be published in a peer-reviewed open-access journal and presented at conferences.
Topics: Humans; Adult; Self-Management; Organ Transplantation; Research Design; Review Literature as Topic
PubMed: 36693696
DOI: 10.1136/bmjopen-2022-064347 -
The Journal of Surgical Research Jun 2018Hepatic cell transplantation (HCT) continues to garner interest as an alternative to orthotopic liver transplantation and the attendant donor shortage. When compared... (Review)
Review
Hepatic cell transplantation (HCT) continues to garner interest as an alternative to orthotopic liver transplantation and the attendant donor shortage. When compared with solid organ transplantation, advantages of cell transplantation include the potential to treat more patients with a considerably less invasive procedure, the ability to utilize organs otherwise unsuitable for transplant, and leaving the native organ in situ with the potential for regeneration. While studies date back to the early 1960s, advancement of clinical application has been slow due in part to limitations of suitable tissue supplies and reproducible robust techniques. Compared with orthotopic liver transplantation, there are fewer absolute contraindications for donor selection. And, current techniques used to harvest, isolate, store, and even transfuse cells vary little between institutions. Significant variation is seen due to a lack of consensus with maintenance therapy. Although the ideal recipient has not been clearly identified, the most significant results have been demonstrated with correction of congenital metabolic liver disorders, with a few trials examining its utility in cirrhotics and more recently acute liver failure. The most exciting new topic of discussion examines techniques to improve engraftment, with many such as ischemic preconditioning and nonselective partial embolization (microbead therapy), while not yet used in HCT study, showing promise in solid organ research. Advancements in HCT, although slow in progress, have great potential in the ability to alleviate the burden faced in solid organ transplantation and possibly become a long-term viable option, beyond that of a bridge or salvage therapy.
Topics: Allografts; Animals; Cell Transplantation; Cells, Cultured; Consensus; Donor Selection; Hepatocytes; History, 20th Century; History, 21st Century; Humans; Liver; Liver Failure; Liver Transplantation; Models, Animal; Primary Cell Culture; Treatment Outcome
PubMed: 29661288
DOI: 10.1016/j.jss.2018.01.031