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Blood Reviews Jan 2020Solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients are at increased risk for developing infections due to underlying... (Review)
Review
Solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients are at increased risk for developing infections due to underlying immunosuppression. Antibiotic use, and in HSCT recipients, the use of preparative regimens prior to transplantation can deplete gut commensal bacteria, resulting in intestinal dysbiosis. Emerging evidence in transplant patients, particularly HSCT, suggest that disturbances in gut microbiota populations are associated with a number of adverse outcomes. Here, we review the outcomes of HSCT and SOT recipients with gut microbiota imbalance or dysbiosis, explore the nascent field of gut microbiome therapeutic approaches including fecal microbiota transplantation and the use of precision probiotics in HSCT and SOT recipients.
Topics: Fecal Microbiota Transplantation; Gastrointestinal Microbiome; Hematopoietic Stem Cell Transplantation; Humans; Organ Transplantation; Transplantation Conditioning
PubMed: 31492463
DOI: 10.1016/j.blre.2019.100614 -
Transplant International : Official... 2022
Topics: Humans; Organ Transplantation; Tissue and Organ Procurement
PubMed: 37304736
DOI: 10.3389/ti.2022.11005 -
American Journal of Transplantation :... Oct 2019
Topics: Health Care Rationing; Health Policy; Humans; Organ Transplantation; Resource Allocation; Tissue Donors; Tissue and Organ Procurement
PubMed: 31267655
DOI: 10.1111/ajt.15521 -
Presse Medicale (Paris, France : 1983) Dec 2022The COVID-19 pandemic affects the transplant recipients since March 2020. Transplant centers quickly organized themselves to optimize the management of the...
The COVID-19 pandemic affects the transplant recipients since March 2020. Transplant centers quickly organized themselves to optimize the management of the immunocompromised patients and to progress in the knowledge of this new disease. To this end, a French Registry was created, which includes all solid organ transplant patients who have developed a SARS Cov2 infection. Numerous studies have been carried out using these data to describe this new disease in transplant patients, to characterize its clinical and biological risk factors and to define its prognosis. The 60 days-mortality of transplant patients hospitalized for COVID-19 was evaluated at 23% and renal failure plays a major role in the poor prognosis in addition to the classical risk factors described in the general population. The advent of vaccination has been a great relief but transplanted patients have shown a poor vaccine response keeping them at risk of severe disease even after an adapted vaccination scheme. Specific strategies was proposed in this particularly fragile population like increasing vaccine doses or using anti SARS Cov-2 monoclonal antibodies.
Topics: Humans; Kidney Transplantation; Pandemics; COVID-19; Organ Transplantation; Immunocompromised Host
PubMed: 36347343
DOI: 10.1016/j.lpm.2022.104146 -
Deutsches Arzteblatt International Jun 2023This new clinical practice guideline concerns the psychosocial diagnosis and treatment of patients before and after organ transplantation. Its objective is to establish...
BACKGROUND
This new clinical practice guideline concerns the psychosocial diagnosis and treatment of patients before and after organ transplantation. Its objective is to establish standards and to issue evidence-based recommendations that will help to optimize decision making in psychosocial diagnosis and treatment.
METHODS
For each key question, the literature was systematically searched in at least two databases (Medline, Ovid, Cochrane Library, and CENTRAL). The end date of each search was between August 2018 and November 2019, depending on the question. The literature search was also updated to capture recent publications, by using a selective approach.
RESULTS
Lack of adherence to immunosuppressant drugs can be expected in 25-30% of patients and increases the odds of organ loss after kidney transplantation (odds ratio 7.1). Psychosocial interventions can significantly improve adherence. Metaanalyses have shown that adherence was achieved 10-20% more frequently in the intervention group than in the control group. 13-40% of patients suffer from depression after transplantation; mortality in this group is 65% higher. The guideline group therefore recommends that experts in psychosomatic medicine, psychiatry, and psychology (mental health professionals) should be involved in patient care throughout the transplantation process.
CONCLUSION
The care of patients before and after organ transplantation should be multidisciplinary. Nonadherence rates and comorbid mental disorders are common and associated with poorer outcomes after transplantation. Interventions to improve adherence are effective, although the pertinent studies display marked heterogeneity and a high risk of bias.
Topics: Humans; Anxiety; Organ Transplantation; Systematic Reviews as Topic; Practice Guidelines as Topic
PubMed: 37101343
DOI: 10.3238/arztebl.m2023.0087 -
Transplant International : Official... 2024
Topics: Humans; Tissue and Organ Procurement; Organ Transplantation; Tissue Donors
PubMed: 38655205
DOI: 10.3389/ti.2024.13011 -
Polish Archives of Internal Medicine Oct 2019The 3 leading causes of death in patients after solid organ transplantation (SOT) include cardiovascular diseases, malignancies, and infections. According to our current...
The 3 leading causes of death in patients after solid organ transplantation (SOT) include cardiovascular diseases, malignancies, and infections. According to our current understanding, the latter play the key role in the pathogenesis of atherosclerosis. Similarly, infections (mainly viral) are implicated in the pathogenesis of at least 20% of known neoplasms. In other words, the implications of acute and chronic infectious diseases in modern medicine, not only transplantology, are significant and ever‑increasing. Immunosuppressive treatment impairs the immune function, which renders the patient more susceptible to infections. Furthermore, treatment of infections in immunocompromised patients poses a challenge and SOT. The current publication provides a brief summary of the key information provided in 20 lectures on viral infections in patients after SOT delivered during the 9th Practical Transplantology Course in Warsaw, Poland on September 15-16, 2017.
Topics: Female; Humans; Immunosuppressive Agents; Male; Organ Transplantation; Practice Guidelines as Topic; Virus Diseases
PubMed: 31593147
DOI: 10.20452/pamw.15012 -
Transplant International : Official... 2022
Topics: Humans; Organ Transplantation
PubMed: 35529594
DOI: 10.3389/ti.2022.10529 -
Induced Coma, Death, and Organ Transplantation: A Physiologic, Genetic, and Theological Perspective.International Journal of Molecular... Mar 2023In the clinic, the death certificate is issued if brain electrical activity is no longer detectable. However, recent research has shown that in model organisms and... (Review)
Review
In the clinic, the death certificate is issued if brain electrical activity is no longer detectable. However, recent research has shown that in model organisms and humans, gene activity continues for at least 96 h postmortem. The discovery that many genes are still working up to 48 h after death questions our definition of death and has implications for organ transplants and forensics. If genes can be active up to 48 h after death, is the person technically still alive at that point? We discovered a very interesting parallel between genes that were upregulated in the brain after death and genes upregulated in the brains that were subjected to medically-induced coma, including transcripts involved in neurotransmission, proteasomal degradation, apoptosis, inflammation, and most interestingly, cancer. Since these genes are involved in cellular proliferation, their activation after death could represent the cellular reaction to escape mortality and raises the question of organ viability and genetics used for transplantation after death. One factor limiting the organ availability for transplantation is religious belief. However, more recently, organ donation for the benefit of humans in need has been seen as "posthumous giving of organs and tissues can be a manifestation of love spreading also to the other side of death".
Topics: Humans; Coma; Organ Transplantation; Tissue and Organ Procurement; Brain; Autopsy; Tissue Donors
PubMed: 36982814
DOI: 10.3390/ijms24065744 -
Revista Da Associacao Medica Brasileira... Mar 2020Melatonin has anti-inflammatory and antioxidant properties that can influence tissue growth and apoptosis. This aspect may influence the success of organ...
OBJECTIVE
Melatonin has anti-inflammatory and antioxidant properties that can influence tissue growth and apoptosis. This aspect may influence the success of organ transplantation. To evaluate the relationship between melatonin and organ transplantation.
METHODS
A systematic review was performed in PubMed databases using the search terms: "melatonin physiology" or "melatonin therapy" and "transplant pharmacology" or "transplant physiology" or "transplant therapy" or "Transplant therapy". Experiments on the organs of the reproductive system were not included. After analysis, five articles were selected after reading the title and abstract of 50 manuscripts. The works were divided into two aspects: a) analysis of the influence of the organ transplantation procedure on melatonin production; b) action of melatonin on organ transplantation.
RESULTS
The cardiac transplantation surgical procedure, immunosuppression, and graft did not influence melatonin secretion in rodents, but there was a significant reduction of melatonin in the renal transplantation procedure in patients with renal insufficiency. Melatonin administration in experimental models decreased rejection and improved transplant success.
CONCLUSION
Studies show that melatonin can reduce organ and species dependence, and the use of melatonin decreases graft rejection.
Topics: Animals; Antioxidants; Graft Rejection; Graft Survival; Heart Transplantation; Humans; Immunosuppression Therapy; Kidney Transplantation; Melatonin; Organ Transplantation; Rats
PubMed: 32520157
DOI: 10.1590/1806-9282.66.3.353