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Journal of Thrombosis and Haemostasis :... Jun 2015There has been extraordinary progress over the last half-century in the field of medical transplantation in which tissue, organs, or body parts from one human are placed... (Review)
Review
There has been extraordinary progress over the last half-century in the field of medical transplantation in which tissue, organs, or body parts from one human are placed into another. Solid organ transplants have allowed thousands of children with otherwise devastating inherited or acquired disorders to survive. Depending upon the clinical situation, there are many specific peri-transplant issues that must be carefully addressed to optimize outcomes. Although surgical, immunologic, and infectious concerns are usually in the forefront, important aspects regarding hemostasis frequently arise. The number of solid organs that can be successfully transplanted in children has expanded over the last decades and includes kidney, liver, heart, lung, intestine, pancreas, and thymus. Bleeding complications may occur in the setting of organ failure prior to transplantation, during the surgical procedure, or in the post-transplant setting, and can results in significant morbidity. This report will focus on preventing and managing non-surgical-related bleeding complications in children undergoing liver, heart, kidney transplantation, in whom there are often unique aspects of coagulation to be considered.
Topics: Adolescent; Age Factors; Blood Coagulation; Blood Coagulation Disorders; Child; Child, Preschool; Coagulants; Heart Transplantation; Hemorrhage; Humans; Infant; Kidney Transplantation; Liver Transplantation; Risk Factors; Treatment Outcome
PubMed: 26149048
DOI: 10.1111/jth.12913 -
Current Opinion in Organ Transplantation Feb 2022Solid organ transplantation (SOT) has become a widely accepted therapy for end-stage disease across the spectrum of thoracic and abdominal organs. With contemporary... (Review)
Review
PURPOSE OF REVIEW
Solid organ transplantation (SOT) has become a widely accepted therapy for end-stage disease across the spectrum of thoracic and abdominal organs. With contemporary advances in medical and surgical therapies in transplantation, candidates for SOT are increasingly older with a larger burden of comorbidities, including cardiovascular disease (CVD). CVD, in particular, is a leading cause of morbidity and mortality in SOT candidates with end-stage disease of noncardiac organs [1].
RECENT FINDINGS
Identification of coronary artery disease (CAD), heart failure, and valvular disease are important in noncardiac SOT to ensure both appropriate peri-transplant management and equitable organ allocation. Although the American College of Cardiology (ACC) and the American Heart Association (AHA) have published guidelines and recommendations for the perioperative cardiovascular evaluation of patients undergoing noncardiac surgery, the implications of both symptomatic and asymptomatic CVD differ in patients with end-stage organ failure being considered for SOT when compared to the general population.
SUMMARY
Herein, we review the epidemiology, diagnosis, and evidence for the management of CVD in kidney and liver transplantation, combining current guidelines from the 2012 ACC/AHA scientific statement on cardiac disease evaluation in SOT with more contemporary evidenced-based algorithms.
Topics: American Heart Association; Cardiovascular Diseases; Coronary Artery Disease; Humans; Organ Transplantation; Risk Factors; United States
PubMed: 34939961
DOI: 10.1097/MOT.0000000000000942 -
Experimental and Clinical... Aug 2022With the introduction of effective screening strategies, cancers are being diagnosed at earlier stages and cumulative survival rates of patients with cancer are... (Review)
Review
With the introduction of effective screening strategies, cancers are being diagnosed at earlier stages and cumulative survival rates of patients with cancer are increasing. On the other hand, the number of people who would benefit from a solid-organ transplant is also increasing. Continued organ shortages have resulted in evaluations of further potential donors, including patients with cancer. The literature related to donor- derived malignancy transmission is mostly limited to case reports, data registry series, and retrospective studies. According to data from the literature, organs from deceased and living donors with some types of current or past cancers may be safely used for transplant. The risk of cancer transmission must be balanced against the risk of a patient dying or becoming clinically worse during the period of waiting for a transplant on a case-by-case basis. Current transplant protocols are only allowed for patients with central nervous system tumors in Turkey and most other countries. However, some other patients with a history of cancer can be acceptable as organ donors. This review has summarized data from the literature.
Topics: Central Nervous System Neoplasms; Humans; Living Donors; Organ Transplantation; Retrospective Studies; Tissue Donors; Tissue and Organ Procurement; Treatment Outcome
PubMed: 36018022
DOI: 10.6002/ect.DonorSymp.2022.L30 -
Blood Advances Mar 2018Sickle-cell disease (SCD) leads to recurrent vaso-occlusive crises, chronic end-organ damage, and resultant physical, psychological, and social disabilities. Although... (Review)
Review
Sickle-cell disease (SCD) leads to recurrent vaso-occlusive crises, chronic end-organ damage, and resultant physical, psychological, and social disabilities. Although hematopoietic stem-cell transplantation (HSCT) is potentially curative for SCD, this procedure is associated with well-recognized morbidity and mortality and thus is ideally offered only to patients at high risk of significant complications. However, it is difficult to identify patients at high risk before significant complications have occurred, and once patients experience significant organ damage, they are considered poor candidates for HSCT. In turn, patients who have experienced long-term organ toxicity from SCD such as renal or liver failure may be candidates for solid-organ transplantation (SOT); however, the transplanted organs are at risk of damage by the original disease. Thus, dual HSCT and organ transplantation could simultaneously replace the failing organ and eliminate the underlying disease process. Advances in HSCT conditioning such as reduced-intensity regimens and alternative donor selection may expand both the feasibility of and potential donor pool for transplantation. This review summarizes the current state of HSCT and organ transplantation in SCD and discusses future directions and the clinical feasibility of dual HSCT/SOT.
Topics: Anemia, Sickle Cell; Hematopoietic Stem Cell Transplantation; Humans; Organ Transplantation; Tissue Donors
PubMed: 29535106
DOI: 10.1182/bloodadvances.2017012500 -
Seminars in Nephrology Jul 2022Despite the effectiveness of solid organ transplantation, progress to close the gap between donor organs and demand remains slow. An organ shortage increases the waiting... (Review)
Review
Despite the effectiveness of solid organ transplantation, progress to close the gap between donor organs and demand remains slow. An organ shortage increases the waiting time for transplant and involves significant costs including patient morbidity and mortality. Against the background of a low deceased organ donation rate, this article discusses the option of introducing incentives and removing disincentives to deceased organ donation. Perspectives from ethics, general public opinion, and the health care profession are examined to ensure a comprehensive appraisal and illustrate different facets of opinion on this complex area. Special cultural and psychosocial considerations in Asia, including the family based consent model, are discussed.
Topics: Humans; Tissue Donors; Motivation; Tissue and Organ Procurement; Organ Transplantation; Attitude
PubMed: 36577641
DOI: 10.1016/j.semnephrol.2022.07.002 -
Annals of Transplantation Sep 2013Gender as a critical, intrinsic, non-immunologic factor plays a pivotal role in the field of transplantation. The gender of donors and recipients is involved in the... (Review)
Review
Gender as a critical, intrinsic, non-immunologic factor plays a pivotal role in the field of transplantation. The gender of donors and recipients is involved in the entire process, including organ donation and transplant surgery. This review article aims to summarize the literature related to the role of gender in solid organ donation and transplantation and to unveil the underlying mechanism by which gender mismatch between donor and recipient impacts transplant rejection. A systematic search was conducted through PubMed by using the following key words: "gender", or "sex", and "transplant", "organ donation" for published articles. The prima facie evidence demonstrated that females are more likely to donate their organs and are less willing than males to accept transplant surgery; however, their donated liver organs will have a higher risk of graft failure compared with males. With respect to kidney, heart, and lung transplantations, the role of gender remains controversial. Results of animal studies support the negative impact of gender mismatch on allograft function. In conclusion, our present study advances the knowledge of gender issues in the field of solid organ donation and transplantation. In general, gender mismatch is not advantageous to transplant outcome, as evidenced by many aspects of biological investigations on immunogenicity of H-Y antigen to females. Therefore, gender issues should be highlighted and an a priori intervention is needed to improve graft survival in clinical practice.
Topics: Female; Graft Rejection; Graft Survival; Humans; Male; Organ Transplantation; Sex Factors; Tissue Donors; Tissue and Organ Procurement
PubMed: 24064859
DOI: 10.12659/AOT.889323 -
Vaccines Aug 2022Solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection is extremely rare but can occur. T-cell recognition of antigen is the primary and central event... (Review)
Review
BACKGROUND
Solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection is extremely rare but can occur. T-cell recognition of antigen is the primary and central event that leads to the cascade of events that result in rejection of a transplanted organ.
OBJECTIVES
To describe the results of a systematic review for solid organ rejections following SARS-CoV-2 vaccination or COVID-19 infection.
METHODS
For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines for studies on the incidence of solid organ rejection post-SARS-CoV-2 vaccination or COVID-19 infection, published from 1 December 2019 to 31 May 2022, with English language restriction.
RESULTS
One hundred thirty-six cases from fifty-two articles were included in the qualitative synthesis of this systematic review (56 solid organs rejected post-SARS-CoV-2 vaccination and 40 solid organs rejected following COVID-19 infection). Cornea rejection (44 cases) was the most frequent organ observed post-SARS-CoV-2 vaccination and following COVID-19 infection, followed by kidney rejection (36 cases), liver rejection (12 cases), lung rejection (2 cases), heart rejection (1 case) and pancreas rejection (1 case). The median or mean patient age ranged from 23 to 94 years across the studies. The majority of the patients were male ( = 51, 53.1%) and were of White (Caucasian) ( = 51, 53.7%) and Hispanic ( = 15, 15.8%) ethnicity. A total of fifty-six solid organ rejections were reported post-SARS-CoV-2 vaccination [Pfizer-BioNTech ( = 31), Moderna ( = 14), Oxford Uni-AstraZeneca ( = 10) and Sinovac-CoronaVac ( = 1)]. The median time from SARS-CoV-2 vaccination to organ rejection was 13.5 h (IQR, 3.2-17.2), while the median time from COVID-19 infection to organ rejection was 14 h (IQR, 5-21). Most patients were easily treated without any serious complications, recovered and did not require long-term allograft rejection therapy [graft success ( = 70, 85.4%), graft failure ( = 12, 14.6%), survived ( = 90, 95.7%) and died ( = 4, 4.3%)].
CONCLUSION
The reported evidence of solid organ rejections post-SARS-CoV-2 vaccination or COIVD-19 infection should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively small in relation to the hundreds of millions of vaccinations that have occurred, and the protective benefits offered by SARS-CoV-2 vaccination far outweigh the risks.
PubMed: 36016180
DOI: 10.3390/vaccines10081289 -
Frontiers in Endocrinology 2018Mammalian silent information regulator 1 (SIRT1) is reported to play a role in cancers of the secretory organs, including thyroid, pancreatic endocrine, and ovarian... (Review)
Review
Mammalian silent information regulator 1 (SIRT1) is reported to play a role in cancers of the secretory organs, including thyroid, pancreatic endocrine, and ovarian tumors [1, 2, 3, 4]. A recent meta-analysis conducted on 37 selected studies of human cancers analyzed the correlations of overall survival (OS), disease-free survival (DFS) and relapse-free survival (RFS) with SIRT1 expression [5]. This study reported that SIRT1 overexpression was associated with a worse OS in liver and lung cancers, while it was not correlated with OS in breast cancer, colorectal cancer, or gastric carcinoma. Collectively, the meta-analysis revealed that an unfavorable OS was associated with SIRT1 expression for solid malignancies. Given the growing importance of this class of lysine/histone deacetylases in human endocrine malignancies, a rational and focused literature assessment is desirable in light of future clinical translations.
PubMed: 30319549
DOI: 10.3389/fendo.2018.00569 -
Cells Sep 2023Organ transplantation remains the only treatment option for patients with end-stage organ dysfunction. However, there are numerous limitations that challenge its... (Review)
Review
Organ transplantation remains the only treatment option for patients with end-stage organ dysfunction. However, there are numerous limitations that challenge its clinical application, including the shortage of organ donations, the quality of donated organs, injury during organ preservation and reperfusion, primary and chronic graft dysfunction, acute and chronic rejection, infection, and carcinogenesis in post-transplantation patients. Acute and chronic inflammation and cell death are two major underlying mechanisms for graft injury. Necroptosis is a type of programmed cell death involved in many diseases and has been studied in the setting of all major solid organ transplants, including the kidney, heart, liver, and lung. It is determined by the underlying donor organ conditions (e.g., age, alcohol consumption, fatty liver, hemorrhage shock, donation after circulatory death, etc.), preservation conditions and reperfusion, and allograft rejection. The specific molecular mechanisms of necroptosis have been uncovered in the organ transplantation setting, and potential targeting drugs have been identified. We hope this review article will promote more clinical research to determine the role of necroptosis and other types of programmed cell death in solid organ transplantation to alleviate the clinical burden of ischemia-reperfusion injury and graft rejection.
PubMed: 37759518
DOI: 10.3390/cells12182296 -
Clinical Microbiology and Infection :... Jun 2022The COVID-19 pandemic has influenced the field of solid organ transplantation (SOT) in many ways. COVID-19 has led to programmatic impacts and changes in donor and... (Review)
Review
BACKGROUND
The COVID-19 pandemic has influenced the field of solid organ transplantation (SOT) in many ways. COVID-19 has led to programmatic impacts and changes in donor and recipient selection. Several studies have evaluated the course, optimal treatment, and prevention of COVID-19 in SOT recipients.
OBJECTIVES
To review the literature on COVID-19 in SOT recipients.
SOURCES
PubMed, Web of Science, and Google Scholar were searched. The search was restricted to articles published between January 1, 2019 and December 1, 2021.
CONTENT
The COVID-19 pandemic initially led to a decreased volume of solid organ transplants. However, transplant volumes at most centres have rebounded. Donor selection remains an incompletely defined issue. Several reports suggest that donor-derived SARS-CoV-2 infections occur only in lung transplant recipients and that other organs from SARS-CoV-2 PCR-positive donors could potentially be safely used. However, these data are limited to case series. Transplantation for end-stage lung disease after COVID-19 infection is increasingly common and has been performed with acceptable outcomes. In acute COVID-19 in a transplant candidate, transplantation should be delayed when feasible. After adjustment, mortality after COVID-19 appear similar in SOT recipients compared to the general population, with notable increased use of antiviral and anti-inflammatory treatment options. Prevention of COVID-19 is key in SOT recipients. Vaccination of SOT recipients and anyone who is in contact with SOT recipients is one of the cornerstones of prevention. Nonpharmacological interventions such as face coverings, hand hygiene, and physical distancing remain ever important as well.
IMPLICATIONS
The COVID-19 pandemic continues to have an important impact on SOT candidates and recipients. Prevention of infection is the most important measure and requires careful attention to approaches to vaccination and messaging of the ongoing need for face coverings, physical distancing, and hand hygiene.
Topics: COVID-19; Humans; Organ Transplantation; Pandemics; SARS-CoV-2; Transplant Recipients
PubMed: 35189336
DOI: 10.1016/j.cmi.2022.02.005