-
Current Opinion in Organ Transplantation Oct 2021The Final Rule clearly states that geography should not be a determinant of a chance of a potential candidate being transplanted. There have been multiple concerns about... (Review)
Review
PURPOSE OF REVIEW
The Final Rule clearly states that geography should not be a determinant of a chance of a potential candidate being transplanted. There have been multiple concerns about geographic disparities in patients in need of solid organ transplantation. Allocation policy adjustments have been designed to address these concerns, but there is little evidence that the disparities have been solved. The purpose of this review is to describe the main drivers of geographic disparities in solid organ transplantation and how allocation policy changes and other potential actions could impact these inequalities.
RECENT FINDINGS
Geographical disparities have been reported in kidney, pancreas, liver, and lung transplantation. Organ Procurement and Transplant Network has modified organ allocation rules to underplay geography as a key determinant of a candidates' chance of receiving an organ. Thus, heart, lung, and more recently liver and Kidney Allocation Systems have incorporated broader organ sharing to reduce geographical disparities. Whether these policy adjustments will indeed eliminate geographical disparities are still unclear.
SUMMARY
Modern allocation policy focus in patients need, regardless of geography. Innovative actions to further reduce geographical disparities are needed.
Topics: Humans; Lung Transplantation; Organ Transplantation; Tissue Donors; Tissue and Organ Procurement; Transplants; United States; Waiting Lists
PubMed: 34411039
DOI: 10.1097/MOT.0000000000000914 -
International Journal of Surgery... Oct 2020Dynamic preservation strategies are a promising option to improve graft quality before transplantation, and to extend preservation time for either logistic or treatment... (Review)
Review
Dynamic preservation strategies are a promising option to improve graft quality before transplantation, and to extend preservation time for either logistic or treatment reasons. In contrast to normothermic oxygenated perfusion, which intends to mimic physiological conditions in the human body, with subsequent clinical application for up to 24 hrs, hypothermic perfusion is mainly used for a relatively short period with protection of mitochondria and subsequent reduction of oxidative injury upon implantation. The results from two randomized controlled trials, where recruitment has finished are expected this year. Both ex situ perfusion techniques are increasingly applied in clinical transplantation including recent reports on viability assessment, which could open the door for an increased liver utilization in the future.
Topics: Humans; Hypothermia, Induced; Liver; Liver Transplantation; Organ Preservation; Perfusion; Transplants; Treatment Outcome
PubMed: 32353556
DOI: 10.1016/j.ijsu.2020.04.057 -
Current Opinion in Cardiology Mar 2023Despite advances in the technology of mechanical circulatory support, the need for heart transplantation continues to grow. The longevity of heart transplants continues... (Review)
Review
PURPOSE OF REVIEW
Despite advances in the technology of mechanical circulatory support, the need for heart transplantation continues to grow. The longevity of heart transplants continues to be superior to mechanical solutions, though the short-term differences are shrinking. In this review, we cover three timely developments and summarize the recent literature.
RECENT FINDINGS
After stagnant rates of heart transplant activity for some years, recently, transplant volume has increased. The developments that have ignited interest have been the use of hepatitis C infected donors, which can now be safely transplanted with the advent of curative oral regimens, and the worldwide use of donors following withdrawal of life support as opposed to traditional brain death donors. In addition, the recent experience of human cardiac xenotransplantation has been very exciting, and though it is not of clinical utility yet, it holds the promise for a virtually unlimited supply of organs at some time in the future.
SUMMARY
Much work remains to be done, but together, all three of these developments are exciting and important to be aware of in the future. Each will contribute to additional donors for human heart transplantation and hopefully will alleviate suffering and death on the waiting list.
Topics: Humans; Heart Transplantation; Tissue Donors; Heart; Transplants
PubMed: 36598449
DOI: 10.1097/HCO.0000000000001023 -
Current Opinion in Organ Transplantation Aug 2020Vascularized composite allograft (VCA) transplants constitute multiple tissues transplanted together as one functional unit. These procedures are increasing in frequency... (Review)
Review
PURPOSE OF REVIEW
Vascularized composite allograft (VCA) transplants constitute multiple tissues transplanted together as one functional unit. These procedures are increasing in frequency and complexity, yet data about graft survival, quality of life, and infection risk remain limited.
RECENT FINDINGS
Informative guidance for this patient population is often inferred from the solid organ transplantation literature. Yet, it is important to understand that VCA transplantation additionally carries its own significant and distinctive risk factors for infection.
SUMMARY
In this review, we give an overview of previously described infectious complications of VCA transplantation in the literature, discuss risk factors for future infection in these patients, and discuss how to manage such obstacles.
Topics: Composite Tissue Allografts; Graft Survival; Humans; Infections; Organ Transplantation; Quality of Life; Vascularized Composite Allotransplantation
PubMed: 32487889
DOI: 10.1097/MOT.0000000000000780 -
International Journal of Surgery... Oct 2020A dilemma of graft selection between right or left livers occurs during the planning of living-donor liver transplantation (LDLT) as well as splitting a whole liver...
A dilemma of graft selection between right or left livers occurs during the planning of living-donor liver transplantation (LDLT) as well as splitting a whole liver graft into full right/full left grafts in deceased-donor liver transplantation. The right liver's relation to the whole liver could be considered as the trunk of a tree; it has a larger volume, the main axis of bile ducts, and the inferior vena cava mainly belongs to the right liver. Therefore, it was considered as the standard graft in LDLTs. Whether to procure the middle hepatic vein (MHV) with a right liver graft or to leave it attached to the left-liver remnant largely depends on the transplant institute. Recently, most transplant institutes tend to leave the MHV with the left liver for the sake of donor safety. Unlike hepatectomy for liver tumors, it is vital to preserve inflow and outflow for both the resected as well as the remaining livers. While procuring any graft type, the most important is to procure a liver graft with reconstructable portal veins, hepatic arteries, hepatic veins, and bile ducts, which should be well preoperatively planned using 3D-computed tomography with considerations given to graft volume and potential congestion areas.
Topics: Adult; Female; Hepatectomy; Hepatic Artery; Hepatic Veins; Humans; Liver; Liver Transplantation; Living Donors; Male; Middle Aged; Portal Vein; Tissue and Organ Harvesting; Transplants; Vena Cava, Inferior
PubMed: 32619620
DOI: 10.1016/j.ijsu.2020.06.022 -
Liver Transplantation : Official... Jun 2018
Topics: Child; Humans; Liver Transplantation; Transplants; Waiting Lists
PubMed: 29729118
DOI: 10.1002/lt.25192 -
ACS Nano Nov 2021Targeted delivery of therapeutics through the use of nanoparticles (NPs) has emerged as a promising method that increases their efficacy and reduces their side effects.... (Review)
Review
Targeted delivery of therapeutics through the use of nanoparticles (NPs) has emerged as a promising method that increases their efficacy and reduces their side effects. NPs can be tailored to localize to selective tissues through conjugation to ligands that bind cell-specific receptors. Although the vast majority of nanodelivery platforms have focused on cancer therapy, efforts have begun to introduce nanotherapeutics to the fields of immunology as well as transplantation. In this review, we provide an overview from a clinician's perspective of current nanotherapeutic strategies to treat solid organ transplants with NPs during the time interval between organ harvest from the donor and placement into the recipient, an innovative technology that can provide major benefits to transplant patients. The use of normothermic machine perfusion (NMP), which is associated with preserving the function of the organ following transplantation, also provides an ideal opportunity for a localized, sustained, and controlled delivery of nanotherapeutics to the organ during this critical time period. Here, we summarize previous endeavors to improve transplantation outcomes by treating the organ with NPs prior to placement in the recipient. Investigations in this burgeoning field of research are promising, but more extensive studies are needed to overcome the physiological challenges to achieving effective nanotherapeutic delivery to transplanted organs discussed in this review.
Topics: Humans; Organ Preservation; Perfusion; Transplants; Organ Transplantation
PubMed: 34714050
DOI: 10.1021/acsnano.1c04707 -
Progress in Brain Research 2012Cellular transplantation to the brain and spinal cord remains a promising approach both for probing basic biological questions and as a potential therapy for... (Review)
Review
Cellular transplantation to the brain and spinal cord remains a promising approach both for probing basic biological questions and as a potential therapy for neurological diseases. This chapter summarizes some of the main constraints that continue to limit general biological applications and, specifically, clinical applications. These constraints include the critical features of the successful donor cell as well as those of the receptive host tissue and organism. In addition, we explore future directions, with special emphasis on genetic engineering, combinations of novel cell types combined with trophic factors, and training of the host organism to improve the accurate integration of grafted cells. Some speculations are made regarding universal donor cells, but these advances will depend on additional basic work to bring this approach to the clinic. The convergence of advanced molecular and cellular methods together with improved methods of in vivo imaging adds to our optimism for significant advances in cellular transplantation in the near future.
Topics: Animals; Cell Transplantation; Humans; Nervous System Diseases; Transplants
PubMed: 23195412
DOI: 10.1016/B978-0-444-59575-1.00001-6 -
Progress in Brain Research 2012Cellular transplantation to the brain and spinal cord remains a promising approach both for probing basic biological questions and as a potential therapy for... (Review)
Review
Cellular transplantation to the brain and spinal cord remains a promising approach both for probing basic biological questions and as a potential therapy for neurological diseases. This chapter summarizes some of the main constraints that continue to limit general biological applications and, specifically, clinical applications. These constraints include the critical features of the successful donor cell as well as those of the receptive host tissue and organism. In addition, we explore future directions, with special emphasis on genetic engineering, combinations of novel cell types combined with trophic factors, and training of the host organism to improve the accurate integration of grafted cells. Some speculations are made regarding universal donor cells, but these advances will depend on additional basic work to bring this approach to the clinic. The convergence of advanced molecular and cellular methods together with improved methods of in vivo imaging adds to our optimism for significant advances in cellular transplantation in the near future.
Topics: Bioengineering; Brain; Cell Transplantation; Humans; Spinal Cord; Transplantation; Transplants
PubMed: 23186707
DOI: 10.1016/B978-0-444-59544-7.00001-9 -
International Journal of Surgery... Oct 2020To expand the donor pool of suitable organs for transplantation, there is an increased interest in utilizing extended criteria donor grafts (ECD). Ex-situ machine... (Review)
Review
To expand the donor pool of suitable organs for transplantation, there is an increased interest in utilizing extended criteria donor grafts (ECD). Ex-situ machine perfusion has shown to be a promising new modality in the organ preservation field to reduce injury and recover ECD liver grafts. Machine perfusion (MP) is considered a significant improvement in the field of transplantation over the past 20 years. Normothermic machine perfusion has entered the clinical arena in the last decade and has shown promising results to improve the quality of marginal organs and to increase the pool of liver grafts. It allows assessment of viability and function of grafts prior to transplantation. In addition, it has the potential to serve as a platform for pharmacologic organ treatment and graft optimization. Machine perfusion moved from the experimental phase to a more mature phase after safety was confirmed by initial clinical trials. Now, it is time to confirm its superiority and cost-effectiveness before a broader clinical use. In this paper we review the history, current status including outcomes of all clinical trials, limitations, and future trends of normothermic machine preservation.
Topics: Clinical Trials as Topic; Humans; Liver; Liver Transplantation; Organ Preservation; Perfusion; Transplants; Treatment Outcome
PubMed: 32417462
DOI: 10.1016/j.ijsu.2020.05.026