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Experimental Biology and Medicine... May 2019Over the past several decades, ex vivo perfusion has emerged as a promising technology for the assessment, preservation, and recovery of donor organs. Many exciting... (Review)
Review
Over the past several decades, ex vivo perfusion has emerged as a promising technology for the assessment, preservation, and recovery of donor organs. Many exciting pre-clinical findings have now been translated to clinical use, and successful transplantation following ex vivo perfusion has been achieved for heart, lung, and liver. While machine perfusion provides distinct advantages over traditional cold preservation, many challenges remain, including that of long-term (multi-day) ex vivo support. Here, we provide an overview of the current status of ex vivo machine perfusion in the pre-clinical and clinical setting and share our perspective on the future direction of the field.
Topics: Bioengineering; Cadaver; Cold Ischemia; Forecasting; Heart; Heart Transplantation; Humans; Liver; Liver Transplantation; Lung; Lung Transplantation; Organ Preservation; Perfusion; Reperfusion Injury; Tissue and Organ Harvesting; Transplants; Warm Ischemia
PubMed: 30889963
DOI: 10.1177/1535370219834498 -
Clinics (Sao Paulo, Brazil) 2019
Topics: Brazil; Humans; Tissue and Organ Procurement; Transplantation; Transplants
PubMed: 31116230
DOI: 10.6061/clinics/2019/e832 -
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 -
Frontiers in Immunology 2019Recent data from the World Population Prospects projects that, by 2050, nearly all regions in the world will have a quarter or more of the population aged 60 and above.... (Review)
Review
Recent data from the World Population Prospects projects that, by 2050, nearly all regions in the world will have a quarter or more of the population aged 60 and above. Chronic kidney disease (CKD) has a high global prevalence (~13%) worldwide, and the prevalence of chronic kidney disease and end-stage kidney disease increase with age. Kidney transplantation remains the best therapeutic option for end-stage kidney disease, offering a survival benefit in comparison with dialysis maintenance for most patients. This review focuses on immunological aspects of kidney transplantation in older patients and marginal donors, i.e., 60 years or older deceased kidney donors or 50-59 years old deceased kidney donors with comorbidities. Clinical outcomes of kidney recipients in terms of renal and patient survival are more than acceptable even for patients over 70. In this population, the first cause of graft loss is death with a functional graft. However, the inherent issues of these transplantations are the acceptance or refusal of frail kidney from an old donor and the increased immunogenicity of these organs in balance with potential frail and immunosenescent recipients. Finally, the immunosuppressive regimen itself is a challenge for the future of the transplant, to prevent adverse effects such as nephrotoxicity and higher risk of infections or cancer in a population already at risk. Belatacept may have a good place in the immunosuppressive strategy to improve efficacy and the safety posttransplantation.
Topics: Age Factors; Aged; Allografts; Female; Humans; Kidney Transplantation; Male; Middle Aged; Patient Selection; Tissue Donors
PubMed: 32082306
DOI: 10.3389/fimmu.2019.03142 -
Bioscience Trends Jul 2023The match between donor and recipient (D-R match) in the field of liver transplantation (LT) is one of the most widely debated topics today. Within the cohort of... (Review)
Review
The match between donor and recipient (D-R match) in the field of liver transplantation (LT) is one of the most widely debated topics today. Within the cohort of patients waiting for a transplant, better matching of the donor organ to the recipient will improve transplant outcomes, and benefit the waiting list by minimizing graft failure and the need for re-transplantation. In an era of suboptimal matches due to the sparse organ pool and the increase in extended criteria donors (ECD), ensuring adequate outcomes becomes the primary goal for clinicians in the field. The objective of this mini-review is to analyze the main variables in the evaluation of the D-R match to ensure better outcomes, the existence of scores that can help in the realization of this match, and the latest advances made thanks to the technology and development of artificial intelligence (AI).
Topics: Humans; Adult; Liver Transplantation; Artificial Intelligence; Graft Survival; Tissue Donors; Transplants
PubMed: 37344395
DOI: 10.5582/bst.2023.01076 -
Journal of the American Society of... Jun 2017
Topics: Acidosis; Allografts; Humans; Kidney; Kidney Transplantation; Transplantation, Homologous
PubMed: 28348064
DOI: 10.1681/ASN.2017020133 -
Cell and Tissue Banking Nov 2010The importance of effective and timely traceability in both the recall of substances of human origin (blood, cells, tissues and organs) implicated in infectious...
The importance of effective and timely traceability in both the recall of substances of human origin (blood, cells, tissues and organs) implicated in infectious transmission, and in the prevention of inappropriate use of substances of human origin is now well recognised. However, traceability remains poorly understood and inadequately controlled in many cases. In particular there is: a lack of appreciation of the complexity of the traceability pathway; a fragmented approach to traceability; and, an assumption that traceability data is static. The traceability path for a single tissue donor may involve dozens or even hundreds of different organizations, each responsible for one segment of the path. Whilst responsibility within each organization may be clearly defined, responsibility for maintaining the interfaces between organizations is often less clear. Traceability is seldom regarded in a holistic manner, the assumption being made that if each segment of the pathway is correctly maintained then the full path will be intact. End to end traceability audits are not routinely performed, and the only true test of the trail occurs when recall is required-often with inadequate results.
Topics: Electronic Data Processing; Humans; Organ Transplantation; Records; Tissue Donors; Tissue Transplantation; Transplants
PubMed: 20628821
DOI: 10.1007/s10561-010-9195-3 -
American Journal of Transplantation :... Oct 2021Although cellular transplantation remains a relatively small field compared to solid organ transplantation, the prospects for advancement in basic science and clinical... (Review)
Review
Although cellular transplantation remains a relatively small field compared to solid organ transplantation, the prospects for advancement in basic science and clinical care remain bountiful. In this review, notable historical events and the current landscape of the field of cellular transplantation are reviewed with an emphasis on islets (allo- and xeno-), hepatocytes (including bioartificial liver), adoptive regulatory immunotherapy, and stem cells (SCs, specifically endogenous organ-specific and mesenchymal). Also, the nascent but rapidly evolving field of three-dimensional bioprinting is highlighted, including its major processing steps and latest achievements. To reach its full potential where cellular transplants are a more viable alternative than solid organ transplants, fundamental change in how the field is regulated and advanced is needed. Greater public and private investment in the development of cellular transplantation is required. Furthermore, consistent with the call of multiple national transplant societies for allo-islet transplants, the oversight of cellular transplants should mirror that of solid organ transplants and not be classified under the unsustainable, outdated model that requires licensing as a drug with the Food and Drug Administration. Cellular transplantation has the potential to bring profound benefit through progress in bioengineering and regenerative medicine, limiting immunosuppression-related toxicity, and providing markedly reduced surgical morbidity.
Topics: Diabetes Mellitus, Type 1; Humans; Immune Tolerance; Immunosuppression Therapy; Islets of Langerhans Transplantation; Stem Cells; Transplants
PubMed: 34212485
DOI: 10.1111/ajt.16740 -
Blood Mar 2022
Topics: Kidney Transplantation; Standard of Care; Transplants
PubMed: 35357483
DOI: 10.1182/blood.2022015612 -
Transplant International : Official... Jul 2019
Topics: Allografts; Cohort Studies; Hand Transplantation; Infections; Upper Extremity
PubMed: 31140659
DOI: 10.1111/tri.13465