by Marion Hemmersbach-Miller  , Cameron R. Wolfe  and Kenneth E. Schmader

Received: 30 November 2018;  Published: 01 February 2019;  doi: 10.21926/obm.transplant.1901046

In the U.S., older adults aged 65 or above comprise nearly one quarter of the solid organ transplant (SOT) waitlists, and the number of transplants performed in this age group continues to increase. There are no specific guidelines for the assessment and follow up of the older SOT candidate or recipient. Older adults are at increased risk of infectious complications after SOT. Despite these complications and even with the use of suboptimal donors, overall outcomes are favorable. We provide an overview to specific c [...]

by Michael Czapka  , Carlos A.Q. Santos  and Laurie A. Proia

Received: 08 October 2018;  Published: 31 January 2019;  doi: 10.21926/obm.transplant.1901045

Mucormycosis is a rare fungal infection associated with high morbidity and mortality that typically afflicts immunocompromised hosts. We present a case of isolated hepatic mucormycosis with Rhizopus spp. that developed in the early post-transplant period. Initial presentation was concerning for allograft rejection, but definitive diagnosis was made with histopathology and fungal culture. The patient had a favourable outcome with surgical resection, a course of liposomal amphotericin B combined with micafungin, and [...]

by Anouk A. J. Hamers  , Sunil K. Joshi  and Asha B. Pillai

Received: 29 September 2018;  Published: 31 January 2019;  doi: 10.21926/obm.transplant.1901044

The success of tissue transplantation from a healthy donor to a diseased individual (allo-transplantation) is regulated by the immune systems of both donor and recipient. Developing a state of specific non‐reactivity between donor and recipient, while maintaining the salutary effects of immune function in the recipient, is called “immune (transplantation) tolerance”. In the classic early post‐transplant period, minimizing bidirectional donor ←→ recipient reactivity requires the administration [...]

by Carly M. Darden  , Srividya Vasu  , Kenjiro Kumano  , Bashoo Naziruddin  and Michael C. Lawrence

Received: 21 November 2018;  Published: 29 January 2019;  doi: 10.21926/obm.transplant.1901043

Islet transplantation is a minimally invasive cell based replacement therapy to prevent or reverse diabetes or hypoglycemia through natural hormonal responses to regulate blood glucose. However, extending the islet graft functional lifespan remains a challenge that prevents long-term success and widespread use of the procedure. Islets are subject to stress and damage and undergo immunological assault during transplantation procedures. Current treatments to prevent immune reactivity toward the graft come with toxic [...]

by Alexandria J Coughlan  , Kendall R. McEachron  , Mariya E. Skube  , Sydne Muratore  , Melena D. Bellin  and Greg J Beilman

Received: 29 October 2018;  Published: 24 January 2019;  doi: 10.21926/obm.transplant.1901042

The current predominant location for allo- and auto-transplantation of islets is the liver. Despite the historical success of this site, recent studies have revealed multiple disadvantages. Portal hypertension, portal vein thrombosis, bleeding, low oxygen tension, instant blood mediated inflammatory reaction, inadequate alpha cell function, and delays in neovascularization are factors that continue to drive researchers to explore alternative sites for islet transplantation. Factors of an optimal site include: capac [...]

by Darren E. Stewart  , Amber R. Wilk  and David K. Klassen

Received: 14 December 2018;  Published: 22 January 2019;  doi: 10.21926/obm.transplant.1901041

Background: This study examines very recent trends in deceased donor kidney transplantation to assess the performance of the kidney allocation system (KAS), implemented December 4, 2014, and whether bolus effects associated with KAS have stabilized nearly four years after implementation. Methods: The overall number of deceased donor kidney transplants, as well as the proportion of transplants by recipient and transplant characteristics, were calculated monthly from December 2013 through September 2018 and examined [...]

by Margaret E. Newman  , Kenneth Pursell  and David Pitrak

Received: 05 November 2018;  Published: 20 January 2019;  doi: 10.21926/obm.transplant.1901040

Infection with parvovirus B19 is common, with up to 55% of adults showing seropositive evidence of prior infection. Clinical disease can occur due to acute infection, chronic persistent viremia, rarely secondary infection, or possibly viral reactivation of latent virus. The clinical presentation of primary infection depends on age, the presence of a hematologic condition, and immune status. We report a renal transplant recipient who developed transfusion dependent anemia refractory to erythropoietin that responded [...]

by Spinello Antinori  and Laura Milazzo

Received: 28 October 2018;  Published: 15 January 2019;  doi: 10.21926/obm.transplant.1901039

Solid organ transplantation (SOT) is increasingly employed worldwide to treat several diseases causing both acute and chronic organ failure. Recipients of SOT are at an increased risk to develop infections as a consequence of immunosuppressive therapy. Sometimes such infections may be acquired by the transplanted organ or by reactivation of a previously acquired latent infection. The globalization and the increase of international travel poses a risk for exposure to infections such as Chagas disease (CD), leishmani [...]

by Makeda L. Robinson  , Kyle Enriquez  and Dora Y. Ho

Received: 02 November 2018;  Published: 08 January 2019;  doi: 10.21926/obm.transplant.1901038

Flaviviruses can cause epidemics and endemics with substantial public health threat and economic impacts. In the last few decades, many flaviviruses have re-emerged or expanded their territories to new regions or continents, including West Nile virus (WNV) which has become endemic in the US since its arrival in 1999 and Zika virus (ZIKV) which recently spread across the Americas. These events demonstrate the speed with which a vector-borne pathogen can disseminate when introduced into a susceptible population with [...]

by David C. Gaston  and Marwan M. Azar

Received: 14 November 2018;  Published: 29 December 2018;  doi: 10.21926/obm.transplant.1804037

The approach to diagnosing fungal infections following solid organ transplantation (SOT) is patient-specific. An assessment of an individual’s risk for particular infections, also understood as the pre-test probability, should guide appropriate diagnostic testing whereas diagnostic stewardship is needed to produce interpretable, actionable and cost-sensitive results. This review provides a cognitive framework for practitioners aiming to diagnose fungal infections in recipients of SOT, taking into consideration the [...]