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Table of Content

Open Access Case Report

Plasmapheresis for Thrombotic Microangiopathy Due to a Post-transplant Lymphoproliferative Disorder

Received: 13 February 2022;  Published: 02 June 2022;  doi: 10.21926/obm.transplant.2202160

Abstract

We report a case of thrombotic microangiopathy (TMA) diagnosed in the kidney allograft of a 59-year-old woman who had developed plasmacytoma type monomorphic posttransplant lymphoproliferative disorder (PTLD) 30 years after a simultaneous pancreas and kidney transplant. This report demonstrates a rare etiology of TMA in a kidney allograft occurring in association with PTLD-associated monoclonal gammopathy. The main teaching points are: 1) PTLD may be considered in the work-up of a new TMA in the immunosuppressed po [...]

1054 9021

Open Access Interview

An Interview with Prof. Peter Schemmer

Received: 16 May 2022;  Published: 18 May 2022;  doi: 10.21926/obm.transplant.2202159

Abstract

InterviewAn Interview with Prof. Peter SchemmerOBM Transplantation Editorial OfficeLIDSEN Publishing Inc., 2000 Auburn Drive, One Chagrin Highlands, Suite 200, Beachwood, OH, USA; E-Mail: transplantation@lidsen.com OBM Transplantation2022, volume 6, issue 2doi:10.21926/obm.transplant.2202159Received: May 16, 2022Accepted: May 17, 2022Published: May 18, 2022

779 7391

Open Access Original Research

Organ System Bleeding in the PLADO Trial

Received: 30 December 2021;  Published: 26 April 2022;  doi: 10.21926/obm.transplant.2202158

Abstract

In the multi-institutional platelet dose trial (PLADO Trial), there were 1,077 hematology/oncology patients ≥18 years of age who received at least one platelet transfusion. These patients were analyzed for types and severity of organ system bleeding based on baseline patient characteristics, laboratory assays, primary diagnosis, and type of treatment. Patients were randomly assigned to receive one of three different prophylactic platelet doses for morning platelet counts of ≤10 × 109 /L. Daily assessmen [...]

1342 9263

Open Access Editorial

Acknowledgement to Reviewers of OBM Transplantation in 2021

Received: 06 January 2022;  Published: 07 January 2022;  doi: 10.21926/obm.transplant.2201157

Abstract

The editors of OBM Transplantation would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2021. We greatly appreciate the contribution of expert reviewers, which is crucial to the journal's editorial process. We aim to recognize reviewer contributions through several mechanisms, of which the annual publication of reviewer names is one. Reviewers receive a voucher entitling them to a discount on their next LIDSEN publication and can download a certificate of recogni [...]

840 7139

Open Access Original Research

The Donor – Recipient Weight Ratio is a Reliable Marker for Cell Yield in Hematopoietic Stem Cell Donations

Received: 22 November 2021;  Published: 24 December 2021;  doi: 10.21926/obm.transplant.2104156

Abstract

Bone marrow transplants remain an import source of hematopoietic stem cells for patients suffering from specific diseases like aplastic anemia, for pediatric patients with malignant and non-malignant blood cell disorders, and for situations in which graft-versus-host disease (GvHD) is a concern. Identifying the optimal donor to achieve a 3-5 x 108/kg of recipient weight TNC yield may be challenging. In an analysis of 687 consecutive donors, donor and procedure characteristics were related to TNC/kg of recipient wei [...]

1575 13343

Open Access Communication

Adipose Tissue as a Useful Material for the Grafting of Tumorigenic Cells and Juvenile Tissues in Mice

Received: 15 March 2021;  Published: 04 November 2021;  doi: 10.21926/obm.transplant.2104155

Abstract

Although the aging process expands the adipose tissue habitation in mice and due to its close association with the female reproductive system, it can be easily exposed surgically under anesthesia when reproductive organs (including ovary, oviduct, and part of the uterus) are pulled and exposed onto the dorsal skin. This study aimed to consider the suitability of adipose tissue as a target for manipulation, particularly for the grafting of cells or small-sized tissue sections due to its ease of handling. Subsequentl [...]

1289 9644

Open Access Review

Economic Considerations in Using HCV and HIV Positive Donors for Kidney Transplant

Received: 29 August 2021;  Published: 18 October 2021;  doi: 10.21926/obm.transplant.2104154

Abstract

End Stage Renal Disease is becoming more prevalent in the United States of America, with demand for kidney transplant exceeding the available organ supply. A novel method to increase the donor pool has been to consider transplanting organs from deceased patients who have had Hepatitis C Virus (HCV) or Human Immunodeficiency Virus (HIV) infections. Transplants with HCV infected kidneys are becoming more prevalent, due to increased organ supply due to increased mortality from injection opioid use. Similarly, deceased [...]

1131 8968

Open Access Original Research

Experience with Alpha-1 Proteinase Replacement Post-Lung Transplantation in Alpha-1 Antitrypsin Deficiency: A Single Center Case Series

Received: 14 July 2021;  Published: 15 October 2021;  doi: 10.21926/obm.transplant.2104153

Abstract

Alpha-1 antitrypsin deficiency (AATD) accounts for approximately 5% of lung transplants (LTx) performed annually. No studies have addressed the potential benefit of ongoing alpha-1 proteinase inhibitor (A1-PI) replacement to AATD patients post-LTx. Our primary objective was to assess potential benefits of continually administering A1-PI from pre- to post-transplantation for AATD LTx recipients. A retrospective case series was performed on AATD LTx recipients between 2002 and 2018. Data reviewed included date of A1- [...]

1330 13174

Open Access Opinion

Belatacept Dosing in Lung Transplantation: Is There a Method to the Madness?

Received: 09 July 2021;  Published: 30 August 2021;  doi: 10.21926/obm.transplant.2103152

Abstract

Data supporting the use of belatacept in non-abdominal organs are limited to case series and small cohorts involving patients requiring conversion due to CNI intolerance or contraindication. Review articles summarizing the efficacy of belatacept salvage therapy in lung transplantation have previously been published, however, dosing regimens are highly variable and uniform guidance is lacking. In this article, indications and considerations for belatacept use in lung transplant recipients are reviewed with a specifi [...]

1601 12677

Open Access Review

Defining Clinically Pathogenic HLA-Specific Antibodies - Granular Details in Characteristics in Pre and Early Time Following HLA-Antibody Incompatible Kidney Transplantation

Received: 11 May 2021;  Published: 17 August 2021;  doi: 10.21926/obm.transplant.2103151

Abstract

Antibodies against donor HLA determine access to solid organ transplantation and in many cases the outcome of transplantation, but graft failure is not an inevitable consequence of their presence. Much research has been performed with two main aims – which antibodies represent the highest risk factor prior to transplantation, and second to understand how donor specific HLA antibodies behave after transplantation, with a long-term aim of being able to manipulate their production. HLA antibody incompatible kidney tra [...]

1510 10446

Open Access Original Research

Predictors of Mid-Term Glomerular Filtration Rate after Deceased Donor Renal Transplantation: Kidney Donor Profile Index as a Predictor of Mid-Term GFR

Received: 17 March 2021;  Published: 20 July 2021;  doi: 10.21926/obm.transplant.2103150

Abstract

Glomerular filtration rate (GFR) is an excellent indicator of renal function; however, it is rarely evaluated as an endpoint. We investigated donor and recipient factors for associations that might be predictive of mid-term GFR after renal transplantation. We performed a retrospective review of 828 deceased donor renal transplantations performed at Montefiore Medical Center between the years 2009-2015. Donor characteristics included KDPI, [low (<20%), medium (20-80%), high (>80%)], age, graft types [extended [...]

1331 9954

Open Access Review

Sarcopenia; An Endemic in the Times of Pandemic in Liver Transplantation

Received: 31 March 2021;  Published: 20 July 2021;  doi: 10.21926/obm.transplant.2103149

Abstract

Liver transplantation (LT) has grown monumentally in the last 40 years. Sarcopenia has emerged as an independent factor associated with increased mortality in patients with end stage liver disease. In this review we aim to shed light upon recent developments in assessment, clinical implications, management of sarcopenia in patients requiring a liver transplant. We also bring attention to the impact of COVID-19 pandemic on sarcopenia which ranges from the disease pathology to the unprecedented preventive measures ta [...]

1543 10598

Open Access Case Report

Efficacy of Autologous Stem Cell Transplantation for the Treatment of Multiple Myeloma in HIV-Positive Patients

Received: 12 April 2021;  Published: 09 July 2021;  doi: 10.21926/obm.transplant.2103148

Abstract

Prior to the advent of anti-retroviral therapy (ART), autologous stem cell transplant (ASCT) was relatively contraindicated for multiple myeloma (MM) patients with human immunodeficiency virus (HIV) due to issues associated with stem cell harvest and the risk of opportunistic infections. With the widespread use of ART for control of HIV, ASCT is now the preferred treatment for relapsed lymphoma, the leading hematopoietic malignancy associated with HIV/AIDS. Hence, MM patients with HIV controlled by ART may benefit [...]

1392 8532

Open Access Case Report

Macroscopic Aspergillus Infection at the Anastomosis of a Lung Transplant Recipient

Received: 25 October 2020;  Published: 03 July 2021;  doi: 10.21926/obm.transplant.2103147

Abstract

A 65-year-old female with a history of right lung transplantation (LTx) for chronic obstructive pulmonary disease (COPD) 9-years prior complicated by grade 3 bronchiolitis obliterans syndrome (BOS) was admitted to the hospital for chest pain and dyspnea on exertion (DOE). Her bronchoscopy revealed fluffy, endobronchial lesions that were adherent to the right sided anastomosis resulting in mild obstruction of the right mainstem bronchus. Pathology from biopsies of the endobronchial lesions revealed hyphal fungal org [...]

1267 7857

Open Access Short Communication

Lack of Effect of Human Chorionic Gonadotropin in Mixed Lymphocyte Reaction in Xenotransplantation

Received: 29 December 2020;  Published: 30 June 2021;  doi: 10.21926/obm.transplant.2102146

Abstract

It has been speculated that the immunomodulation associated with pregnancy, e.g., decreasing pro-inflammatory cytokines, increasing anti-inflammatory cytokines, upregulation of T regulatory cells (Tregs), is in part due to the effect of human chorionic gonadotropin (hCG). In this study, we tested the effect of hCG on proliferation of human peripheral blood mononuclear cells (PBMCs) stimulated by irradiated pig PBMCs. Mixed lymphocyte reaction (MLR) was carried out with human PBMCs as responders and irradiated wild- [...]

1512 8266

Open Access Review

Cytomegalovirus in Lung Transplant

Received: 15 March 2021;  Published: 27 June 2021;  doi: 10.21926/obm.transplant.2102145

Abstract

Lung transplantation is a therapeutic option for patients with advanced lung diseases. Lung transplant outcomes have improved over time with improvements in the management of these complex patients. Cytomegalovirus is a common opportunistic organism affecting all solid organ transplant recipients. Characteristics unique to lung transplantation can make this virus difficult to manage, with myriad complications including graft failure and death. Ongoing research into and understanding of cytomegalovirus has opened ex [...]

2971 17634

Open Access Research Article

Effects of Oxygen on Renal Function and Oxidative Stress During Hypothermic Machine Perfusion in an Experimental Porcine Model of Kidney Donation after Cardiac Death

Received: 22 December 2020;  Published: 10 June 2021;  doi: 10.21926/obm.transplant.2102144

Abstract

The efficacy and safety of using high concentrations of oxygen during hypothermic machine perfusion (HMP) have not been fully elucidated to date. This study investigated the impact of administering high concentrations of oxygen on renal function during HMP in a porcine donation after circulatory death (DCD), as well as the metabolic and biochemical effects of this method. A randomized nonblinded cohort study was established in a porcine transplant (KT) model mimicking Maastricht type III DCD under oxygen-supplement [...]

1281 8939

Open Access Short Report

Beyond CPRA: Identifying Sensitized Kidney Candidates with Markedly Low Access to Deceased Donor Transplantation by Granular CPRA and Blood Type

Received: 01 April 2021;  Published: 03 June 2021;  doi: 10.21926/obm.transplant.2102143

Abstract

Prioritization in the US Kidney Allocation System (KAS) has led to an improvement in the rates of transplantation in highly sensitized (HS) patients. However, there is a subset of HS patients who are at a disadvantage, despite prioritization under KAS. The purpose of this study was to describe the transplant rate (TR) by calculated panel reactive antibody (CPRA) of HS candidates before and five years post-KAS to characterize their access to deceased donor transplants and quantify the number of HS candidates who are [...]

1778 11193

Open Access Case Report

Generation of Unexpected Allele-Specific Anti-HLA Antibodies after the Transplantation of a Fully-Matched Kidney Allograft and the Diagnostic Approaches Required for Excluding Harmful Effects after Subsequent Renal Regrafts

Received: 26 January 2021;  Published: 02 June 2021;  doi: 10.21926/obm.transplant.2102142

Abstract

The specification of anti-human leukocyte antigen (HLA) antibodies is an important task for patients awaiting kidney allografts. Especially the patients immunized in previous transplantations, transfusions, or pregnancies must be carefully observed, since grafting patients with HLA antigens/phenotypes recognized by their pre-formed antibodies are the main cause of harmful hyperacute and acute rejection. The complement-dependent lymphocytotoxicity-based de facto (physical) crossmatching (CDC-CM) has thus been implem [...]

1663 10678

Open Access Review

The Great Masquerade: Donor-derived Infections with Uncommon Central Nervous System Pathogens

Received: 29 January 2021;  Published: 02 May 2021;  doi: 10.21926/obm.transplant.2102141

Abstract

Donor-derived infections (DDI) are an infrequent event in solid organ transplant (SOT) due to advances in screening recommendations, prophylaxis, and surveillance of common infections. However, unexpected pathogen transmission can still occur when a donor is not known to be infected prior to organ procurement, which can lead to significant morbidity and mortality in the organ recipient. Solid organ donors with central nervous system (CNS) pathogens are an uncommon but deadly source of unexpected DDI. Clinically rec [...]

1263 93494

Open Access Review

The Future of Clinical Islet Transplantation in the United States

Received: 12 January 2021;  Published: 25 March 2021;  doi: 10.21926/obm.transplant.2101140

Abstract

Clinical islet transplantation was first realized over four decades ago at the University of Minnesota. Autologous islet transplantation is now widely recognized as a treatment to prevent diabetes in patients after pancreas excision and is offered at major transplant centers throughout the United States and the world. Type 1 diabetes represents a much larger demographic in which islet transplantation may benefit patients. Allogeneic islet transplantation can now offer similar outcomes to pancreas transplantation in [...]

1572 16904

Open Access Perspective

Acute Graft-Versus-Host Disease, Prophylaxis and Therapy

Received: 26 October 2020;  Published: 25 March 2021;  doi: 10.21926/obm.transplant.2101139

Abstract

Graft-versus host disease is one of the major causes of death in patients undergoing allogeneic hematopoietic stem cell transplantation. Major contributing factors to severity of graft-versus host disease include HLA mismatch, conditioning regimen intensity, age of donor and recipient, source of stem cell, and donor type. Strategies and clinical trials are ongoing to reduce the incidence of graft-versus host disease, and to improve on the survival outcome of patients with graft-versus host disease, Research efforts [...]

1488 12417

Open Access Short Communication

Reconstruction of Aberrant Left Hepatic Artery in Orthotopic Liver Transplantation – Single Center Experience

Received: 04 January 2021;  Published: 11 March 2021;  doi: 10.21926/obm.transplant.2101138

Abstract

One of the most feared complications in liver transplantation is hepatic arterial thrombosis (HAT). The incidence of HAT in liver transplantation varies from 1.2% and 8%. One of the risk factors for this complication is anatomical complexity of hepatic arterial system. The focus of this short communication is to show our approach in dealing with aberrant left hepatic artery in settings of liver transplantation. This is a single center experience. Between January 2016 and June 2019, we procured and transplanted 357 [...]

1521 10414

Open Access Case Report

Improved Awareness of Tuberculosis Infection in Advanced Stage Chronic Renal Disease Could Reduce Cases of Active TB: Lessons from Four Challenging Cases

Received: 14 August 2020;  Published: 08 March 2021;  doi: 10.21926/obm.transplant.2101137

Abstract

Patients with chronic kidney disease (CKD) have an increased risk of developing tuberculosis (TB) compared to those with normal renal function. The reasons for this are well described, but include impaired cellular immunity, a high incidence of co-morbid conditions as well as the concomitant use of immunosuppressive medications. Ethnicity as well as socio-economic factors also prevail. Expert guidelines recommend TB chemoprophylaxis in renal transplant recipients deemed at high risk – invariably those from ethnic m [...]

1666 9532

Open Access Research Article

Umbilical Cord Blood as an Alternate Donor Sources for High Risk Elderly Patients Undergoing Allogeneic Stem Cell Transplantation for Hematological Malignancies

Received: 04 November 2020;  Published: 07 February 2021;  doi: 10.21926/obm.transplant.2101136

Abstract

Allogeneic stem cell transplantation remains the only curative option for many hematological malignancies. Umbilical cord blood (UCB) is an alternate donor source with potentially increased morbidity in elderly patients. We evaluated outcomes in alternate donor sources, prior to the initiation of haploidentical transplantation at our institution, of matched unrelated donor (MUD) and UCB in elderly patients (mean age 64, range 60-75). One hundred and eighty-four patients were included (MRD: 57; MUD: 69; UCB: 58). Th [...]

1399 9146

Open Access Research Article

Malignancies and Pediatric Liver Transplantation: Promising Management with the mTOR-inhibitor Everolimus

Received: 07 June 2020;  Published: 25 January 2021;  doi: 10.21926/obm.transplant.2101135

Abstract

Some malignancies such as hepatoblastoma may be an indication for liver transplantation (LT) or some, for example, post-transplant lymphoproliferative disease (PTLD) may develop after successful LT. An immunosuppressive therapy after LT can promote the recurrence of the primary malignancy. The mammalian target-of-rapamycin inhibitors (mTORi) are immunosuppressive agents with anti-tumor properties. We examined the impact of everolimus (EVL) together with calcineurin inhibitors on allograft outcome and patient surviv [...]

1343 9115

Open Access Research Article

Transmitted Donor Immunology Not Infection: Common Persistence of Donor Hepatitis C Antibody Production in Aviremic Lung Transplant Recipients

Received: 16 September 2020;  Published: 13 January 2021;  doi: 10.21926/obm.transplant.2101134

Abstract

Since 2018 The American Society of Transplant has recommended that Hepatitis C Virus seropositive positive, non-viremic donors (HCVAb+/NAT-) be considered non-infectious and safe for transplantation. This report describes clinical outcomes and HCV serological and virological outcomes following lung transplantation (LTx) utilizing such donors. This retrospective cohort study describes seven HCVAb+/NAT- donors used for bilateral LTx. Donor information was sourced from the national organ donation service and recipient [...]

1678 9222

Open Access Review

The Puzzle of Immunosuppressive Drugs

Received: 30 August 2020;  Published: 11 January 2021;  doi: 10.21926/obm.transplant.2101133

Abstract

Kidney transplantation has become the preferred treatment option in end-stage chronic renal failure as it provides significant improvements over dialysis in terms of both quality and duration of life. Even after several randomized studies conducted in the last 20 years, the combination of CNI, MMF, and steroids continues to be considered the gold standard for kidney transplantation. However, novel molecules aimed at minimizing renal and cardiovascular toxicity, particularly with CNI sparing, are being identified. T [...]

1429 9264

Open Access Editorial

Acknowlegement to Reviewers of OBM Transplantation in 2020

Received: 04 January 2021;  Published: 06 January 2021;  doi: 10.21926/obm.transplant.2101132

Abstract

The editors of OBM Transplantation would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2020. We greatly appreciate the contribution of expert reviewers, which is crucial to the journal's editorial process. We aim to recognize reviewer contributions through several mechanisms, of which the annual publication of reviewer names is one. Reviewers receive a voucher entitling them to a discount on their next LIDSEN publication and can download a certificate of recogni [...]

1026 5712

Open Access Short Report

Pediatric Thoracoscopic Repair of Diaphragmatic Herniation Following Liver Transplantation

Received: 09 August 2020;  Published: 05 January 2021;  doi: 10.21926/obm.transplant.2101131

Abstract

Diaphragmatic Hernia (DH) after Liver Transplantation (LT) is a rare complication with unclear pathophysiology. Among 261 LT, we recognized six DH during the post transplant period (2.30%). All patients with DH had received a left lateral segment (LLS) reduced graft. The mean graft weight was 340g with a mean graft-to-recipient body weight ratio (GBWR) of 4.20%. LLS grafts, a GBWR > 4%, previous abdominal surgery and direct trauma during surgery can be enumerated as potential risk factors for DH post-LT. These chil [...]

1229 7863

Open Access Review

Management of the Sensitized Cardiac Transplantation Recipient

Received: 11 September 2020;  Published: 04 January 2021;  doi: 10.21926/obm.transplant.2101130

Abstract

Preoperative sensitization of the cardiac transplant recipient, defined as the presence of anti-Human Leukocyte Antigen (HLA) antibodies before transplant, represents a significant management challenge for physicians. Sensitization prolongs the pre-transplant wait time and is associated with postoperative transplant complications and death. It is critical that sensitized heart transplant candidates be identified and optimized before surgery. In this review, we describe the risk for sensitization, discuss the means [...]

1792 9814

Open Access Review

The Role of Surveillance Bronchoscopy Following a Lung Transplantation

Received: 01 July 2020;  Published: 21 December 2020;  doi: 10.21926/obm.transplant.2004129

Abstract

Pulmonary transplantation (LuTx) is established as a treatment option for patients with end-stage lung diseases, such as chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease, and pulmonary arterial hypertension. Acute rejection and infection are implicated as potential risk factors in developing complications such as bronchiolitis obliterans syndrome (BOS) and chronic rejection, leading to high morbidity and mortality rates after the LuTx. Thus, surveillance procedures after transplanta [...]

1520 14134

Open Access Case Report

Donor Cell-Derived Acute Myeloid Leukaemia with 3q26.2 Involvement/MECOM Rearrangement ‐ A Case Report and Literature Review

Received: 13 October 2020;  Published: 07 December 2020;  doi: 10.21926/obm.transplant.2004128

Abstract

Donor cell-derived leukaemia (DCL) is an uncommon complication of allogeneic hematopoietic stem cell transplantation (HSCT). DCL might represent up to 5% of the post-HSCT disease relapses, but case numbers reported in the literature might underestimate the frequency. The leukemogenesis of DCL is not well understood due to the limited numbers of cases reported and lack of detailed molecular genetic information from recipients and donors. Although many theories have been proposed for leukemogenesis of DCL, the underl [...]

1428 9112

Open Access Review

The Roles of Collagen in Islet Transplantation

Received: 02 October 2020;  Published: 27 November 2020;  doi: 10.21926/obm.transplant.2004127

Abstract

Islet transplantation is a cellular replacement therapy for severe diabetes mellitus. Although the clinical outcome of islet transplant has been improving, the transplant efficacy of this treatment is not superior to that of pancreatic organ transplantation, a similar transplant therapy. Various factors have been characterized as ‘islet transplantation specific’, which includes lack of revascularization and ischemia, innate inflammation, or autoimmunity, affect the therapeutic outcome of this treatment. Among them, [...]

1867 11290

Open Access Editorial

Challenges of Organ Transplantation in COVID-19 Era

Received: 01 November 2020;  Published: 19 November 2020;  doi: 10.21926/obm.transplant.2004126

1428 8124

Open Access Review

Current Assessment of Clinical Pancreatic Islet Allotransplantation

Received: 20 September 2020;  Published: 16 November 2020;  doi: 10.21926/obm.transplant.2004125

Abstract

Clinical islet allotransplantation represents a minimally invasive, efficacious alternative to pancreas transplantation for restoring glycemic control and insulin independence in select patients with type 1 diabetes that is complicated by intractable impaired hypoglycemia awareness and/or severe hypoglycemic events refractory to stabilization by other means. Over the last decade, islet transplantation outcomes have steadily improved in part due to refinements in the selection of optimal donors, islet isolation tech [...]

1807 12139

Open Access Review

Mauss and Organ Transplants: Ideas of Connectivity between Recipients and Donors and the “Spirit of the Gift”

Received: 22 July 2020;  Published: 16 November 2020;  doi: 10.21926/obm.transplant.2004124

Abstract

This article aims to describe the relationship between donors and their recipients in the context of organ transplants. This analysis is made in the light of Marcel Mauss’s work, offering an expansion on an analysis of his discussion on the “spirit of the gift” and his idea that gifts require reciprocation. It is argued that some recipients of donated organs receive a personal element from the donor in that there is a transfer or sharing of the donors’ personality and spiritual qualities. The article examines the n [...]

1679 10002

Open Access Case Report

Liver Transplantation as a Cure for Neurologically Advanced Wilson’s disease. Learning More from Experience

Received: 05 July 2020;  Published: 12 November 2020;  doi: 10.21926/obm.transplant.2004123

Abstract

Clinical presentation and progression of Wilson’s disease can be diverse in different groups of patients. While young children most likely to present with acute or chronic liver failure, older children and adults may exhibit extrahepatic manifestation like neuropsychiatric, cardiac, renal, pancreatic and several others. Diagnosis of Wilson’s disease is based on the combination of specific clinical findings, laboratory and genetic testing. There are different modalities of treatment available for this condition. Liv [...]

1273 9357

Open Access Communication

Appropriate Vancomycin Use and Incidence of Vancomycin-Resistant Enterococci in Liver Transplant Recipients

Received: 24 July 2020;  Published: 09 November 2020;  doi: 10.21926/obm.transplant.2004122

Abstract

Liver transplant recipients (LTRs) are at risk for vancomycin-resistant Enterococcus (VRE) infections which can lead to significant morbidity or mortality. Antibiotic exposure, including vancomycin, is associated with greater risk of VRE infection. This study aimed to assess the appropriateness of vancomycin use and rates of VRE infection in this population. We performed a retrospective cohort study of 327 patients who underwent liver transplantation at our center from January 1, 2012 to June 30, 2017. Sixty (18.3% [...]

1235 7975

Open Access Original Research

“Real World” Australian Experience of Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Adults with Severe Aplastic Anaemia.

Received: 23 June 2020;  Published: 23 October 2020;  doi: 10.21926/obm.transplant.2004121

Abstract

Acquired Severe Aplastic Anaemia (SAA) is a rare bone marrow failure syndrome, for which allogeneic haematopoietic stem cell transplant (HSCT) is a proven curative therapy. Despite excellent outcomes for matched sibling SAA recipients in terms of engraftment and survival, HSCT remains highly challenging in older matched-unrelated-donor (MUD) recipients, due to increased non-relapse mortality (NRM) from causes such as graft versus host disease (GVHD), organ failure and infection. We sought to evaluate our local HSCT [...]

1484 8863

Open Access Case Report

Donor Derived Strongyloidiasis in a Lung Transplant Recipient: From Life Cycle to Hyperinfection Syndrome

Received: 04 September 2020;  Published: 13 October 2020;  doi: 10.21926/obm.transplant.2004120

Abstract

Strongyloides stercoralis infection derived from the donor in solid organ transplant (SOT) places recipients at risk for hyperinfection syndrome and death. We describe the case of a lung transplant recipient who developed strongyloidiasis presenting with GI symptoms and progressing to diffuse alveolar hemorrhage, bacteremia and multi-organ failure. The patient's clinical course illustrates the life cycle of Strongyloides. For treatment, the patient received ivermectin and albendazole. We advocate that early diagnos [...]

1456 9004

Open Access Review

Treatment Strategies for Antibody-mediated Rejection in Kidney Transplantation and Its Prevention

Received: 22 August 2020;  Published: 28 September 2020;  doi: 10.21926/obm.transplant.2003119

Abstract

This article reviews the current treatment strategies of antibody-mediated rejection in kidney transplantation, which is increasingly recognized as the leading immunological cause of graft failure. The pathophysiologic complexity of this condition poses significant challenges for its treatment; however, progress toward advancing our understanding of its pathogenesis and diagnosis will allow for identification of new therapeutic targets. Emphasis is also given to prevention, which is mainly based on careful assessme [...]

1363 14607

Open Access Case Report

Severe Hypercholesterolemia Associated with Steroid-Refractory Acute Liver GVHD: Unusual Complication of Allogeneic Hematopoietic Cell Transplantation

Received: 19 July 2020;  Published: 18 September 2020;  doi: 10.21926/obm.transplant.2003118

Abstract

Severe hypercholesterolemia is an uncommon complication of allogenic hematopoietic cell transplantation (HCT). Treatment options for hypercholesterolemia due to liver graft-versus-host disease (GVHD) are limited because many antilipidemic medications are known to worsen hepatic functions. We report our experience on a case of a 38-year-old male with Philadelphia chromosome positive acute lymphoblastic leukemia presenting with steroid-refractory hepatic and lower gastrointestinal acute GVHD after matched sibling don [...]

1446 7859

Open Access Research Article

A Computational Simulation Technology for Specific Counting of Perinatal and Postnatal Human Tissue Stem Cells for Transplantation Medicine

Received: 22 April 2020;  Published: 28 August 2020;  doi: 10.21926/obm.transplant.2003117

Abstract

Although tissue stem cells are essential for the maintenance, renewal, and repair of vertebrate organs and tissues, previously, the simple act of counting them has not been possible. For more than a half-century, progress in tissue stem cell research and medicine has been undermined by the lack of a means to determine tissue stem cell number. In particular, a major unmet need for stem cell transplantation medicine has been a way to quantify the specific dosage of tissue stem cell treatments. The counting problem pe [...]

1949 13938

Open Access Case Report

The Use of ECMO in Treatment of Post Liver Transplant Septic Shock

Received: 28 May 2020;  Published: 17 August 2020;  doi: 10.21926/obm.transplant.2003116

Abstract

Liver transplant is a life-saving therapy for patients with end stage liver disease and liver cancer. Liver re-transplantation cases are usually more challenging and riskier than primary surgery, they require careful consideration and larger recourse utilization. Decision making on who receives transplantation surgery includes individual patient risks and benefits, physician judgment, specific transplant center policies, surgical experience, geographic organ availability, and ethical considerations. Several mathema [...]

1719 11596

Open Access Review

Pancreatic Islet Cell Transplantation: Graft Stability and Metabolic Outcomes

Received: 07 June 2020;  Published: 07 July 2020;  doi: 10.21926/obm.transplant.2003115

Abstract

Pancreatic islet transplantation is a rapidly evolving field. It has been increasingly regarded as a promising approach for the correction of dysglycemia associated with type 1 diabetes mellitus (allogenic islet transplantation), or the prevention of surgical diabetes in chronic pancreatitis subjects undergoing total pancreatectomy (autologous islet transplantation). In this review, we discuss the latest literature pertaining to metabolic outcomes of autologous and allogenic islet transplantation, shedding close li [...]

1920 11091

Open Access Original Research

Single-Center Outcomes of Heart Transplantation in Patients with Pulmonary Hypertension Bridged with Mechanical Circulatory Support

Received: 14 April 2020;  Published: 06 July 2020;  doi: 10.21926/obm.transplant.2003114

Abstract

In advanced heart failure, orthotopic heart transplantation (OHT) remains the standard for definitive treatment. Patients with heart failure and concomitant pulmonary hypertension (PH) represent a challenging subgroup, with poor outcomes following OHT. Recently, Mechanical Circulatory Support (MCS) devices have been utilized as a bridge to OHT for these patients. Patients with MCS devices who underwent OHT were evaluated at a single center. Patients were stratified into three groups, depending on baseline pulmonary [...]

1509 8741

Open Access Case Report

An Unusual Case of Recurrent Capillary Leak Syndrome Following Lung Transplantation

Received: 24 April 2020;  Published: 15 June 2020;  doi: 10.21926/obm.transplant.2002113

Abstract

Systemic capillary leak syndrome is a disorder characterized by recurrent, life-threatening episodes of acute capillary hyperpermeability resulting in edema and hypovolemic shock. We report a case of systemic capillary leak syndrome in a lung transplant recipient who developed recurrent episodes of volume overload, respiratory failure, and acute kidney injury in association with hypotension and hypoalbuminemia. Initiation of monthly high dose intravenous immunoglobulin prophylaxis effectively abrogated the syndrome [...]

1324 8435

Open Access Review

Birth Tissue-Derived Mesenchymal Stromal/Stem Cell Isolation and Assessment

Received: 25 September 2019;  Published: 09 June 2020;  doi: 10.21926/obm.transplant.2002112

Abstract

Mesenchymal Stromal/Stem Cells (MSCs) were originally discovered in the 1970s. MSCs are considered a multipotent population that retain tri-lineage differentiation. These cells can be sourced from a variety of tissues, including bone marrow, adipose, molar pulp, and birth tissues. Historically varying definitions of MSCs have existed, but in 2006, the International Society for Cellular Therapy (ISCT) set forth a standardized, minimal criteria for MSCs, including plastic adherence, differentiation into osteoblasts, [...]

2001 14441

Open Access Editorial

Liver Transplantation in Pediatrics

Received: 15 May 2020;  Published: 18 May 2020;  doi: 10.21926/obm.transplant.2002111

1746 8359

Open Access Review

Multidrug-Resistant Bacterial Infections before and after Liver Transplantation

Received: 29 March 2020;  Published: 18 May 2020;  doi: 10.21926/obm.transplant.2002110

Abstract

Bacterial infection represents a common event in the natural history of cirrhosis, especially in patients with end-stage liver disease. An episode of bacterial infection may significantly modify a patient’s outcome in the setting of liver transplantation (LT) by impairing hepatic and extrahepatic organ functions, both in pre-operative and post-operative phases. Infections caused by multidrug-resistant organisms (MDRO) are increasing in cirrhosis due to high antibiotic exposure and hospitalizations. This issue is pa [...]

1592 10536

Open Access Original Research

Donor Age and Ischemia Time Are Independent Factors Affecting Graft Survival after En Bloc Kidney Transplantation from Donors Less than Three Years of Age

Received: 13 January 2020;  Published: 13 May 2020;  doi: 10.21926/obm.transplant.2002109

Abstract

This study aimed to investigate the outcomes of transplantation from donors aged less than three years in a single-center consecutive series. A total of 52 en bloc kidney graft transplantations were performed. In 22 cases, organs were procured from donors aged less than one year (group 1). In 30 cases, the age of donors varied from one to three years (group 2). After transplantation, renal function and graft and patient survival were evaluated retrospectively. No significant difference was observed between the grou [...]

1151 8386

Open Access Review

Clinical Approach to the Management of Infections before and after Liver Transplantation

Received: 14 February 2020;  Published: 11 May 2020;  doi: 10.21926/obm.transplant.2002108

Abstract

The infectious complications before and after liver transplant (LT) are affected by the severity of liver disease and immunosuppression intensity after transplantation. Both cirrhosis and immunosuppression contribute to dysfunction of defensive mechanisms of the host. When a patient is evaluated for transplantation, the opportunity arises to assess the individual’s risk for infection and how one may modify those risks through prophylactic and therapeutic strategies. Pretransplant infectious disease evaluation focus [...]

1837 14852

Open Access Review

Genomic Biomarker Surveillance in the Care of Solid Organ Transplant Recipients: An Update for the General Clinician during the Coronavirus (CoVid-19) Pandemic

Received: 27 March 2020;  Published: 06 May 2020;  doi: 10.21926/obm.transplant.2002107

Abstract

Biomarker surveillance after solid organ transplant is an advancing field with promise for further elucidation through high-throughput analyses and “omics” technologies. To date, Gene Expression Profiling (GEP; AlloMapâ) is the only FDA-cleared genomic assay as surveillance for moderate-severe TCMR versus allograft quiescence after heart transplantation. Clinical validity and utility, however, have been recently established after kidney and heart transplantation, for analysis of donor-derived cell-free DNA in the a [...]

1907 11626

Open Access Editorial

Challenges to Transplantation by the Assault of CoVid-19: Emergence of Molecular Diagnostics as Surveillance

Received: 27 March 2020;  Published: 31 March 2020;  doi: 10.21926/obm.transplant.2001106

1477 8713

Open Access Case Report

Pediatric Mixed Left Ventricular Non-Compaction and Restrictive Cardiomyopathy Bridged to Heart Transplant with Ventricular Assist

Received: 21 May 2019;  Published: 26 March 2020;  doi: 10.21926/obm.transplant.2001105

Abstract

Left ventricular noncompaction cardiomyopathy (LVNC) is a rare form of heritable cardiomyopathy with wide genotypic variability, numerous phenotypic variations, and a wide spectrum of clinical disease from asymptomatic to end stage heart failure. Here, we present a case of a 2-year-old boy who presented to their pediatrician with a cough as a first clinical sign of heart failure, rapidly progressing to severe heart failure. He was found to have mixed LVNC with a restrictive phenotype, a rare phenotype of this form [...]

1512 9925

Open Access Review

Medawar's Paradox and Immune Mechanisms of Fetomaternal Tolerance

Received: 09 May 2019;  Published: 10 March 2020;  doi: 10.21926/obm.transplant.2001104

Abstract

Brazilian-born British biologist Dr. Peter Medawar played an integral role in developing the concepts of immunologic rejection and tolerance, which led to him receiving the Nobel Prize “for the discovery of acquired immunologic tolerance” and eventually made organ transplantation a reality. However, at the time of his early work in tolerance, a paradox to his theories was brought to his attention; how was pregnancy possible? Pregnancy resembles organ transplantation in that the fetus, possessing paterna [...]

2678 14083

Open Access Review

Histoplasmosis in Liver Transplant Recipients: Case Reports and a Review of the Literature

Received: 21 October 2019;  Published: 28 February 2020;  doi: 10.21926/obm.transplant.2001103

Abstract

We report two cases of histoplasmosis in orthotopic liver transplant (OLT) recipients to illustrate the variable presentations, complications encountered during treatment, the spectrum of diagnostic modalities, and case outcomes. Case 1 describes the insidious presentation of presumed gastrointestinal histoplasmosis 12 years after OLT, which was defined by months of intermittent diarrhea and focal colonic disease on colonoscopy. A diagnosis of Histoplasma capsulatum was ultimately made by broad range PCR performed [...]

1741 12807

Open Access Research Article

Febrile Neutropenia in Children: Etiologies, Outcomes, and Risk Factors with Prolonged Fever

Received: 27 November 2019;  Published: 21 February 2020;  doi: 10.21926/obm.transplant.2001102

Abstract

Most studies of children with prolonged fever and neutropenia (PFN) have focused on invasive fungal disease (IFD) as the etiology of fever and not on other causes. Data are lacking regarding risk factors and adverse outcomes in pediatric cancer patients with PFN compared with those whose fevers resolve more rapidly. Retrospective medical record review was performed for all cancer patients with febrile neutropenia (FN) in the pediatric oncology unit at University of Chicago Medicine Comer Children’s Hospital f [...]

1533 10317

Open Access Review

Hematopoietic Stem Cell Transplantation in Refractory Celiac Disease: An Overview with Focus on Infectious Complications

Received: 16 December 2019;  Published: 18 February 2020;  doi: 10.21926/obm.transplant.2001101

Abstract

Refractory celiac disease (RCD) is a rare condition in which a known celiac patient, usually an adult, suffers from persistence or recurrence of gluten-related symptomatology, laboratory abnormalities, and inflammatory enteropathy despite following an optimal dietary therapy with gluten-free diet (GFD). Arbitrarily, a duration of at least 12 months of GFD has been recommended prior to establishing such a diagnosis. Furthermore, exclusion of the other possible causes of non-celiac villous atrophy, particularly enter [...]

1501 10900

Open Access Editorial

Transplantation of a Kidney with an Extra-Renal Organ

Received: 10 February 2020;  Published: 13 February 2020;  doi: 10.21926/obm.transplant.2001100

1228 8358

Open Access Original Research

Eplet-Based HLA Class II Matching for Transplantation: Design of a Repertoire of Interlocus Eplets Shared between HLA-DR, -DQ and -DP Alleles

Received: 13 December 2019;  Published: 10 February 2020;  doi: 10.21926/obm.transplant.2001099

Abstract

Many studies have demonstrated that HLA-DR, HLA-DQ and HLA-DP matching at the eplet level reduces allograft rejection and improves transplant outcome. Such studies have examined the eplet effect for the individual class II loci, but until now little attention has been given to so-called interlocus class II eplets shared between HLA-DR, HLA-DQ and/or HLA-DP alleles. This report summarizes current information about antibody-verified interlocus class II eplets. It describes a structural modeling method to determine po [...]

1822 13521

Open Access Review

Utility of Fungal Cell Markers in Pediatric Bone Marrow Transplant Recipients for Screening and Diagnosis of Invasive Fungal Infections

Received: 12 November 2019;  Published: 04 February 2020;  doi: 10.21926/obm.transplant.2001098

Abstract

Invasive fungal disease (IFD) is a significant contributor to morbidity and mortality in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Early detection and timely initiation of antifungal therapy is important for improved outcome, but diagnosis remains difficult, especially when relying on conventional microbiology methods such as culture and microscopy. Data on the use of fungal biomarkers for screening and diagnosis of IFD in HSCT pediatric patients are limited, precluding the devel [...]

1409 9483

Open Access Editorial

Immunosuppression in Kidney Transplantation

Received: 19 January 2020;  Published: 03 February 2020;  doi: 10.21926/obm.transplant.2001097

Abstract

Immunosuppressive therapy in renal transplantation is divided into two phases as induction and maintenance therapy. Induction therapy is an intense immunosuppressive therapy administered at the time of kidney transplantation to reduce the risk of acute allograft rejection. In general, induction immunosuppressive strategies utilized by kidney transplant centers fall in one of the two categories. One approach relies upon high doses of conventional immunosuppressive agents, while the other uses antibodies directed aga [...]

1531 13898

Open Access Case Report

Dual Kidney Transplantation after Hypothermic Oxygenated Perfusion from Marginal Donor after Circulatory Death with Acute Kidney Injury: A Case Report

Received: 22 November 2019;  Published: 03 February 2020;  doi: 10.21926/obm.transplant.2001096

Abstract

Donation after circulatory death (DCD) is an increasingly used resource to alleviate chronic renal graft shortages. Organs from donors with progressively increased creatinine levels due to acute kidney injury are used, but the effects of this condition on kidney transplantation are still unclear. Ex-situ machine perfusion is emerging as a potential tool to preserve and resuscitate vulnerable grafts. We report a case of DCD kidneys discarded due to severe acute kidney injury with favorable histological Karpinski sco [...]

1370 8345

Open Access Research Article

Long-Term Exposure to Fine Particulate Matter (PM2.5) and Cardiovascular Disease Mortality among Renal Transplant Recipients

Received: 11 August 2019;  Published: 17 December 2019;  doi: 10.21926/obm.transplant.1904095

Abstract

Background: Substantial evidence has established links between air pollution and increased risks of overall morbidity and mortality, especially for respiratory and cardiovascular diseases. However, little research has explored these relationships among highly sensitive populations, such as renal transplant recipients. Despite the improvement in quality of life after renal transplantation, cardiovascular diseases (CVD) are major causes of graft loss and mortality. The present study was designed to assess the associa [...]

1812 11785

Open Access Review

Modelling Recurrent Primary Biliary Cholangitis and Primary Sclerosing Cholangitis as Infectious Diseases Following Liver Transplantation

Received: 19 November 2019;  Published: 13 December 2019;  doi: 10.21926/obm.transplant.1904094

Abstract

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are idiopathic and progressive autoimmune hepatobiliary disorders that lead to liver failure and a need for liver transplantation in a proportion of individuals with poorly controlled disease. It is currently thought that an environmental agent triggers disease in a genetically susceptible host and to date, xenobiotics, bacteria and a human betaretrovirus have all been linked with PBC. However, there is no consensus on which agents predomina [...]

1574 9739

Open Access Review

Therapeutic Apheresis in Prevention and Treatment of Antibody-Mediated Rejection of Renal Allografts

Received: 13 October 2019;  Published: 02 December 2019;  doi: 10.21926/obm.transplant.1904093

Abstract

Antibody-mediated rejection represents a significant barrier to favorable long-term outcomes after kidney transplantation and remains the most common cause of allograft failure. Therapeutic apheresis techniques are commonly used, in combination with other treatments such as immunosuppressive drugs, in the pre-transplant and post-transplant protocols for the prevention and treatment of antibody-mediated injury. The rationale is to remove the donor-specific antibodies and the other inflammatory mediators, which inclu [...]

1462 9967

Open Access Research Article

Incidence, Location, and Natural History of Perihepatic Fluid Collections after Orthotopic Liver Transplantation

Received: 18 February 2019;  Published: 18 November 2019;  doi: 10.21926/obm.transplant.1904092

Abstract

Objective: The purpose of this study was to evaluate the common locations of perihepatic fluid collections after liver transplantation, assess their complexity, and understand their natural history and clinical significance. Materials and Methods: A retrospective analysis of 189 postoperative orthotopic liver transplant patients with a mean age 49.6 years was performed using serial CT or MRI to characterize perihepatic fluid collections. Location, size, complexity of the collections, and clinical course were evalua [...]

1414 11527

Open Access Case Report

Toxoplasmosis: “An Often Forgotten Cause for Fever of Unknown Origin in Liver Transplant Recipients”. Case Report and Review of Literature

Received: 24 October 2019;  Published: 18 November 2019;  doi: 10.21926/obm.transplant.1904091

Abstract

Toxoplasmosis in liver transplantation (LT) is uncommon, especially in the current era of universal prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis jirovecii pneumonia (PJP). Here we present a case of a 55-year-old woman LT recipient, on dapsone or PJP prophylaxis due to sulfa allergy, who presented on day 25 after LT with fever, diarrhea and abdominal pain. Initially she was diagnosed with cytomegalovirus-associated colitis and was treated with intravenous ganciclovir, with good clinical [...]

1661 10060

Open Access Original Research

Combination, Sequential Therapies Incorporating Tocilizumab Decrease the Progression of Chronic Lung Allograft Dysfunction (CLAD) after Lung Transplantation: Initial Clinical Experience

Received: 19 September 2019;  Published: 07 November 2019;  doi: 10.21926/obm.transplant.1904090

Abstract

Introduction: TH-17 and IL-6 interactions and detrimental biologic effects have been shown in rodent models of Chronic Lung Allograft Dysfunction (CLAD). Similarly, these pathways have been found to be upregulated in human CLAD. Tocilizumab (TCZ), a humanized monoclonal antibody targets the IL-6 receptor subunit alpha and prevents binding of IL-6. We herein report our preliminary experience with adjunctive TCZ therapy for human CLAD. Methods: We retrospectively reviewed our initial experience with TCZ given after o [...]

1204 8440

Open Access Case Report

A Silent and Very Early Post-Liver Transplant Death by Candida Arteritis

Received: 29 August 2019;  Published: 28 October 2019;  doi: 10.21926/obm.transplant.1904089

Abstract

Background: Graft site candidiasis is a serious complication after solid organ transplantation, often presenting as invasive arteritis leading to graft loss or even death. Case Report: We report a case of anastomotic site candidiasis leading to arterial rupture and death at postoperative day 10 with no clinical warning signs. Preservation fluid cultures were negative and postoperative Doppler ultrasonography did not show vascular compromise. Postmortem examination revealed microscopic arterial wall abscesses harbou [...]

1441 9342

Open Access Original Research

Oral Management in Pre-HSCT Patients: An Evaluation of Oral and Systemic Complications

Received: 14 June 2019;  Published: 21 October 2019;  doi: 10.21926/obm.transplant.1904088

Abstract

Objective: Hematopoietic stem cells transplant (HSCT) requires being preceded by chemotherapy and radiotherapy. The neutropenia and thrombocytopenia which follows may be the possible cause of post-transplant complications. It is required that the patient undergoing transplantation is eradicated of any possible infectious focus. Currently, a uniform protocol for the oral management of these patients is unavailable. Methods: The approach for the dental management of each patient was designed as a more selective proto [...]

1621 7996

Open Access Case Report

The Surgical Approach for Obtaining Abdominal Wall Closure in Renal Transplant Recipients with Temporary or Permanent Loss of Fascial Integrity Following Emergency Reoperative Surgery

Received: 01 July 2019;  Published: 08 October 2019;  doi: 10.21926/obm.transplant.1904087

Abstract

A range of corrective surgical procedures may be required in adult renal transplant recipients who sustain loss of integrity of the abdominal wall in the first month postoperatively. Where this involves the fascia, such as in acute fascial dehiscence or in renal allograft compartment syndrome, more sophisticated reconstructive procedures may also be required, particularly in the setting of surgical site infection. There is limited data on the use of prosthetic or biologic mesh for this type of scenario, where urgen [...]

1611 9918

Open Access Review

Present and Future Strategies with Curative Intent for Hereditary Hemoglobinopathies

Received: 27 February 2019;  Published: 24 September 2019;  doi: 10.21926/obm.transplant.1903086

Abstract

Nowadays, hematopoietic stem cell transplantation (HSCT) is a common procedure in hematology units within reference centers, mainly for the treatment of hematological malignancies such as multiple myeloma, lymphoma, and acute leukemia. Nevertheless, HSCT has much wider applications, namely in autoimmune diseases, congenital metabolic defects, and hemoglobinopathies. Thalassemia major and sickle cell disease make up the most frequent hereditary hemoglobinopathies worldwide. Despite advances on the prevention and tre [...]

1401 8128

Open Access Review

Infectious Considerations for Patients on Immune Checkpoint Inhibitors

Received: 07 July 2019;  Published: 06 September 2019;  doi: 10.21926/obm.transplant.1903085

Abstract

Chronic inflammatory states lead to T cell exhaustion, characterized by reduced T cell proliferation and activity. Immune checkpoint inhibitors (ICPI) reactivate T cells to restore the immune system’s natural defenses against foreign antigens. The widespread use of these agents in the treatment of malignancy has led to markedly reduced tumor burden and improved patient survival, sparking curiosity about their potential role in the treatment of other chronic inflammatory states, including infectious diseases. While [...]

1313 8363

Open Access Review

Benefits of Combined Liver Transplant: Protection or Tolerance?

Received: 18 April 2019;  Published: 04 September 2019;  doi: 10.21926/obm.transplant.1903084

Abstract

The privileged liver, due to its immunological status, is referred to as a tolerogenic organ. However, this alone does not explain the introduction of tolerance after single or combined liver transplantation (kidney, heart, pancreas, and intestine); other factors, such as recipient’s age, donor’s hepatic volume, iron metabolism, biomarkers, or imprint of cytomegalovirus infection, appear to be involved in the identification of patients who are likely to be tolerant to their graft. All the afore-stated factors appea [...]

1522 9658

Open Access Research Article

Characterization of Early Indicators of Cardiac Allograft Vasculopathy Lesions in a Rat Model Using Non-Invasive Cellular MR

Received: 07 January 2019;  Published: 29 August 2019;  doi: 10.21926/obm.transplant.1903083

Abstract

Background: Cardiac allograft vasculopathy (CAV) remains a major obstacle to long-term heart allograft survival. A number of studies show that immune mechanisms are involved in CAV. Using non-invasive cellular MRI (CMRI) to explore indicators of CAV lesions and characterize its development could provide new insights into the target immune cells that are responsible for the progression of CAV and reveal early markers of the disease before irreversible changes occur. Methods and Results: Rat heart transplant allograf [...]

1624 8898

Open Access Short Report

Estradiol 17-β Induces Pancreatic Beta-Cell Proliferation through Distinct Estrogen Receptors in a Glucose Dependent Manner

Received: 17 April 2019;  Published: 27 August 2019;  doi: 10.21926/obm.transplant.1903082

Abstract

Background: Estradiol 17-beta (E2) enhances the function and survival of pancreatic beta-cells, but its clinical use has been questioned due to concerns regarding oncogenic potential and feminizing effects in males. The G-protein coupled estrogen receptor (GPER), expressed in pancreatic islets, exhibits estrogenic beta-cell protective effects without the feminizing effects of the nuclear ERs. Here, we examine the outcome of selective activation of the three estrogen receptors ERα, ERβ, and GPER on rep [...]

1140 8646

Open Access Review

Viral Infections in Allogeneic Hematopoietic Stem Cell Transplant Recipients: Literature Review

Received: 25 June 2019;  Published: 26 August 2019;  doi: 10.21926/obm.transplant.1903081

Abstract

Hematopoietic stem cell transplant (HSCT) recipients are at an increased risk of bacterial, viral, fungal and parasitic infections. Past exposures to infections, the degree of immunosuppression, prolonged neutropenia and presence of graft versus host disease (GVHD) are some of the factors which make HSCT recipients more susceptible to infections. Viral infections have emerged as a major challenge causing high morbidity and mortality in stem cell transplant recipients. Myeloablative conditioning regimens and GVHD pr [...]

1895 13428

Open Access Review

Induction of Tolerance towards Solid Organ Allografts Using Hematopoietic Cell Transplantation in Large Animal Models

Received: 23 November 2018;  Published: 23 August 2019;  doi: 10.21926/obm.transplant.1903080

Abstract

Background: The application of hematopoietic cell transplantation for induction of immune tolerance has been limited by toxicities associated with conditioning regimens and to graft-versus-host disease (GVHD). Decades of animal studies have culminated into sufficient control of these two problems, making immune tolerance a viable alternative to life-long application of immunosuppressive drugs to prevent allograft rejection. Methods: Studies in mice have paved the way for the application of HCT with limited toxicity [...]

1809 9845

Open Access Original Research

Alemtuzumab Treatment Leads to Delayed Recovery of T Follicular Regulatory Cells, and May Therefore Predispose Patients to de novo Donor-Specific Antibody Formation

Received: 02 June 2019;  Published: 19 August 2019;  doi: 10.21926/obm.transplant.1903079

Abstract

Background: T follicular helper (Tfh) and regulatory (Tfr) cells are key players in the formation of long-lived antibody responses. Their circulating counterparts, cTfh and cTfr, are often used as biomarkers because longitudinal sampling of secondary lymphoid tissues is unfeasible in clinical studies. This is the first study to track cTfh and cTfr cells following therapeutic lymphocyte depletion with alemtuzumab, an anti-CD52 monoclonal antibody, to infer the influence of this treatment on the germinal centre respo [...]

1507 9800

Open Access Research Article

Immunoprotective Encapsulation of Micro-Organs

Received: 07 May 2019;  Published: 14 August 2019;  doi: 10.21926/obm.transplant.1903078

Abstract

Background: Cell encapsulation technology is most likely the ultimate solution for cell therapy based clinical approaches. A key issue when developing a functional encapsulated construct is to consider not only the nature of the capsule but also how the cells should be incorporated into the capsule in order to minimally compromise their function. Methods: We have developed a tissue engineering approach, composed of decellularized micro scaffolds and various types of cells in which fully functional "Engineered Micro [...]

1305 8389

Open Access Original Research

Mortality Risk Factors in Patients who are in Heart Transplantation Waiting List

Received: 01 February 2019;  Published: 05 August 2019;  doi: 10.21926/obm.transplant.1903077

Abstract

Background: To estimate the survival of patients in the heart transplantation waiting list (HTx WL) at Almazov National Medical Research Centre (V.A. Almazov NMRC), Saint-Petersburg, Russia, from 2010 to 2017 and to define risk factors for death among these patients. Methods: It was a single-center retrospective study involving 151 patients with advanced chronic heart failure (CHF) in the HTx WL. Results: Mortality in the HTx WL for the period 2010-2017 was found to decrease. Based on the results of constructing th [...]

1421 8831

Open Access Research Article

Never Say Never: Unexpected Pulmonary Pathogens Found on Autopsy in Hematopoietic Cell Transplantation Recipients

Received: 03 June 2019;  Published: 29 July 2019;  doi: 10.21926/obm.transplant.1903076

Abstract

Hematopoietic cell transplantation is frequently complicated by infectious disease-related complications, especially pneumonia. Candida and enterococci are often overlooked as pulmonary pathogens with some clinicians firmly believing that these organisms never cause pneumonia. Here, we present a series of five cases of Candida pneumonia and five cases of enterococcal pneumonia found on autopsy in hematopoietic cell transplantation recipients. We will also review the literature regarding the epidemiology, risk facto [...]

1102 10270

Open Access Review

Endemic Mycoses and Cryptococcus in Solid Organ Transplant Recipients

Received: 05 April 2019;  Published: 26 July 2019;  doi: 10.21926/obm.transplant.1903075

Abstract

The endemic mycoses are an important cause of morbidity and mortality in transplant recipients. These fungal infections are notable for their dimorphic life cycle, specific geographic distributions, and typical infection via environmental exposure. Their nonspecific presentation can make diagnosis challenging. Because of their geographic associations, assessment of both donor and recipient history is critical in making an accurate and timely diagnosis. Coccidioides spp. are endemic to the southwestern United S [...]

1528 14403

Open Access Review

Our Steps toward Subcutaneous Transplantation of Macro-Encapsulated Islets

Received: 29 May 2019;  Published: 24 July 2019;  doi: 10.21926/obm.transplant.1903074

Abstract

Background: Diabetes mellitus (DM) can be cured or greatly ameliorated by adequate insulin secretion from a relatively small volume of insulin-producing cells. Cell encapsulation enables allo- and even xeno-geneic cell therapy without immunosuppression. However, recent clinical trials show that micro-encapsulated islets are not fully retrievable after transplantation. By contrast, macro-encapsulated islets can be retrieved when necessary. As to the transplantation site, subcutaneous tissue can be promising, if new [...]

1394 10686

Open Access Review

Nutritional Management for Infants and Children Pre and Post-Liver Transplant

Received: 05 December 2018;  Published: 17 July 2019;  doi: 10.21926/obm.transplant.1903073

Abstract

Background: Infants and children undergoing liver transplant require ongoing nutritional evaluation throughout the pre and post-transplant period. The pathophysiologic causes of chronic liver disease and acute liver failure are varied, and each present different and unique nutritional challenges. Methods: A review of the literature and Seattle Children's established guidelines for nutritional management of pediatric liver transplant patients was conducted. Results: We present guidelines of care to optimize nutritio [...]

2307 20695

Open Access Review

Single Cell Transcriptomic Analysis of Pancreatic β Cell Development and Differentiation from Pluripotent Stem Cells

Received: 06 May 2019;  Published: 17 July 2019;  doi: 10.21926/obm.transplant.1903072

Abstract

Single cell genomics is a powerful tool to study cellular heterogeneity and discover novel cell types. Recent studies used single cell RNA sequencing (scRNA-seq) to analyze the transcriptomes of individual pancreatic islet cells. Islets are a complex mixture of endocrine cells and therefore represent an ideal tissue type for single cell transcriptomic analysis. Adult human islets consist of five known endocrine cell types (α, β, δ, γ, ε) and multiple less well-defined non-endocrine cells. In this review, we discuss [...]

1672 12623

Open Access Research Article

A Simple and Effective Non-Human Primate Diabetic Model Combining Sub-Total Pancreatectomy and Low-Dose Streptozotocin Injection

Received: 27 March 2019;  Published: 09 July 2019;  doi: 10.21926/obm.transplant.1903071

Abstract

Background: The existing non-human primate diabetic models, particularly those induced by total pancreatectomy or streptozotocin (STZ) injection, have several disadvantages, including a lengthy surgical procedure, the need for continual supplementation of digestive enzymes, and delayed oral intake after total pancreatectomy, and severe hypoglycemia and hepatic/renal toxicity following injection of high-dose STZ. This study aimed to develop and optimize a non-human primate diabetic model that would avoid the disadva [...]

1462 11374

Open Access Review

Clinical Tolerance Trials in Renal Transplantation – Where Do We Stand?

Received: 05 November 2018;  Published: 27 June 2019;  doi: 10.21926/obm.transplant.1902070

Abstract

In recent years, the potential of hematopoietic stem cells, regulatory T-cells, and mesenchymal stem cells have brought about a variety of clinical tolerance trials. Every approach has yielded promising results; however, the riddle of transplant tolerance has not been solved as of yet. The results of the ongoing trials in this field will provide additional information regarding the risks and benefits of these therapy approaches.

1654 10132

Open Access Research Article

The DPP4 Inhibitor Sitagliptin Increases Active GLP-1 Levels from Human Islets and May Increase Islet Cell Survival Prior to Transplantation

Received: 12 March 2019;  Published: 26 June 2019;  doi: 10.21926/obm.transplant.1902069

Abstract

Background: One of the goals of clinical islet transplantation is to achieve a single-donor transplant that is dependent on obtaining enough quality β cell mass from one donor pancreas. Human islets are routinely cultured prior to transplantation, and pro-survival factors such as GLP-1 analogues have been reported to maintain β cell mass and survival. Interestingly, human islets may secrete GLP-1 and they also express the enzyme DPP4 that proteolytically cleaves GLP-1 into an inactive form. The aim of [...]

1405 13771

Open Access Review

Human Islet Isolation and Distribution Efforts for Clinical and Basic Research

Received: 11 March 2019;  Published: 21 June 2019;  doi: 10.21926/obm.transplant.1902068

Abstract

The ability to routinely and reproducibly obtain purified human islets has facilitated substantial progress in providing a safe and reliable treatment option for adult patients of type 1 diabetes. The availability of human islets for basic research has also significantly improved the understanding of the biology of human islets, and consequently the pathophysiology of diabetes. Presently, about 70 human islet isolation centers are known to exist around the world, in addition to multiple coordinated human islet dist [...]

1857 16033

Open Access Original Research

Ex-Vivo Perfusion of Donor Hearts: The Feasibility of Banked Blood for Normothermic Machine Perfusion

Received: 09 March 2019;  Published: 18 June 2019;  doi: 10.21926/obm.transplant.1902067

Abstract

Background: Normothermic machine perfusion (NMP) utilises 1.2-1.5L of donor blood (DB) with a target perfusate haematocrit of 25% to reanimate the donor heart. Limitations to current practise include small donor size and donor anaemia which can impact on the recovery of these hearts. Furthermore, in donation after circulatory death (DCD), blood collection may delay delivery of preservation solutions resulting in longer warm ischaemic times for the heart and other organs. Banked blood (BB) is a potential alternative [...]

1517 9035

Open Access Review

Non-CMV Viral Infections Following Solid-Organ Transplantation – Focus on Human T-Cell Lymphotropic Virus Type-1 and Human Herpesviruses-6,-7 and -8

Received: 14 February 2019;  Published: 17 June 2019;  doi: 10.21926/obm.transplant.1902066

Abstract

In non-endemic regions of the world, human T-cell lymphotropic virus type-1 (HTLV-1) is an uncommon pathogen in the transplant host, but can be associated with significant morbidity and mortality. Careful assessment for risk factors, targeted screening and heightened awareness of the clinical presentation of HTLV-1 associated disease is necessary for timely recognition and management in the transplant host. The use of antiretroviral agents in the management of symptomatic disease due to HTLV-1 remains controversial [...]

1534 8956

Open Access Review

Respiratory Viral Infections in Lung Transplant Recipients: Implications for Long Term Outcomes and Emerging Therapies

Received: 18 February 2019;  Published: 10 June 2019;  doi: 10.21926/obm.transplant.1902065

Abstract

Lung transplant recipients are at greater risk of respiratory viral infections as compared to other solid organ transplant recipients due to constant exposure of the allograft to the external environment. There are no standardized methods for surveillance, prevention, or treatment of these infections despite their association with increased morbidity and mortality. Various studies have linked respiratory viral infections with acute cellular rejection and chronic allograft dysfunction, and emerging data indicates a [...]

1267 9366

Open Access Original Research

Low Cost, Enriched Collagenase-Purified Protease Enzyme Mixtures Successfully Used for Human Islet Isolation

Received: 29 March 2019;  Published: 24 May 2019;  doi: 10.21926/obm.transplant.1902064

Abstract

Background: Purified bacterial collagenase and protease enzymes are commonly used to recover human islets from clinical grade pancreata for subsequent clinical islet transplantation. The high cost of purified enzymes can be prohibitive for recovering human islets from research pancreata used for translational research or pre-clinical studies. In this study, we successfully isolated islets from human research pancreata using enriched collagenase products supplemented with BP Protease (DE Collagenase 800 or Collagena [...]

1608 14265

Open Access Original Research

Liver Transplantation or Resection for Treatment of Hepatocellular Carcinoma in Patients with Well-Compensated Cirrhosis: A Decision Analysis Model

Received: 18 March 2019;  Published: 13 May 2019;  doi: 10.21926/obm.transplant.1902063

Abstract

Background: Hepatocellular carcinoma (HCC) is a lethal tumor, for which liver resection and transplantation are the only potentially curative treatments. No prospective, randomized study has compared survival in patients with compensated cirrhosis after the two operations Methods: Decision analysis modeling is an objective method to quantify risks and benefits. This study aimed to use decision analysis with a Markov model to estimate the impact of liver transplant and surgical resection on survival for patients wit [...]

1190 9398

Open Access Editorial

Pancreatic Islet Transplantation: State of the Art and Future Perspectives

Received: 08 April 2019;  Published: 15 April 2019;  doi: 10.21926/obm.transplant.1902062

Abstract

Pancreatic islet transplantation represents an effective therapy with lower morbidity for patients carriers of type 1 diabetes compared to whole pancreas transplantation. Although complete insulin independence is usually not achieved it allows control of glycemia balance reducing the risk of severe hypoglycaemia events and impaired awareness of hypoglycaemia. Recent trials had demonstrated islet transplantation to be more effective than current medical treatment and improvements in outcomes also have been reported [...]

1413 7944

Open Access Review

Update in the Use of Percutaneous Coronary Intervention for Cardiac Allograft Vasculopathy After Heart Transplantation

Received: 23 January 2019;  Published: 09 April 2019;  doi: 10.21926/obm.transplant.1902061

Abstract

Cardiac allograft vasculopathy (CAV) limits long-term survival after heart transplantation. CAV with discrete or tubular lesions can be treated with percutaneous coronary intervention (PCI) with high procedural success. Revascularization with balloon angioplasty, bare-metal stents, and first-generation drug-eluting stents has been associated with high and unacceptable restenosis rates. However, second-generation drug-eluting stents are associated with favorable stent and lesion patency. Stent and lesion patency now [...]

1317 8409

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