by Alberto Ferrarese  , Marco Senzolo  and Patrizia Burra

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

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 [...]

by Antoine Buemi  , Jérôme Duisit  , Flora Musuamba  , Tom Darius  , Martine De Meyer  , Selda Aydin  , Nada Kanaan  , Arnaud Devresse  , Eric Goffin  and Michel Mourad

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

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 [...]

by Anita Verma  and Anil Dhawan

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

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 [...]

by Allison Ramsey  , Christine Natori  , Kristen Cisneros  , David J. Ross  and Abbas Ardehali

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

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 [...]

by David J. Ross

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

by Adam K. Morrison  , Robert J. Gajarski  , Ashley Hodge  , Sara Fitzgerald-Butt  , Peter Baker  , Patrick M. McConnell  and Deipanjan Nandi

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

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 [...]

by Victoria Rendell  , Natalie M. Bath  and Todd V. Brennan

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

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 [...]

by Amy Spallone  , Udit Dhal  , Laila Woc-Colburn  and Marion Hemmersbach-Miller

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

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 [...]

by Muayad Alali  , Michael Z. David  , Sandra A. Ham  , Danziger-Isakov LA  , Allison H. Bartlett  , Lindsay Petty  and Jennifer C. Pisano

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

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 [...]

by Abdul Al-Toma  and Harry R. Koene

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

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 [...]

by Steven R. Potter

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

by Rene J. Duquesnoy  and Marilyn Marrari

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

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 [...]

by Nour Hasan  , Ankita P. Desai  and Jignesh Dalal

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

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 [...]

by Maurizio Salvadori  and Aris Tsalouchos

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

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 [...]

by Federica Odaldi  , Vanessa De Pace  , Giacomo Frascaroli  , Giuliana Germinario  , Giorgia Comai  , Francesco Vasuri  , Gaetano La Manna  and Matteo Ravaioli

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

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 [...]

by Salem Dehom  , Synnove Knutsen  , David Shavlik  , Khaled Bahjri  , Hatem Ali  , Lance Pompe  and Rhonda Spencer-Hwang

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

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 [...]

by Victor Dong  , Aldo J. Montano-Loza  and Andrew L. Mason

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

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 [...]

by Maurizio Salvadori  and Aris Tsalouchos

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

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 [...]

by Sumail Bhogal  , Matthew Minn  , Pranay Krishnan  and Reena C. Jha

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

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 [...]

by Jose A. Morillas  and Sherif Beniameen Mossad

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

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 [...]

by David J. Ross  , Abbas Ardehali  , Christine Natori  and John A. Belperio

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

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 [...]

by Kyungmin Ko  , Juan F. Guerra  and David F. Garvin

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

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 [...]

by Renato Pol  , Tiziana Ruggiero  , Luisa Giaccone  , Davide Camisassa  , Andrea Spadafora  , Giulia Rivetti  , Marta Bezzi  and Stefano Carossa

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

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 [...]

by Susanna Lam  , Jerome M Laurence  and Deborah J Verran

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

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 [...]

by Vanessa G. Oliveira  , Ana Filipa Saraiva  , Fátima Costa  and Aida Botelho de Sousa

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

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 [...]