by Amy Spallone  and Marion Hemmersbach-Miller

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

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 [...]

by Michelle F. Sener  , Thaddeus Rogozinski  , James S. George  , Deepak Mital  and Douglas P. Slakey

Received: 08 November 2022;  Published: 29 January 2023;  doi: 10.21926/obm.transplant.2301174

Cytomegalovirus (CMV) infection is the most common infection affecting kidney transplant recipients [1]. CMV may be present as asymptomatic viremia or with symptoms ranging from mild to significant tissue-invasive disease [1,2,3]. Optimal kidney graft function and survival requires that transplant care teams carefully assess individual patient risk of CMV [2,3]. Appropriate patient surveillance and prophylaxis are essential to ensure the best long-term kidney transplant results. Effective treatment of CMV disease r [...]

by Robert C. McCarthy  , Michael L. Green  and Francis E. Dwulet

Received: 24 September 2018;  Published: 07 November 2018;  doi: 10.21926/obm.transplant.1804024

Islet transplantation is becoming an established treatment option for managing a subset of adult patients who have type 1 diabetes mellitus. The success of this procedure is dependent upon the recovery of a sufficient number of functional human islets from donor organs for subsequent transplant. Here, the use of optimized bacterial collagenase-neutral protease enzyme mixtures has been shown to affect the yield and quality (defined by viability and glucose-stimulated insulin secretion) of islets recovered from human [...]

by Melissa Mortensen  , Christine Lundberg  and Simon Horslen

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

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 [...]

by Martin Igbokwe  , Olalekan Olatise  , Thelma Olatise  , Abu Sadiq  , Abayomi Aremu  , Uzodinma Onwuasoanya  , Ahmad Lawal  , Ikechukwu Anosike  , Adegboyega Faponle  , Adam Ochigbo  , Chukwunonso Epundu  , Stephen Asaolu  , Sani Al Hassan  and Rashad Hazem

Received: 19 March 2023;  Published: 19 June 2023;  doi: 10.21926/obm.transplant.2302189

With the rise in the population of patients with End-stage Renal Disease (ESRD) in Nigeria, there is an increased demand for Renal Replacement Therapy (RRT) including kidney transplantation (KT). We present our initial surgical experience and early outcomes with KT at a Nigerian transplant center over 2 years. A 2-year retrospective review of patients who underwent KT was done. Data of both kidney donors and recipients were recorded in designed proformas. Extracted information included demographic characteristics, [...]

by Christopher Thomas  , Matthias Williams  and Oksana A. Shlobin

Received: 07 August 2023;  Published: 11 October 2023;  doi: 10.21926/obm.transplant.2304197

Lung transplantation is a last-resort treatment option for patients with end stage lung disease. The procedure is being performed more frequently and scientific advances continue to be made, but the median post-transplant survival is far shorter than other solid organ transplant recipients. Candidate selection is a resource intensive process that attempts to balance risks of the procedure with the benefits of much higher quality of life. Transplant centers must weigh disease specific considerations, medical comorbi [...]

by Uttayan Chakrabarti  , Manish Chaturvedy  , Nitin Kumar Bajpai  , Jitendra Goswami  , Rajesh Kumar Garsa  and Rajesh Jhorawat

Received: 10 April 2023;  Published: 14 July 2023;  doi: 10.21926/obm.transplant.2303192

BK virus (BKV) is a common opportunistic pathogen in kidney transplant recipients and one of the most challenging causes of allograft dysfunction and loss. Although over-immunosuppression remains the primary risk factor for BKV infection after transplantation, male gender, older recipient age, prior rejection episodes, degree of human leukocyte antigen mismatching, prolonged cold ischemia time, BK virus serostatus and ureteral stent placement have all been implicated as risk factors. Routine screening post-renal tr [...]

by Justin P. Rosenheck  , Mena M Botros  and David R Nunley

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

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 [...]

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 Livia Maria Surdi  , Maribel Dagher  , Tamara Merhej  , John Choi  and Jamil R. Azzi

Received: 17 April 2025;  Published: 10 September 2025;  doi: 10.21926/obm.transplant.2503258

Antibody-mediated rejection (ABMR) remains a major barrier to long-term graft survival in kidney transplantation. Defined by the presence of donor-specific antibodies (DSAs) and characteristic histological changes, such as C4d deposition in peritubular capillaries, ABMR can present acutely, chronically, or subclinically, often manifesting as graft dysfunction. Recent advances in genomic profiling and diagnostic assays have improved our understanding of its pathophysiology, yet therapeutic strategies remain limited. [...]

by Michael F Knoll  , Carmela A Knoll  , Rita Bottino  , Suzanne Bertera  and Massimo Trucco

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

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 [...]

by Onix Cantres-Fonseca  , Shambhu Aryal  , Christopher King  and Steven D. Nathan

Received: 25 May 2023;  Published: 20 February 2024;  doi: 10.21926/obm.transplant.2401207

Chronic allograft dysfunction (CLAD) is one of the leading causes of death after lung transplantation [1]. CLAD is a progressive and irreversible decline in lung function after transplant, manifested as an obstructive, restrictive, or mixed ventilatory impairment without any identifiable etiology as infection or acute rejection. Multiple risk factors have been associated with this condition. Despite its significant effect on the mortality of transplanted patients, there is still a lack of powerfully effective thera [...]

by Shefali Mody  , Soham Nadkarni  , Shreyash Vats  , Akshay Kumar  , Sravanthi Nandavaram  and Suresh Keshavamurthy

Received: 09 July 2023;  Published: 23 November 2023;  doi: 10.21926/obm.transplant.2304203

The shortage of donor lungs for transplantation is a major challenge, resulting in longer waitlist times for patients with a higher risk of waitlist mortality. It is crucial to continue promoting awareness about organ donation through legislation, public campaigns, and health care provider education. Only a small number of cadaveric donors meet the ideal criteria for lung donation, leaving many lungs unused. Donor lung utilization can be improved by carefully considering the extended-criteria donors, actively parti [...]

by Ibrahim Nahit Sendur  , Büsra Köksoy  and Yasemin H. Balaban

Received: 11 November 2024;  Published: 01 April 2025;  doi: 10.21926/obm.transplant.2502244

Cytomegalovirus (CMV) remains a significant cause of morbidity and mortality in solid organ transplant (SOT) recipients. Despite advancements in prophylaxis and antiviral therapy, CMV continues to pose clinical challenges in transplant medicine. This review provides a comprehensive overview of CMV, exploring its pathophysiology, epidemiology, and clinical presentation in SOT patients, in whom CMV infection can lead to direct organ involvement and systemic symptoms. Additionally, CMV has indirect effects, including [...]

by Natasha Hui Jin Ng  , Wei Xuan Tan  , Ye Xin Koh  and Adrian Kee Keong Teo

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

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 [...]

by Jeremy M. Quintana  , Alexandra L. Stinchcomb  , Jessica H. Kostyo  , Blair M. Robichaud  , Michael A. Plunk  and Robert R. Kane

Received: 08 October 2018;  Published: 28 December 2018;  doi: 10.21926/obm.transplant.1804036

Islet transplantation has proven to be a viable treatment for individuals suffering from both Type 1 Diabetes Mellitus (T1D) and chronic pancreatitis. However, a variety of challenges limit the effectiveness of this procedure by reducing the number of islets that survive the harvesting and transplantation processes. Increasing islet survival would increase the long-term effectiveness of the procedure and allow this technique to be used in more patients. A number of factors have been shown to improve the outcomes of [...]

by Pierpaolo Di Cocco  , Alberto Fratti  , Kerim B. Kaylan  , Ivo G. Tzvetanov  and Enrico Benedetti

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

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 [...]

by David W. Scharp  , Jayagowri Arulmoli  , Kelly Morgan  , Hannah Sunshine  and Ergeng Hao

Received: 15 October 2018;  Published: 26 February 2019;  doi: 10.21926/obm.transplant.1901052

Background: This presentation of a six-year study processing human islets for research and transplantation includes a review of multi-center transplant studies identifying key variables critical for successful islet processing and defines standardized processing procedures required to provide highly purified, functional Human Islets. Methods: Human islet processing methods are defined in detail with pancreas retrieval, shipping, trimming for processing, collagenase distension, controlled digestion by digestion/filt [...]

by Shruthi Kodad  , Waleed Sabry  , Assem Elsayed  , Hadi Goubran  and Mohamed Elemary

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

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 [...]

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 In Lam  , Irina Gutman  , Ashley Feist  and Mark Mariski

Received: 10 March 2017;  Published: 22 June 2017;  doi: 10.21926/obm.transplant.1701003

After lung transplant, infection is a leading contributor to morbidity and mortality, and hypogammaglobulinemia (HGG) may be an important risk factor for many of these infections. Some reports suggest that HGG not only increases the risk of various infections, but also worsens survival. The incidence of HGG has been shown to increase after lung transplant, and may be as high as 70%. In order to mitigate this risk, intravenous immunoglobulin G (IVIG) replacement for the treatment of HGG has been utilized. However, t [...]

by Omer Eugene Beaird  , Deepa Nanayakkara  , Pryce Gaynor  and Joanna Schaenman

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

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 [...]

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 Maïté Van Hentenryck  , Zhanzhuo Li  , Philip M. Murphy  and Agnieszka Czechowicz

Received: 24 November 2021;  Published: 08 July 2022;  doi: 10.21926/obm.transplant.2203162

The ability to successfully transplant cells and organs from a donor into an immunologically disparate recipient is one of the greatest treatment advances in the history of medicine. Nevertheless, acute and chronic rejection, graft versus host disease, and the inability to identify suitable donors continue to be challenges and limit broader application of cell and organ transplantation to the many patients that could benefit. Immunosuppression before and after allogeneic transplant has been found to dramatically im [...]

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 [...]