by Shehab Mohamed  , Davide Tosi  , Sara Pieropan  , Andrea Cara  , Giovanni Caffarena  , Giorgio Alberto Croci  and Lorenzo Rosso

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

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 [...]

by Mrudula Munagala  and Anita Phancao

Received: 31 August 2017;  Published: 11 January 2018;  doi: 10.21926/obm.transplant.1801007

Heart transplant remains the gold standard therapy for patients with end stage heart disease and offers improved survival and quality of life. Significant progress has been achieved in improving one-year mortality after heart transplantation. Nonetheless, long-term graft survival has not changed significantly over the past few decades. Long term survival of heart transplant recipients is limited by chronic rejection, cardiac allograft vasculopathy (CAV), and malignancy. CAV is a major contributor for graft failure [...]

by Niccolò Castellani Nicolini  , Jacopo Belfiore  and Giandomenico Biancofiore

Received: 14 May 2023;  Published: 13 October 2023;  doi: 10.21926/obm.transplant.2304198

Liver transplantation (LT) is a life-saving treatment representing the only viable option for patients suffering from end-stage liver disease (ESLD) or acute liver failure. Patients who undergo LT require a multidisciplinary approach to postoperative pain management. However, pain management in this context is often inadequately explored. Limited options exist for proper pain control in patients with hepatic failure, mainly due to the increased risk of kidney and multi-organ failure. In LT candidates, specific anal [...]

by James Farag  and Silvana Marasco

Received: 13 February 2019;  Published: 08 April 2019;  doi: 10.21926/obm.transplant.1902060

Left ventricular assist devices (LVADs) improve quality of life in end-stage heart failure patients but a frequent complication is Right heart failure (RHF) causing significant morbidity and mortality. This review article discusses key issues that need to be considered in the assessment and clinical management of RHF in LVAD patients including the use of Right Ventricle (RV) support devices and off-label LVADs as temporary or permanent RV support.

by Robert B. Diller  , Robert G. Audet  , Mediha Gurel  , Eric E. Lee  , Aaron J. Tabor  , Peter McFetridge  and Robert S. Kellar

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

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, [...]

by Sravanthi Nandavaram  , Hannah Twist  , Rickey Evans  , Sravanthi Paluri  , Ana Castellanos  and Andres Pelaez

Received: 31 January 2024;  Published: 10 April 2024;  doi: 10.21926/obm.transplant.2402211

Thrombotic Microangiopathy (TMA) is a syndrome characterized by microangiopathic hemolytic anemia (MAHA) and thrombocytopenia. The presence of schistocytes on peripheral smear, a negative Coombs test, elevated lactate dehydrogenase, increased reticulocyte count and low haptoglobin are often the clues for MAHA. The microvascular process often targets vasculature in kidneys, brain, gastrointestinal system, heart, and skin. A timely diagnosis and treatment are often crucial to prevent severe end organ damage and death [...]

by Gopalakrishnan Loganathan  , Michael G. Hughes  , Gregory L. Szot  , Kate E. Smith  , Abid Hussain  , Daniel R. Collins  , Michael L. Green  , Francis E. Dwulet  , Stuart K. Williams  , Klearchos K. Papas  , Robert C. McCarthy  and Appakalai N. Balamurugan

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

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 [...]

by Chunhui Xie  , Lillian Ye  , Yeh-Chuin Poh  and George Harb

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

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 [...]

by Margaret E. Newman  , Kenneth Pursell  and David Pitrak

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

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

by Gerald P. Morris

Received: 22 February 2019;  Published: 11 April 2017;  doi: 10.21926/obm.transplant.1701002

(1) Background: Lung transplantation is an increasingly utilized treatment for end-stage lung disease. Scarcity of organ donors limiting transplantation underscores the importance of optimal histocompatibility testing approaches to facilitate organ allocation and avoid immunologic rejection. Significant data has emerged over the past decade to define the role of alloantibodies against HLA in the pathogenesis of post-lung transplant complications. (2) Methods: Medical literature from 1996–2016 related to search term [...]

by Wolfgang Rennert  , Katie Cormier  and Samantha Sprott

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

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 [...]

by Scott A. Campbell  , Matthew Hubert  , Janyne Johnson  , Nicole Salamon  and Peter E. Light

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

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 [...]

by Dagan Coppock  , Caytlin Deering  , Shara Epstein  and Dong Heun Lee

Received: 23 December 2018;  Published: 01 March 2019;  doi: 10.21926/obm.transplant.1901054

Infections are a common cause of morbidity and mortality in solid organ transplantation (SOT) recipients. Procalcitonin (PCT) has garnered attention as an inflammatory marker that has been shown to be a valuable marker for early identification of systemic bacterial infection. However, interpretation of PCTs value in the different types of infections, transplanted organs, and post-operative courses can be challenging. We review the role of PCT in the management of infections in SOT recipients. First, the PCT level c [...]

by Renly Dutton  , Frank Abdi  , Levon Minnetyan  and James L. Sherley

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

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 [...]

by Ashrit Multani  and Stanley Deresinski

Received: 31 October 2018;  Published: 27 December 2018;  doi: 10.21926/obm.transplant.1804035

Strongyloides stercoralis, an intestinal parasitic nematode (roundworm), infects more than 100 million people worldwide. While most infected immunocompetent persons are either asymptomatic or experience only mild, intermittent symptoms, immunosuppressed individuals, including those undergoing solid organ transplantation, are at increased risk for developing the frequently fatal hyperinfection syndrome. Donor-derived strongyloidiasis has recently become increasingly recognized and reported but current donor screenin [...]

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 Preeti Chhabra  and Kenneth L. Brayman

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

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 [...]

by Nidhi Sharma  and Yvonne Efebera

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

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 [...]

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

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

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

by Kamyar Afshar  , Michelle Bremer  , Bharath Ravichandran  , Ashley A. Feist  , Eugene Golts  , Elizabeth H. Schonhoft  and Gordon Yung

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

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- [...]

by Yassamine Bentata

Received: 24 January 2024;  Published: 25 July 2024;  doi: 10.21926/obm.transplant.2403221

Completely unknown before the 90s and exceptional up to the 2000s, BK virus nephropathy (BKvN), usually known as polyomavirus-associated nephropathy, has emerged as a significant and severe viral complication in kidney transplantation (KT). More than twenty years after Gardner's discovery of BKv in 1971, Purighalla described, in 1995, the first case of BKvN. Four years later in 1999, Nickeleit et al. published a first series of five cases of BKvN and made very precious and pertinent contributions to understanding t [...]

by Christine Pham  , Brett J Pierce  , Simon W Yau  , Jihad Georges Youssef  , Ahmad Goodarzi  and Howard J Huang

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

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 [...]

by R. Paul Robertson

Received: 13 February 2023;  Published: 17 May 2023;  doi: 10.21926/obm.transplant.2302184

Pancreatic islet transplantation (ITx) has moved from the experimental phase of development to a position of an accepted and appropriate procedure to apply in clinical medicine. The primary indication for use of ITx is for management of dangerous and recurrent hypoglycemia secondary to use of exogenous insulin for management of hyperglycemia in people with type 1 diabetes. ITx involves procurement of a pancreas donated by a person who has died. The organ is taken to a specialized laboratory for isolation of islets [...]

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 Brandon M Menachem  , Sandrine Hanna  , Deepika Kulkarni  and Hakim Azfar Ali

Received: 08 June 2023;  Published: 21 November 2023;  doi: 10.21926/obm.transplant.2304202

Treatment options for end stage lung diseases are limited to stabilizing lung failure, decreasing disease progression, and symptom management, but significant reversal of lost lung function is often not possible. For well selected patients, lung transplantation may be a viable option to improve both longevity and quality of life. Though outcomes for lung transplant recipients have improved over several decades, long term survival still lags behind that of other solid organ transplant recipients. Longevity after lun [...]