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 Qiqi Yu  , Kran Suknuntha  , Weixiong Zhong  , Daniel R. Matson  , Aaron S. Hess  and William N. Rose

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

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 [...]

by Anita Verma  , Katharina Sophia Weigel  , Sim You Kuan Dexter  and Anil Dhawan

Received: 26 March 2018;  Published: 29 May 2018;  doi: 10.21926/obm.transplant.1802009

Invasive fungal infections (IFI) remain an important cause of morbidity and mortality, especially in hospitalized and immunocompromised or critically ill patients. The incidence of IFIs has been declining in liver transplant recipients (LTR). This is likely due to the evolving immunosuppressive drug regimens, improved surgical techniques and targeted antifungal prophylaxis. However, IFI still contribute to high mortality and are associated with high economic burden due to consumption of costly newer antifungal agen [...]

by Elizabeth F. Wallin  , Michelle A. Linterman  and Kathryn J. Wood

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

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 [...]

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 Katharina Tigges-Limmer  , Stephan Ensminger  , Yvonne Brocks  , Scott Stock Gissendanner  and Jan Gummert

Received: 28 October 2018;  Published: 05 March 2019;  doi: 10.21926/obm.transplant.1901056

Background: The participation of mental health professionals in multidisciplinary care teams for heart transplantation has become an international standard practice. The contribution of these professionals in this setting, which involves assessment and interventions, has not been the subject of systematic study. Methods: This paper explores how psychotherapists contribute to multidisciplinary decision making and care in transplant teams before, during, and after transplantation. To illustrate, it uses the case of a [...]

by Siva Mahendran  , Paramit Chowdhury  , Ronan Breen  , Grainne d’Ancona  and Heather J. Milburn

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

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 [...]

by Maria Simonenko  and Petr Fedotov

Received: 01 February 2019;  Published: 13 February 2019;  doi: 10.21926/obm.transplant.1901049

Sex and gender issues in heart transplantation

by Lynne Uhl  , Taye H. Hamza  , Terry Gernsheimer  and Sherrill J. Slichter

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

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 [...]

by Masahiro Sato  , Yuki Kiyokawa  , Emi Inada  , Eri Akasaka  , Satoshi Watanabe  and Issei Saitoh

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

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 [...]

by Anis Chaba  , Manon Dekeyser  , Julie Oniszczuk  and Antoine Durrbach

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

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 [...]

by Sheila Krishnan  , Chadi Hage  , Raymond Coakley  , David van Duin  and Leonard Jason Lobo

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

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 [...]

by Victoria Gómez-Dos-Santos  , Vital Hevia-Palacios  , María Laura García-Bermejo  , Alberto Alcázar-González  , Miren Edurne Ramos-Muñoz  , Laura Salinas-Muñoz  , Elisa Conde-Moreno  , Alejandro Escobar-Peso  , Ana Belén Serrano-Romero  , Ana Saiz-González  , Miriam Menacho-Román  and Francisco Javier Burgos-Revilla

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

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 [...]

by Silvia Martini  , Ezio David  , Francesco Tandoi  , Dominic Dell Olio  , Antonio Amoroso  , Mauro Salizzoni  , Giorgio Maria Saracco  and Renato Romagnoli

Received: 27 September 2018;  Published: 04 December 2018;  doi: 10.21926/obm.transplant.1804030

Background: We performed a liver transplant (LT) with a graft from a 52-year-old donor of blood group O who was HCV viremic. The recipient was a 52-year-old male with blood group A, HCV-related cirrhosis and hepatocellular carcinoma. Methods: A liver biopsy performed on post-LT day 9 revealed acute T-cell-mediated rejection and the patient received three 1.0-g boluses of methylprednisolone. On day 9, the hemoglobin level dropped and the direct antiglobulin test became positive. Passenger lymphocyte syndrome (PLS) w [...]

by Joanna K. Nelson  and Aruna Subramanian

Received: 30 November 2018;  Published: 01 February 2019;  doi: 10.21926/obm.transplant.1901047

Nontuberculous mycobacteria (NTM) infections are relatively rare but carry significant morbidity in solid organ transplant (SOT) recipients. Given the rarity of disease and diagnostic limitations, a high index of suspicion is required for accurate diagnosis and initiation of appropriate treatment. We discuss the challenges in diagnosis and management of NTM infections specific to the SOT population.

by Laura A. Huppert  , Marie Sinclair  and Jennifer C. Lai

Received: 08 November 2018;  Published: 28 November 2018;  doi: 10.21926/obm.transplant.1804028

Background: Patients with cirrhosis suffer not only from commonly-diagnosed portal hypertensive complications such as ascites and hepatic encephalopathy but also from more insidious effects of chronic liver failure including muscle wasting, under-nutrition, and functional decline. These manifestations of physical frailty have been demonstrated to predict mortality in patients with cirrhosis independently of liver disease severity, but objective biomarkers associated with physical frailty in cirrhosis are needed. Th [...]

by Christine A. Beamish  and Omaima M. sabek

Received: 08 November 2018;  Published: 05 March 2019;  doi: 10.21926/obm.transplant.1901055

Pancreatic islet transplantation holds promise for patients with insulin-dependent diabetes, but is severely limited by a shortage of cadaveric donor islets, and more so because of stringent inclusion criteria for organ donation including donor metabolic function, age, and comorbidities. The impact of these diverse factors on islet health has led to a broad investigation of global influences on islet biology, not least of all, characterization of mature, functional cellular identity and maintenance of appropriate e [...]

by M Wehming  , A Briem-Richter  , R Ganschow  , F Brinkert  , B Winkler  , L Fischer  and Enke Grabhorn

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

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 [...]

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 Michael J Eiswerth  and Joel Wedd

Received: 30 November 2024;  Published: 17 April 2025;  doi: 10.21926/obm.transplant.2502247

The prevalence of alcohol use disorder (AUD) and alcohol-related liver disease (ALD) has increased in the last two decades. ALD is currently the most common indication for both waitlist additions and liver transplant (LT) in the United States, including alcohol-associated cirrhosis, alcohol-associated hepatitis (AH), and acute-on-chronic liver failure (ACLF). ALD also has a significant global disease burden. LT in ALD is a complex paradigm that poses both medical and ethical challenges, requiring a multidisciplinar [...]

by Rama Bindu Manchikalapudi

Received: 31 May 2017;  Published: 28 September 2017;  doi: 10.21926/obm.transplant.1703005

Cardiac allograft vasculopathy is one of the leading causes of death following the first 5 years after orthotopic heart transplantation along with late graft failure, likely secondary to undiagnosed CAV. Currently there is no single medical treatment available for this condition except modification of risk factors and immunosuppression. Retrasplantation remains the hope for this entity with some limitations.

by Victoria Gómez-Dos-Santos  , Vital Hevia-Palacios  , Edurne Ramos-Muñoz  , María Laura García-Bermejo  , Esperanza Macarena Rodríguez-Serrano  , Ana Saiz-González  , Jose Manuel Del Rey-Sánchez  and Francisco Javier Burgos-Revilla

Received: 22 March 2018;  Published: 21 June 2018;  doi: 10.21926/obm.transplant.1802012

Background: Extended criteria donors and donation after cardiac death donors provide organs which tend to be more sensitive to the stress of preservation. There is a lack of evidence about the potential role of oxygen in preservation techniques, and literature comparing oxygenated and non-oxygenated techniques is very limited. The aim of the study was to compare HMP with oxygen versus HMP without oxygen in a pig model of kidney auto-transplantation (KT) reproducing conditions of DCD. We have also set up miRNAs expr [...]

by Amanda B. Cooper  , Stephen M. Downs  , Nicholas J Skill  , Richard S. Mangus  , Chandrashekhar A. Kubal  and Mary A. Maluccio

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

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 [...]

by Victoria Lorenzetti  , Elena Bargagli  , Antonella Fossi  , David Bennett  , Paolo Cameli  and Paola Rottoli

Received: 30 August 2018;  Published: 18 December 2018;  doi: 10.21926/obm.transplant.1804033

Background: Alpha-1-antitrypsin (AAT) deficiency is the most common hereditary disorder in adults and is associated with an increased risk of developing lung emphysema. Methods:Here, we report the case of a 54-year-old man, who underwent bilateral lung transplantation due to AAT deficiency emphysema in the general hospital of Siena, Italy. Results:The patient was diagnosed with partial AAT deficiency (189 mg/dL) associated with the PIMZ genotype; although he quit smoking, his lung disease progressed to chronic resp [...]

by Hong Chee Chew  , Ling Gao  , Jeanette E. Villaneuva  , Aoife Doyle  , Mark Hicks  , Andrew Jabbour  , Kumud K. Dhital  and Peter S. Macdonald

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

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 [...]