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 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 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 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 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 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 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 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 Angela Q Maldonado  , Kristoffer Sjöholm,  , Joshua Lee  , Håkan Olsson  , Christian Kjellman  and Darren E Stewart

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

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 [...]

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 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 Khawla F. Ali  and Betul Hatipoglu

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

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 [...]

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 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 Naoaki Sakata  , Gumpei Yoshimatsu  and Shohta Kodama

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

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, [...]

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 Scott S. Graves  , DavidW. Mathes  and Rainer Storb

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

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 [...]

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 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 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 Malcolm Voyce

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

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 [...]

by Spinello Antinori  and Laura Milazzo

Received: 28 October 2018;  Published: 15 January 2019;  doi: 10.21926/obm.transplant.1901039

Solid organ transplantation (SOT) is increasingly employed worldwide to treat several diseases causing both acute and chronic organ failure. Recipients of SOT are at an increased risk to develop infections as a consequence of immunosuppressive therapy. Sometimes such infections may be acquired by the transplanted organ or by reactivation of a previously acquired latent infection. The globalization and the increase of international travel poses a risk for exposure to infections such as Chagas disease (CD), leishmani [...]

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 Michael Mazzei  , Suresh Keshavamurthy  , Olga Timofeeva  and Yoshiya Toyoda

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

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 [...]

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 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 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 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 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 Makeda L. Robinson  , Kyle Enriquez  and Dora Y. Ho

Received: 02 November 2018;  Published: 08 January 2019;  doi: 10.21926/obm.transplant.1901038

Flaviviruses can cause epidemics and endemics with substantial public health threat and economic impacts. In the last few decades, many flaviviruses have re-emerged or expanded their territories to new regions or continents, including West Nile virus (WNV) which has become endemic in the US since its arrival in 1999 and Zika virus (ZIKV) which recently spread across the Americas. These events demonstrate the speed with which a vector-borne pathogen can disseminate when introduced into a susceptible population with [...]

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 Marina Moguilevitch  , Michael Rufino  , Shalom Frager  and Tracey Straker

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

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 [...]

by Yasuhiko Sugawara

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

by Olivia C Smibert  , Joseph S Doyle  , Adam WJ Jenney  , David Pilcher  , Miranda A Paraskeva  , Glen P Westall  and Greg I Snell

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

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 [...]

by Marion Hemmersbach-Miller  , Cameron R. Wolfe  and Kenneth E. Schmader

Received: 30 November 2018;  Published: 01 February 2019;  doi: 10.21926/obm.transplant.1901046

In the U.S., older adults aged 65 or above comprise nearly one quarter of the solid organ transplant (SOT) waitlists, and the number of transplants performed in this age group continues to increase. There are no specific guidelines for the assessment and follow up of the older SOT candidate or recipient. Older adults are at increased risk of infectious complications after SOT. Despite these complications and even with the use of suboptimal donors, overall outcomes are favorable. We provide an overview to specific c [...]

by Gerald Schlaf  , Jakob Kehlen  , Anja Wahle  , Diana Mauer  and Wolfgang Altermann

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

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 [...]

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 Yoshitaro Shindo  and Mazhar A. Kanak

Received: 29 March 2018;  Published: 22 June 2018;  doi: 10.21926/obm.transplant.1802013

Islet cell transplantation is a developing treatment for patients suffering from severe Type-1 diabetes. The long-term insulin independence after islet cell transplantation has been difficult to achieve, and this has been linked to several factors. One of the major cause of poor long-term outcome is inflammation surrounding the islets. Inflammation in islets is caused at several stages, donor induced, during organ preservation, islet isolation stress, peri-transplant inflammation or instant blood mediated inflammat [...]

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 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 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 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 Masayuki Shimoda  and Shinichi Matsumoto

Received: 25 February 2018;  Published: 25 April 2018;  doi: 10.21926/obm.transplant.1802008

More than 10 million people worldwide suffer from type 1 diabetes mellitus (T1DM). Allogeneic islet transplantation has been established to prevent severe hypoglycemia in unstable T1DM patients although there is a serious shortage of donors. Islet xenotransplantation using porcine islets is a promising solution to this issue. Porcine islets offer several advantages over human islets, including unlimited and on-demand supplies, a higher quality of islets from healthy donors, greater safety with designated pathogen-f [...]

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 Tessa M. Andermann  , Ke Zeng  , Sayal Guirales-Medrano  , Adam Groth  , Bhanu C. Ramachandran  , Shan Sun  , Alicia A. Sorgen  , Lauren Hill  , Amy T. Bush  , Hongwei Liu  , Corbin Jones  , Jeffrey Roach  , Brian P. Conlon  , Gauri Rao  , Nelson J. Chao  , Anthony A. Fodor  and Anthony D. Sung

Received: 24 April 2025;  Published: 25 August 2025;  doi: 10.21926/obm.transplant.2503255

Home-based hematopoietic stem cell transplantation (HCT) is an innovative care model with growing interest, but its impact on the gut microbiome remains unexplored in a randomized setting. We present interim results from the first randomized controlled trials (RCT) evaluating the effect of HCT location—home versus hospital—on gut microbial diversity and antimicrobial resistance (AMR) gene carriage. We hypothesize that patients randomized to undergo home HCT would have higher gut taxonomic diversity and lower AMR ge [...]

by Joachim Andrassy  and Antje Habicht

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

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.

by Raquel López-Vilella  , Alba Cecilia Ruiz Gaitán  , José Ricardo Gimeno Costa  , Elena Marqués-Sulé  , Rosario Vicente Guillén  , Javier Pemán García  , Ignacio Sánchez-Lázaro  and Luis Almenar Bonet

Received: 15 October 2018;  Published: 27 February 2019;  doi: 10.21926/obm.transplant.1901053

In recent years, several agencies have issued warnings about the spread of Candida auris infections, a multidrug-resistant yeast that is associated with serious infections and with a mortality rate that can reach 70%. This problem is especially serious in transplant recipients receiving intense immunosupressive therapy. There are no established criteria on the relevance of this colonization or on when the transplant should be contraindicated in these cases. Five cases of colonization and two of candidemia have been [...]

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 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 Preeti Chhabra  and Kenneth L. Brayman

Received: 02 April 2018;  Published: 05 June 2018;  doi: 10.21926/obm.transplant.1802010

Pancreas or islet transplantation is the only reliable cure for Type 1 Diabetes. However, shortage of donor tissue supply, longitudinal graft attrition due to innate and adaptive immunity and the recurrence of autoimmunity, as well as the harmful side-effects of chronic immunosuppressive therapy limit the wide-spread acceptance of islet transplantation as a mainstream cure for autoimmune diabetes. Herein, preclinical and clinical stem-cells based research approaches aimed at obtaining large quantities of islets for [...]

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 Qing Ye  , Yijen L. Wu  , Lesley M. Moley  , Parker H. Mills  , Fang-Cheng Yeh  , Haosen Zhang  , Danielle F. Eytan  , Li Liu  , T. Kevin Hitchens  and Chien Ho

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

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 [...]

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 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 Khawla F. Ali  , Vicente T. San Martin  , Tyler Stevens  , R. Matthew Walsh  , Rita Bottino  , Massimo Trucco  and Betul Hatipoglu

Received: 29 March 2018;  Published: 02 July 2018;  doi: 10.21926/obm.transplant.1803014

Total pancreatectomy (TP) is increasingly being utilized for definitive treatment in patients with debilitating chronic pancreatitis (CP). In an effort to prevent surgical diabetes, the procedure can be performed in conjunction with transplantation of islets of Langerhans recovered from the patients’ own resected pancreas (autologous islet transplantation, AIT). Given that patients undergoing TP and AIT are traditionally assumed not to be at risk for the development of beta-cell autoimmunity, it is possible that th [...]

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 Salim Hamdani  and Daniel Azoulay

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

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 [...]

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 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 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 Katerina G. Oikonomou  and Sarah Taimur

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

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 [...]

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 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 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 [...]

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 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 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 Sunil Daga  , Adarsh Babu  , Natasha Khovanova  and Robert Higgins

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

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 [...]

by Hamid Ullah  , Sara Iqbal  , Blanca Lizaola Mayo  and Elizabeth Carey

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

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 [...]

by Abhijit Jagdale  , C. Adam Banks  , Hayato Iwase  , David K.C. Cooper  and Hidetaka Hara

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

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- [...]

by Julianna Holzer  , John Wu  , Yi He  , Mingyang Ma  , Yuan Xing  , Jose Oberholzer  and Yong Wang

Received: 08 November 2018;  Published: 21 December 2018;  doi: 10.21926/obm.transplant.1804034

In this review, we discuss the application of microfluidic devices in studying the physiology and pathophysiology of human islets and beta-cells, especially its application for human islet transplantation. Human islet transplantation is a promising therapy for Type I diabetes; however, the islet transplant outcomes for achieving complete insulin independence are far from perfect and face many challenges. This review focuses on the microfluidic devices developed in our laboratory, which can address these challenges [...]

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 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 [...]