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 Plamen Mihaylov  , Burcin Ekser  , Daiki Soma  , Andrew Lutz  , Jonathan Fridell  and Chandrashekhar A. Kubal

Received: 04 January 2021;  Published: 11 March 2021;  doi: 10.21926/obm.transplant.2101138

One of the most feared complications in liver transplantation is hepatic arterial thrombosis (HAT). The incidence of HAT in liver transplantation varies from 1.2% and 8%. One of the risk factors for this complication is anatomical complexity of hepatic arterial system. The focus of this short communication is to show our approach in dealing with aberrant left hepatic artery in settings of liver transplantation. This is a single center experience. Between January 2016 and June 2019, we procured and transplanted 357 [...]

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 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 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 David J. Epstein  and Aruna K. Subramanian

Received: 18 November 2018;  Published: 12 February 2019;  doi: 10.21926/obm.transplant.1901048

Background: Tuberculosis (TB) is a common infection with challenges in diagnosis and treatment. Management of TB in solid organ transplant (SOT) candidates and recipients poses unique challenges not seen in other populations. Questions and Recommendations: Latent TB infection (LTBI) is important to diagnose pre-transplant through history, physical examination, imaging, and laboratory tests. Tuberculin skin tests and interferon-gamma release assays are important tools but not sufficiently sensitive nor specific to d [...]

by Dominic Emerson  , Jon Kobashigawa  , Ryan Levine  , Jamie Moriguchi  , Dominick Megna  , Joshua Chung  , Dany Ramzy  , Alfredo Trento  and Fardad Esmailian

Received: 14 April 2020;  Published: 06 July 2020;  doi: 10.21926/obm.transplant.2003114

In advanced heart failure, orthotopic heart transplantation (OHT) remains the standard for definitive treatment. Patients with heart failure and concomitant pulmonary hypertension (PH) represent a challenging subgroup, with poor outcomes following OHT. Recently, Mechanical Circulatory Support (MCS) devices have been utilized as a bridge to OHT for these patients. Patients with MCS devices who underwent OHT were evaluated at a single center. Patients were stratified into three groups, depending on baseline pulmonary [...]

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 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 Ashley Rosenberg  , Gilles Dongmo  , Pallavi Yadav  , Nathaniel Lee  and Kunal Yadav

Received: 13 August 2018;  Published: 21 September 2018;  doi: 10.21926/obm.transplant.1803020

Even though renal ectopia is common, there have been very few reports of these kidneys being used for transplantation. The concerns with using such kidneys are subnormal function, ureteral anomalies and complications and anomalous arterial supply which makes arterial reconstruction challenging. Majority of reports are for use in living donor transplantation where good preoperative imaging is available. There is very scant literature reporting use of ectopic pelvic kidneys from deceased donors. We report a case of a [...]

by Maurizio Salvadori  and Aris Tsalouchos

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

Antibody-mediated rejection represents a significant barrier to favorable long-term outcomes after kidney transplantation and remains the most common cause of allograft failure. Therapeutic apheresis techniques are commonly used, in combination with other treatments such as immunosuppressive drugs, in the pre-transplant and post-transplant protocols for the prevention and treatment of antibody-mediated injury. The rationale is to remove the donor-specific antibodies and the other inflammatory mediators, which inclu [...]

by 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 David C. Gaston  and Marwan M. Azar

Received: 14 November 2018;  Published: 29 December 2018;  doi: 10.21926/obm.transplant.1804037

The approach to diagnosing fungal infections following solid organ transplantation (SOT) is patient-specific. An assessment of an individual’s risk for particular infections, also understood as the pre-test probability, should guide appropriate diagnostic testing whereas diagnostic stewardship is needed to produce interpretable, actionable and cost-sensitive results. This review provides a cognitive framework for practitioners aiming to diagnose fungal infections in recipients of SOT, taking into consideration the [...]

by Abdul Al-Toma  and Harry R. Koene

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

Refractory celiac disease (RCD) is a rare condition in which a known celiac patient, usually an adult, suffers from persistence or recurrence of gluten-related symptomatology, laboratory abnormalities, and inflammatory enteropathy despite following an optimal dietary therapy with gluten-free diet (GFD). Arbitrarily, a duration of at least 12 months of GFD has been recommended prior to establishing such a diagnosis. Furthermore, exclusion of the other possible causes of non-celiac villous atrophy, particularly enter [...]

by Ibrahim Fathi  , Takehiro Imura  , Kozue Imura  , Megumi Goto  , Yasuhiro Igarashi  , Akiko Inagaki  , Makiko Kikkawa  , Fumiko Ono  , Hiroo Iwata  , Yohichi Yasunami  and Masafumi Goto

Received: 27 March 2019;  Published: 09 July 2019;  doi: 10.21926/obm.transplant.1903071

Background: The existing non-human primate diabetic models, particularly those induced by total pancreatectomy or streptozotocin (STZ) injection, have several disadvantages, including a lengthy surgical procedure, the need for continual supplementation of digestive enzymes, and delayed oral intake after total pancreatectomy, and severe hypoglycemia and hepatic/renal toxicity following injection of high-dose STZ. This study aimed to develop and optimize a non-human primate diabetic model that would avoid the disadva [...]

by Shalika B. Katugaha  , Oksana Shlobin  , Chris King  , Steve Nathan  , Shambu Aryal  , Kareem Ahmad  and Whitney Brown

Received: 04 September 2020;  Published: 13 October 2020;  doi: 10.21926/obm.transplant.2004120

Strongyloides stercoralis infection derived from the donor in solid organ transplant (SOT) places recipients at risk for hyperinfection syndrome and death. We describe the case of a lung transplant recipient who developed strongyloidiasis presenting with GI symptoms and progressing to diffuse alveolar hemorrhage, bacteremia and multi-organ failure. The patient's clinical course illustrates the life cycle of Strongyloides. For treatment, the patient received ivermectin and albendazole. We advocate that early diagnos [...]

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 Courtney Tate  , Jason P Butler  , Cameron Curley  , Siok-Keen Tey  , Glen A Kennedy  and Ashleigh P Scott

Received: 23 June 2020;  Published: 23 October 2020;  doi: 10.21926/obm.transplant.2004121

Acquired Severe Aplastic Anaemia (SAA) is a rare bone marrow failure syndrome, for which allogeneic haematopoietic stem cell transplant (HSCT) is a proven curative therapy. Despite excellent outcomes for matched sibling SAA recipients in terms of engraftment and survival, HSCT remains highly challenging in older matched-unrelated-donor (MUD) recipients, due to increased non-relapse mortality (NRM) from causes such as graft versus host disease (GVHD), organ failure and infection. We sought to evaluate our local HSCT [...]

by Jessica Lum  and Sherif B. Mossad

Received: 26 October 2018;  Published: 14 February 2019;  doi: 10.21926/obm.transplant.1901050

Despite the advances that have been made in the field of solid organ transplant (SOT), organ shortage remains a persistent problem. In addition, the donor pool has been changing with the ongoing opioid epidemic and increase in deaths related to drug overdose each year. More donors are meeting the 2013 United States (U.S.) Public Health Service criteria for increased risk donors (IRDs), or donors who are at higher risk for transmission of Human Immunodeficiency Virus (HIV), Hepatitis C virus (HCV), and other multidr [...]

by Jun Gu  , Wei Wang  , Guilin Tang  , Gokce A. Toruner  , Ming Zhao  , Steven Sfamenos  , Zhenya Tang  , Joseph D. Khoury  and L. Jeffrey Medeiros

Received: 13 October 2020;  Published: 07 December 2020;  doi: 10.21926/obm.transplant.2004128

Donor cell-derived leukaemia (DCL) is an uncommon complication of allogeneic hematopoietic stem cell transplantation (HSCT). DCL might represent up to 5% of the post-HSCT disease relapses, but case numbers reported in the literature might underestimate the frequency. The leukemogenesis of DCL is not well understood due to the limited numbers of cases reported and lack of detailed molecular genetic information from recipients and donors. Although many theories have been proposed for leukemogenesis of DCL, the underl [...]

by Alexandria J Coughlan  , Kendall R. McEachron  , Mariya E. Skube  , Sydne Muratore  , Melena D. Bellin  and Greg J Beilman

Received: 29 October 2018;  Published: 24 January 2019;  doi: 10.21926/obm.transplant.1901042

The current predominant location for allo- and auto-transplantation of islets is the liver. Despite the historical success of this site, recent studies have revealed multiple disadvantages. Portal hypertension, portal vein thrombosis, bleeding, low oxygen tension, instant blood mediated inflammatory reaction, inadequate alpha cell function, and delays in neovascularization are factors that continue to drive researchers to explore alternative sites for islet transplantation. Factors of an optimal site include: capac [...]

by Nicholas Lim  , Gregory Beilman  and Timothy Pruett

Received: 21 March 2018;  Published: 12 June 2018;  doi: 10.21926/obm.transplant.1802011

Portal hypertension often occurs transiently with injection of islet cells into the portal system during total pancreatectomy-islet autotransplantation (TPIAT). We describe a TPIAT patient with non-cirrhotic portal hypertension (NCPH) two years after surgery initially identified with esophageal varices on upper endoscopy. The underlying mechanism for the development of NCPH after TPIAT is unclear but infectious and immune-related pathways have been proposed. Management of NCPH is primarily treatment of complication [...]

by David J. Ross

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

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 Bhagyashree Deshmankar  , Craig E. Eckfeldt  , Graf Oliver  , Aleksandr Lazaryan  and Nelli Bejanyan

Received: 19 July 2020;  Published: 18 September 2020;  doi: 10.21926/obm.transplant.2003118

Severe hypercholesterolemia is an uncommon complication of allogenic hematopoietic cell transplantation (HCT). Treatment options for hypercholesterolemia due to liver graft-versus-host disease (GVHD) are limited because many antilipidemic medications are known to worsen hepatic functions. We report our experience on a case of a 38-year-old male with Philadelphia chromosome positive acute lymphoblastic leukemia presenting with steroid-refractory hepatic and lower gastrointestinal acute GVHD after matched sibling don [...]

by Michael Y. Shino  , Ariss Derhovanessian  , David M. Sayah  , Rajan Saggar  , Ying Ying Xue  , Abbas Ardehali  , Barry R. Stripp  , David J. Ross  , Joseph P. Lynch  , Robert M. Elashoff  , S. Samuel Weigt  and John A. Belperio

Received: 11 September 2018;  Published: 30 November 2018;  doi: 10.21926/obm.transplant.1804029

Background: The long term clinical significance of respiratory infections after lung transplantation remains uncertain. Methods: In this retrospective single-center cohort study of 441 lung transplant recipients, we formally evaluate the association between respiratory infection and chronic lung allograft dysfunction (CLAD). We furthermore hypothesized that bronchoalveolar lavage fluid (BALF) CXCL9 concentrations are augmented during respiratory infections, and that episodes of infection with elevated BALF CXCL9 ar [...]

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

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

Background: Graft site candidiasis is a serious complication after solid organ transplantation, often presenting as invasive arteritis leading to graft loss or even death. Case Report: We report a case of anastomotic site candidiasis leading to arterial rupture and death at postoperative day 10 with no clinical warning signs. Preservation fluid cultures were negative and postoperative Doppler ultrasonography did not show vascular compromise. Postmortem examination revealed microscopic arterial wall abscesses harbou [...]

by 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 Alicia M Teagarden  , Emma M Tillman  and Courtney M Rowan

Received: 24 April 2018;  Published: 29 October 2018;  doi: 10.21926/obm.transplant.1804022

Background: Hematopoietic cell transplant (HCT) patients are a high-risk population for poor nutrition and decreased survival. There is little data on how nutrition in pediatric HCT patients affects need for critical care interventions and outcomes. Methods: We hypothesized that patients who did not meet goal nutrition by 72 hours post-admission to the pediatric intensive care unit (PICU) had increased in-hospital mortality and increased need for critical care interventions. We performed a retrospective cohort stud [...]

by Yujie Wen  , Anita Y. Chhabra  , Joseph R. Leventhal  and Suzanne T. Ildstad

Received: 29 October 2018;  Published: 20 November 2018;  doi: 10.21926/obm.transplant.1804027

This review summarizes the latest results from the interventional clinical trials for inducing clinical tolerance in the recipients of human leukocyte antigen (HLA)-matched or mismatched living donor kidney transplants via allogeneic hematopoietic stem cell (HSC)-based therapies. The protocols utilized by the three medical centers in the United States differ in degree of HLA-matching, relatedness or unrelatedness, donor cell composition of the hematopoietic stem cells transplant (HSCT), timing for infusion and cond [...]

by Gianluca Donatini  , Sébastien Giraud  , Jean-Louis Kraimps  , Jérôme Danion  and Thierry Hauet

Received: 08 April 2019;  Published: 15 April 2019;  doi: 10.21926/obm.transplant.1902062

Pancreatic islet transplantation represents an effective therapy with lower morbidity for patients carriers of type 1 diabetes compared to whole pancreas transplantation. Although complete insulin independence is usually not achieved it allows control of glycemia balance reducing the risk of severe hypoglycaemia events and impaired awareness of hypoglycaemia. Recent trials had demonstrated islet transplantation to be more effective than current medical treatment and improvements in outcomes also have been reported [...]

by Bin Ni  , Nidhi Sharma  , Ashley Rosko  , Don M. Benson  and Yvonne A. Efebera

Received: 12 April 2021;  Published: 09 July 2021;  doi: 10.21926/obm.transplant.2103148

Prior to the advent of anti-retroviral therapy (ART), autologous stem cell transplant (ASCT) was relatively contraindicated for multiple myeloma (MM) patients with human immunodeficiency virus (HIV) due to issues associated with stem cell harvest and the risk of opportunistic infections. With the widespread use of ART for control of HIV, ASCT is now the preferred treatment for relapsed lymphoma, the leading hematopoietic malignancy associated with HIV/AIDS. Hence, MM patients with HIV controlled by ART may benefit [...]

by Patrick Hagen  , William Adams  , Shruti Singh  , Shuai Qin  , Loredana Campo  , Stephanie Tsai  , Nasheed Hossain  , Scott E Smith  and Patrick J Stiff

Received: 04 November 2020;  Published: 07 February 2021;  doi: 10.21926/obm.transplant.2101136

Allogeneic stem cell transplantation remains the only curative option for many hematological malignancies. Umbilical cord blood (UCB) is an alternate donor source with potentially increased morbidity in elderly patients. We evaluated outcomes in alternate donor sources, prior to the initiation of haploidentical transplantation at our institution, of matched unrelated donor (MUD) and UCB in elderly patients (mean age 64, range 60-75). One hundred and eighty-four patients were included (MRD: 57; MUD: 69; UCB: 58). Th [...]

by Justin Cole  , Eugene Golts  , Michael Bernales  , Dina Shirazi  , Deepa Kurup  , Sarah Golts  , Gordon Yung  , Aarya Kafi  , Christine M. Lin  , Travis Pollema  and Kamyar Afshar

Received: 19 October 2023;  Published: 08 May 2024;  doi: 10.21926/obm.transplant.2402214

Despite the concerted efforts by lung transplant recipients (LTR) and their medical teams, hospital readmissions are common in the first year following transplantation. Reasons for unplanned readmissions include allograft rejection, infections, and respiratory failure before the SARS-COV-2 pandemic. Clinical predictors of readmissions have changed over time with the higher risk factors of acceptable criteria for recipients and donors. We aimed to assess more recent readmission rates based on group classifications t [...]

by Javier Carbone  , Juan Fernandez-Yañez  , Iago Sousa  , Patricia Muñoz  and Elizabeth Sarmiento

Received: 23 November 2018;  Published: 22 March 2019;  doi: 10.21926/obm.transplant.1901058

Secondary antibody deficiency has been associated with risk of invasive fungal infections in solid organ transplantation. Single center, multi-center and meta-analysis studies have tested this association. Therapy of these infectious complications in the presence of a secondary antibody deficiency after transplantation remain a challenge for transplant teams. Currently, there are no guidelines for the management of this combined clinical scenario. We report the case of a patient with severe secondary immunodeficien [...]

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

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

Objective: The purpose of this study was to evaluate the common locations of perihepatic fluid collections after liver transplantation, assess their complexity, and understand their natural history and clinical significance. Materials and Methods: A retrospective analysis of 189 postoperative orthotopic liver transplant patients with a mean age 49.6 years was performed using serial CT or MRI to characterize perihepatic fluid collections. Location, size, complexity of the collections, and clinical course were evalua [...]

by 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 Kamal Kant Sahu

Received: 01 November 2020;  Published: 19 November 2020;  doi: 10.21926/obm.transplant.2004126

by Sean A. Hebert  , Aleksandra M. De Golovine  , Rita D. Swinford  , Cynthia S. Bell  , Karen J. Vigil  and Sonal Bhatnagar

Received: 30 June 2018;  Published: 14 August 2018;  doi: 10.21926/obm.transplant.1803017

Background: Human Papilloma virus (HPV) infections are an increasingly concerning etiology for post-transplantation viral-related malignancies. The nonavalent HPV vaccine (Gardasil 9) affords transplant recipients the best opportunity for malignancy prevention, but vaccine uptake remains low. Not previously reported for solid organ transplant recipients, we studied influential factors for HPV vaccine non-initiation. Methods: This survey, conducted from May to December 2017, examined influential factors for HPV vacc [...]

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

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

Nowadays, hematopoietic stem cell transplantation (HSCT) is a common procedure in hematology units within reference centers, mainly for the treatment of hematological malignancies such as multiple myeloma, lymphoma, and acute leukemia. Nevertheless, HSCT has much wider applications, namely in autoimmune diseases, congenital metabolic defects, and hemoglobinopathies. Thalassemia major and sickle cell disease make up the most frequent hereditary hemoglobinopathies worldwide. Despite advances on the prevention and tre [...]

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 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 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 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 Shoichiro Sumi  , Sin-Yu Yang  , Priyadarshini Canning  and Kai-Chiang Yang

Received: 29 May 2019;  Published: 24 July 2019;  doi: 10.21926/obm.transplant.1903074

Background: Diabetes mellitus (DM) can be cured or greatly ameliorated by adequate insulin secretion from a relatively small volume of insulin-producing cells. Cell encapsulation enables allo- and even xeno-geneic cell therapy without immunosuppression. However, recent clinical trials show that micro-encapsulated islets are not fully retrievable after transplantation. By contrast, macro-encapsulated islets can be retrieved when necessary. As to the transplantation site, subcutaneous tissue can be promising, if new [...]

by Petr A. Fedotov  , Maria A. Simonenko  , Yulia V. Sazonova  , Mariya A. Bortsova  , Artem N. Kostomarov  and Mariya Yu. Sitnikova

Received: 01 February 2019;  Published: 05 August 2019;  doi: 10.21926/obm.transplant.1903077

Background: To estimate the survival of patients in the heart transplantation waiting list (HTx WL) at Almazov National Medical Research Centre (V.A. Almazov NMRC), Saint-Petersburg, Russia, from 2010 to 2017 and to define risk factors for death among these patients. Methods: It was a single-center retrospective study involving 151 patients with advanced chronic heart failure (CHF) in the HTx WL. Results: Mortality in the HTx WL for the period 2010-2017 was found to decrease. Based on the results of constructing th [...]

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

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

Donation after circulatory death (DCD) is an increasingly used resource to alleviate chronic renal graft shortages. Organs from donors with progressively increased creatinine levels due to acute kidney injury are used, but the effects of this condition on kidney transplantation are still unclear. Ex-situ machine perfusion is emerging as a potential tool to preserve and resuscitate vulnerable grafts. We report a case of DCD kidneys discarded due to severe acute kidney injury with favorable histological Karpinski sco [...]

by Oya M. Andacoglu  , Jack Liu  , Abigail L. Brooks  , Amit Blumfield  , Mehul Trivedi  , Shoshana Lehman  , Michael K. Parides  , Enver Akalin  , Jay A. Graham  , Juan P. Rocca  and Stuart M. Greenstein

Received: 17 March 2021;  Published: 20 July 2021;  doi: 10.21926/obm.transplant.2103150

Glomerular filtration rate (GFR) is an excellent indicator of renal function; however, it is rarely evaluated as an endpoint. We investigated donor and recipient factors for associations that might be predictive of mid-term GFR after renal transplantation. We performed a retrospective review of 828 deceased donor renal transplantations performed at Montefiore Medical Center between the years 2009-2015. Donor characteristics included KDPI, [low (<20%), medium (20-80%), high (>80%)], age, graft types [extended [...]

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 Brian C. Keller  , Sadia Z. Shah  and Amy Pope-Harman

Received: 24 April 2020;  Published: 15 June 2020;  doi: 10.21926/obm.transplant.2002113

Systemic capillary leak syndrome is a disorder characterized by recurrent, life-threatening episodes of acute capillary hyperpermeability resulting in edema and hypovolemic shock. We report a case of systemic capillary leak syndrome in a lung transplant recipient who developed recurrent episodes of volume overload, respiratory failure, and acute kidney injury in association with hypotension and hypoalbuminemia. Initiation of monthly high dose intravenous immunoglobulin prophylaxis effectively abrogated the syndrome [...]

by Pål-Dag Line

Received: 20 December 2017;  Published: 24 December 2017;  doi: 10.21926/obm.transplant.1704006

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 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 Yi-nan Guo  , Michael Grzelak  and Byoung Chol Oh

Received: 10 October 2018;  Published: 13 December 2018;  doi: 10.21926/obm.transplant.1804031

One of the major hurdles still facing the field of transplantation is the management of immunosuppression and the morbidity that results from treatment. Due to toxicity and complications from a maintenance immunosuppression therapies, a necessary improvement in post-transplant immunosuppressive therapies must be the development of a low-side effect therapy. Cell-based therapies as an emerging candidate offer a novel approach to generating graft tolerance, and when utilized within a combination therapeutic strategy, [...]

by Dayu Lv  , Jose Garcia-Tirado  and Chiara Fabris

Received: 17 May 2018;  Published: 11 September 2018;  doi: 10.21926/obm.transplant.1803019

Background: Human pancreatic islet transplantation is a minimally-invasive procedure that is gaining recognition for the treatment of type 1 diabetes (T1D). Selected patients with unstable T1D, hypoglycemia unawareness, history of severe hypoglycemia, and glycemic lability, not successfully stabilized with intensive insulin treatment, can be offered this alternative therapy that has been shown to provide long-term glycemic control with near-normalization of hemoglobin A1c in the absence of severe hypoglycemia. Toda [...]

by Mostafa T. Mohammed  , Esmat Al Sharkawy  , Amel M. Kamal Eldin  , Emad Allam  , Manal M. Saber  , Anthony Nassar  , Nour Younis  , Christa Deban  , Ahmad Jaser  , Indira Guleria  , Basset El Essawy  , Anil Chandraker  , Mahmoud Nasr  and Jamil R. Azzi

Received: 15 March 2023;  Published: 06 November 2023;  doi: 10.21926/obm.transplant.2304201

Human leukocyte antigens (HLA) are unique proteins expressed on the surface of human cells, playing a pivotal role in the immune system, particularly in the contexts of infection, cancer, and transplantation. The widespread adoption of HLA typing methods has become an essential component in assessing donor-recipient compatibility, a crucial limiting factor in solid organ transplantation. In general, the greater the disparity between a donor's and recipient's HLA types, the higher the likelihood of provoking an allo [...]

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 Michael Czapka  , Carlos A.Q. Santos  and Laurie A. Proia

Received: 08 October 2018;  Published: 31 January 2019;  doi: 10.21926/obm.transplant.1901045

Mucormycosis is a rare fungal infection associated with high morbidity and mortality that typically afflicts immunocompromised hosts. We present a case of isolated hepatic mucormycosis with Rhizopus spp. that developed in the early post-transplant period. Initial presentation was concerning for allograft rejection, but definitive diagnosis was made with histopathology and fungal culture. The patient had a favourable outcome with surgical resection, a course of liposomal amphotericin B combined with micafungin, and [...]

by Amer Belal  , Shawna Lord  , Rohan V. Mehta  and Alfonso Santos

Received: 28 October 2022;  Published: 19 April 2023;  doi: 10.21926/obm.transplant.2302182

Cryptococcosis is a common invasive fungal infection in solid organ transplant recipients (SOTR) that can be challenging to manage. We discuss a case of disseminated cryptococcosis in a transplant recipient. A 26-year-old woman with a history of ESRD from C1q nephropathy, living-related kidney transplant in early 2012, and allograft nephrectomy in 2015, received a deceased donor kidney transplant (DDKT). Induction after the first transplant was anti-thymocyte globulin (ATG) and maintenance immunosuppression (IS) in [...]

by Masayuki Nigo  , Rodrigo Hasbun  and Karen J Vigil

Received: 29 March 2018;  Published: 02 November 2018;  doi: 10.21926/obm.transplant.1804023

Liver transplantation is a life-saving procedure available worldwide. Despite advances in its surgical and immunosuppressive strategies, infectious complications carry significant morbidity and mortality. Bacterial infections are the most common infective etiologies, and the majority are seen during the first four weeks post liver transplantation. Infectious complications are often intra-abdominal in origin, such as biliary complications and abdominal abscesses. Infections due to multi-drug resistant organisms are [...]

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 Carly M. Darden  , Srividya Vasu  , Kenjiro Kumano  , Bashoo Naziruddin  and Michael C. Lawrence

Received: 21 November 2018;  Published: 29 January 2019;  doi: 10.21926/obm.transplant.1901043

Islet transplantation is a minimally invasive cell based replacement therapy to prevent or reverse diabetes or hypoglycemia through natural hormonal responses to regulate blood glucose. However, extending the islet graft functional lifespan remains a challenge that prevents long-term success and widespread use of the procedure. Islets are subject to stress and damage and undergo immunological assault during transplantation procedures. Current treatments to prevent immune reactivity toward the graft come with toxic [...]

by Shalika B. Katugaha  , Amit K. Mahajan  , Meg Fregoso  , Haresh Mani  and Oksana A. Shlobin

Received: 25 October 2020;  Published: 03 July 2021;  doi: 10.21926/obm.transplant.2103147

A 65-year-old female with a history of right lung transplantation (LTx) for chronic obstructive pulmonary disease (COPD) 9-years prior complicated by grade 3 bronchiolitis obliterans syndrome (BOS) was admitted to the hospital for chest pain and dyspnea on exertion (DOE). Her bronchoscopy revealed fluffy, endobronchial lesions that were adherent to the right sided anastomosis resulting in mild obstruction of the right mainstem bronchus. Pathology from biopsies of the endobronchial lesions revealed hyphal fungal org [...]

by Sylvaine You  and Lucienne Chatenoud

Received: 25 September 2018;  Published: 09 November 2018;  doi: 10.21926/obm.transplant.1804025

Transplant tolerance has been achieved in experimental models using immune intervention strategies. Yet, their clinical translation remains unsuccessful and requires further optimization of immunotherapeutic regimens based on a deeper understanding of the cellular and molecular mechanisms at play in the induction and maintenance phases of immune tolerance. Intensive investigations have shed light on the tolerogenic networks underlying graft survival and have unraveled their complexity, which may depend on several p [...]

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 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 Zaid Albayati  , Sally Heyworth  , Jane Moberly  , Derek Middleton  , Brian Flanagan  , Abdul Hammad  and Stephen E Christmas

Received: 10 October 2018;  Published: 14 December 2018;  doi: 10.21926/obm.transplant.1804032

Background:HLA-G is an immunosuppressive molecule with a potential role in allograft acceptance. Methods:Expression of HLA-G on leucocyte subpopulations was studied in a group of 21 renal transplant patients immediately prior to and 2 months post-transplantation. Results:Significant increases in proportions of total HLA-G+CD4+ T cells were seen (0.5+/-0.1% to 7.9+/-3.2%; p<0.01) and also for CD45RA+, CD45RO+ and CD69+ subsets. Increases in proportions of HLA-G+ cells were also seen in CD8+ T cells and their [...]

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 Christine M. Bojanowski  , Ian Britton  and Kamyar Afshar

Received: 18 April 2018;  Published: 16 July 2018;  doi: 10.21926/obm.transplant.1803015

Here we present a case of a lung transplant recipient with alpha 1-antitrypsin deficiency as well as conducted a retrospective review of the United Network for Organ Sharing (UNOS) database from 1990 – 2016 specifically grouping patients with alpha-1 antitrypsin deficiency (A1ATD) and chronic obstructive pulmonary disease (COPD).

by Richard Cheng  and Jon Kobashigawa

Received: 23 January 2019;  Published: 09 April 2019;  doi: 10.21926/obm.transplant.1902061

Cardiac allograft vasculopathy (CAV) limits long-term survival after heart transplantation. CAV with discrete or tubular lesions can be treated with percutaneous coronary intervention (PCI) with high procedural success. Revascularization with balloon angioplasty, bare-metal stents, and first-generation drug-eluting stents has been associated with high and unacceptable restenosis rates. However, second-generation drug-eluting stents are associated with favorable stent and lesion patency. Stent and lesion patency now [...]

by Marina Moguilevitch  and Tracey Straker

Received: 05 July 2020;  Published: 12 November 2020;  doi: 10.21926/obm.transplant.2004123

Clinical presentation and progression of Wilson’s disease can be diverse in different groups of patients. While young children most likely to present with acute or chronic liver failure, older children and adults may exhibit extrahepatic manifestation like neuropsychiatric, cardiac, renal, pancreatic and several others. Diagnosis of Wilson’s disease is based on the combination of specific clinical findings, laboratory and genetic testing. There are different modalities of treatment available for this condition. Liv [...]

by Jill Gualdoni  , Jeff Ritzenthaler  , Ibrahim Elkhawas  , Gerene Bauldoff  , David Nunley  and Jesse Roman

Received: 29 November 2018;  Published: 20 February 2019;  doi: 10.21926/obm.transplant.1901051

Background: Gastroesophageal reflux disease has been associated with the development of chronic lung allograft dysfunction following lung transplantation. While the mechanisms are unclear, it is postulated that microaspiration of gastrointestinal material (GIM) leads to inflammation and airway remodeling that culminates in obliterative bronchiolitis. As the expression of the matrix glycoprotein fibronectin has been shown to be an early marker of this fibroproliferative process, its induction could suggest a causal [...]

by Anita Modi  and Sherif Beniameen Mossad

Received: 07 July 2019;  Published: 06 September 2019;  doi: 10.21926/obm.transplant.1903085

Chronic inflammatory states lead to T cell exhaustion, characterized by reduced T cell proliferation and activity. Immune checkpoint inhibitors (ICPI) reactivate T cells to restore the immune system’s natural defenses against foreign antigens. The widespread use of these agents in the treatment of malignancy has led to markedly reduced tumor burden and improved patient survival, sparking curiosity about their potential role in the treatment of other chronic inflammatory states, including infectious diseases. While [...]