by Amy Spallone  and Marion Hemmersbach-Miller

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

Donor-derived infections (DDI) are an infrequent event in solid organ transplant (SOT) due to advances in screening recommendations, prophylaxis, and surveillance of common infections. However, unexpected pathogen transmission can still occur when a donor is not known to be infected prior to organ procurement, which can lead to significant morbidity and mortality in the organ recipient. Solid organ donors with central nervous system (CNS) pathogens are an uncommon but deadly source of unexpected DDI. Clinically rec [...]

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

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

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

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

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

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

by Melissa Mortensen  , Christine Lundberg  and Simon Horslen

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

Background: Infants and children undergoing liver transplant require ongoing nutritional evaluation throughout the pre and post-transplant period. The pathophysiologic causes of chronic liver disease and acute liver failure are varied, and each present different and unique nutritional challenges. Methods: A review of the literature and Seattle Children's established guidelines for nutritional management of pediatric liver transplant patients was conducted. Results: We present guidelines of care to optimize nutritio [...]

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

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

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

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

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

The endemic mycoses are an important cause of morbidity and mortality in transplant recipients. These fungal infections are notable for their dimorphic life cycle, specific geographic distributions, and typical infection via environmental exposure. Their nonspecific presentation can make diagnosis challenging. Because of their geographic associations, assessment of both donor and recipient history is critical in making an accurate and timely diagnosis. Coccidioides spp. are endemic to the southwestern United S [...]

by Maurizio Salvadori  and Aris Tsalouchos

Received: 19 January 2020;  Published: 03 February 2020;  doi: 10.21926/obm.transplant.2001097

Immunosuppressive therapy in renal transplantation is divided into two phases as induction and maintenance therapy. Induction therapy is an intense immunosuppressive therapy administered at the time of kidney transplantation to reduce the risk of acute allograft rejection. In general, induction immunosuppressive strategies utilized by kidney transplant centers fall in one of the two categories. One approach relies upon high doses of conventional immunosuppressive agents, while the other uses antibodies directed aga [...]

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

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

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

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

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

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

by 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 Nidhi Sharma  and Yvonne Efebera

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

Graft-versus host disease is one of the major causes of death in patients undergoing allogeneic hematopoietic stem cell transplantation. Major contributing factors to severity of graft-versus host disease include HLA mismatch, conditioning regimen intensity, age of donor and recipient, source of stem cell, and donor type. Strategies and clinical trials are ongoing to reduce the incidence of graft-versus host disease, and to improve on the survival outcome of patients with graft-versus host disease, Research efforts [...]

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

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

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

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

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

Data supporting the use of belatacept in non-abdominal organs are limited to case series and small cohorts involving patients requiring conversion due to CNI intolerance or contraindication. Review articles summarizing the efficacy of belatacept salvage therapy in lung transplantation have previously been published, however, dosing regimens are highly variable and uniform guidance is lacking. In this article, indications and considerations for belatacept use in lung transplant recipients are reviewed with a specifi [...]

by R. Paul Robertson

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

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

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

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

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

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 Yassamine Bentata

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

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

by Yue Qiu  , Yinqian Kang  , Hao Liu  and Ibtesam Hilmi

Received: 12 May 2024;  Published: 30 August 2024;  doi: 10.21926/obm.transplant.2403224

Machine perfusion (MP) techniques, which simulate physiological conditions to allow for the assessment and preservation of organ viability, are currently applied in various solid organ transplantation fields. Owing to the growing demand for liver transplants and the scarcity of available donor livers, MP offers a practical solution for recovering high-risk grafts and increasing the number of potentially usable donor organs. Furthermore, testing and administering novel therapies to allografts may also become advanta [...]

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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 [...]