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

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

Liver transplantation (LT) has grown monumentally in the last 40 years. Sarcopenia has emerged as an independent factor associated with increased mortality in patients with end stage liver disease. In this review we aim to shed light upon recent developments in assessment, clinical implications, management of sarcopenia in patients requiring a liver transplant. We also bring attention to the impact of COVID-19 pandemic on sarcopenia which ranges from the disease pathology to the unprecedented preventive measures ta [...]

by Sunil Daga  , Adarsh Babu  , Natasha Khovanova  and Robert Higgins

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

Antibodies against donor HLA determine access to solid organ transplantation and in many cases the outcome of transplantation, but graft failure is not an inevitable consequence of their presence. Much research has been performed with two main aims – which antibodies represent the highest risk factor prior to transplantation, and second to understand how donor specific HLA antibodies behave after transplantation, with a long-term aim of being able to manipulate their production. HLA antibody incompatible kidney tra [...]

by Muayad Alali  , Michael Z. David  , Sandra A. Ham  , Danziger-Isakov LA  , Allison H. Bartlett  , Lindsay Petty  and Jennifer C. Pisano

Received: 27 November 2019;  Published: 21 February 2020;  doi: 10.21926/obm.transplant.2001102

Most studies of children with prolonged fever and neutropenia (PFN) have focused on invasive fungal disease (IFD) as the etiology of fever and not on other causes. Data are lacking regarding risk factors and adverse outcomes in pediatric cancer patients with PFN compared with those whose fevers resolve more rapidly. Retrospective medical record review was performed for all cancer patients with febrile neutropenia (FN) in the pediatric oncology unit at University of Chicago Medicine Comer Children’s Hospital f [...]

by 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 Joachim Andrassy  and Antje Habicht

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

In recent years, the potential of hematopoietic stem cells, regulatory T-cells, and mesenchymal stem cells have brought about a variety of clinical tolerance trials. Every approach has yielded promising results; however, the riddle of transplant tolerance has not been solved as of yet. The results of the ongoing trials in this field will provide additional information regarding the risks and benefits of these therapy approaches.

by 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 Jose A. Morillas  and Sherif Beniameen Mossad

Received: 24 October 2019;  Published: 18 November 2019;  doi: 10.21926/obm.transplant.1904091

Toxoplasmosis in liver transplantation (LT) is uncommon, especially in the current era of universal prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis jirovecii pneumonia (PJP). Here we present a case of a 55-year-old woman LT recipient, on dapsone or PJP prophylaxis due to sulfa allergy, who presented on day 25 after LT with fever, diarrhea and abdominal pain. Initially she was diagnosed with cytomegalovirus-associated colitis and was treated with intravenous ganciclovir, with good clinical [...]

by 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 Malcolm Voyce

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

This article aims to describe the relationship between donors and their recipients in the context of organ transplants. This analysis is made in the light of Marcel Mauss’s work, offering an expansion on an analysis of his discussion on the “spirit of the gift” and his idea that gifts require reciprocation. It is argued that some recipients of donated organs receive a personal element from the donor in that there is a transfer or sharing of the donors’ personality and spiritual qualities. The article examines the n [...]

by 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 Ashrit Multani  , Libby S. Allard  and Joanna K. Nelson

Received: 03 June 2019;  Published: 29 July 2019;  doi: 10.21926/obm.transplant.1903076

Hematopoietic cell transplantation is frequently complicated by infectious disease-related complications, especially pneumonia. Candida and enterococci are often overlooked as pulmonary pathogens with some clinicians firmly believing that these organisms never cause pneumonia. Here, we present a series of five cases of Candida pneumonia and five cases of enterococcal pneumonia found on autopsy in hematopoietic cell transplantation recipients. We will also review the literature regarding the epidemiology, risk facto [...]

by Camilo A. Velasquez  , Simon Yaguare  , Sabrina Gambini  , Elizabeth McElhiney  and Suresh Keshavamurthy

Received: 19 September 2024;  Published: 27 April 2025;  doi: 10.21926/obm.transplant.2502248

Lung transplantation (LTx) is the gold standard for the surgical treatment of end-stage lung disease. Ongoing discussions persist whether single lung transplantation (SLT) or bilateral lung transplantation (BLT) lead to better patient outcomes and quality of life. This study analyzed 58 peer-reviewed articles from 1990 to 2024, comparing SLT and BLT across several parameters, including indications for transplantation, overall survival, pulmonary hypertension, complications, chronic rejection, functional status, and [...]

by Salim Hamdani  and Daniel Azoulay

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

The privileged liver, due to its immunological status, is referred to as a tolerogenic organ. However, this alone does not explain the introduction of tolerance after single or combined liver transplantation (kidney, heart, pancreas, and intestine); other factors, such as recipient’s age, donor’s hepatic volume, iron metabolism, biomarkers, or imprint of cytomegalovirus infection, appear to be involved in the identification of patients who are likely to be tolerant to their graft. All the afore-stated factors appea [...]

by Scott S. Graves  , DavidW. Mathes  and Rainer Storb

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

Background: The application of hematopoietic cell transplantation for induction of immune tolerance has been limited by toxicities associated with conditioning regimens and to graft-versus-host disease (GVHD). Decades of animal studies have culminated into sufficient control of these two problems, making immune tolerance a viable alternative to life-long application of immunosuppressive drugs to prevent allograft rejection. Methods: Studies in mice have paved the way for the application of HCT with limited toxicity [...]

by Michael Mazzei  , Suresh Keshavamurthy  , Olga Timofeeva  and Yoshiya Toyoda

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

Preoperative sensitization of the cardiac transplant recipient, defined as the presence of anti-Human Leukocyte Antigen (HLA) antibodies before transplant, represents a significant management challenge for physicians. Sensitization prolongs the pre-transplant wait time and is associated with postoperative transplant complications and death. It is critical that sensitized heart transplant candidates be identified and optimized before surgery. In this review, we describe the risk for sensitization, discuss the means [...]

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

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

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

by Susanna Lam  , Jerome M Laurence  and Deborah J Verran

Received: 01 July 2019;  Published: 08 October 2019;  doi: 10.21926/obm.transplant.1904087

A range of corrective surgical procedures may be required in adult renal transplant recipients who sustain loss of integrity of the abdominal wall in the first month postoperatively. Where this involves the fascia, such as in acute fascial dehiscence or in renal allograft compartment syndrome, more sophisticated reconstructive procedures may also be required, particularly in the setting of surgical site infection. There is limited data on the use of prosthetic or biologic mesh for this type of scenario, where urgen [...]

by Atena Samarehfekri  , Mohammad Ali Zakeri  , Hemn Kaka Mirza  , Adnan Rashid Aziz  and Mahlagha Dehghan

Received: 21 December 2022;  Published: 02 June 2023;  doi: 10.21926/obm.transplant.2302186

Foot reflexology has improved numerous physical and psychological symptoms in patients. The researchers in this study aimed to investigate the effect of foot reflexology on laboratory parameters, intake/output/weight and medication regimen after kidney transplant surgery. The research was a secondary analysis of a parallel randomized controlled trial. The research included patients who were admitted to the transplantation ward. The stratified randomization approach divided 53 eligible patients into two groups: foot [...]

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 Adam K. Morrison  , Robert J. Gajarski  , Ashley Hodge  , Sara Fitzgerald-Butt  , Peter Baker  , Patrick M. McConnell  and Deipanjan Nandi

Received: 21 May 2019;  Published: 26 March 2020;  doi: 10.21926/obm.transplant.2001105

Left ventricular noncompaction cardiomyopathy (LVNC) is a rare form of heritable cardiomyopathy with wide genotypic variability, numerous phenotypic variations, and a wide spectrum of clinical disease from asymptomatic to end stage heart failure. Here, we present a case of a 2-year-old boy who presented to their pediatrician with a cough as a first clinical sign of heart failure, rapidly progressing to severe heart failure. He was found to have mixed LVNC with a restrictive phenotype, a rare phenotype of this form [...]

by Ajay Kumar  and Juveriya Israr

Received: 03 August 2024;  Published: 12 March 2025;  doi: 10.21926/obm.transplant.2501241

Allogeneic stem cell transplantation (allo-SCT) improves the treatment of hematopoietic cancer and non-malignant disease. In this case, stem cells from a genetically similar but not identical donor may stimulate immune-mediated tumor cell destruction. Allogeneic stem cell transplantation, or allo-SCT, has significantly extended the life expectancy of numerous people. Nevertheless, complications such as infections, graft-versus-host disease (GVHD), and recurrence continue. This paper provides a thorough analysis of [...]

by Preeti Chhabra  and Kenneth L. Brayman

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

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

by Spinello Antinori  and Laura Milazzo

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

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

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

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

Background: T follicular helper (Tfh) and regulatory (Tfr) cells are key players in the formation of long-lived antibody responses. Their circulating counterparts, cTfh and cTfr, are often used as biomarkers because longitudinal sampling of secondary lymphoid tissues is unfeasible in clinical studies. This is the first study to track cTfh and cTfr cells following therapeutic lymphocyte depletion with alemtuzumab, an anti-CD52 monoclonal antibody, to infer the influence of this treatment on the germinal centre respo [...]

by Victor Dong  , Aldo J. Montano-Loza  and Andrew L. Mason

Received: 19 November 2019;  Published: 13 December 2019;  doi: 10.21926/obm.transplant.1904094

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are idiopathic and progressive autoimmune hepatobiliary disorders that lead to liver failure and a need for liver transplantation in a proportion of individuals with poorly controlled disease. It is currently thought that an environmental agent triggers disease in a genetically susceptible host and to date, xenobiotics, bacteria and a human betaretrovirus have all been linked with PBC. However, there is no consensus on which agents predomina [...]

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

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

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

by 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 Maria Simonenko  and Petr Fedotov

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

Sex and gender issues in heart transplantation

by Jade M Kozuch  , Kamyar Afshar  and Ashley Feist

Received: 15 November 2024;  Published: 20 February 2025;  doi: 10.21926/obm.transplant.2501235

Lung transplant recipients represent a high-risk group for cytomegalovirus (CMV) infection and disease, even among solid organ transplant (SOT) recipients, due to multiple factors. Additionally, CMV has significant consequences in this group including pneumonitis, acute rejection, and chronic lung allograft dysfunction. For the past two plus decades, treatment of CMV in SOT recipients has been limited to off-label use of 4 antiviral medications associated with significant toxicities including myelosuppression and n [...]

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

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

In the multi-institutional platelet dose trial (PLADO Trial), there were 1,077 hematology/oncology patients ≥18 years of age who received at least one platelet transfusion. These patients were analyzed for types and severity of organ system bleeding based on baseline patient characteristics, laboratory assays, primary diagnosis, and type of treatment. Patients were randomly assigned to receive one of three different prophylactic platelet doses for morning platelet counts of ≤10 × 109 /L. Daily assessmen [...]

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

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

Although the aging process expands the adipose tissue habitation in mice and due to its close association with the female reproductive system, it can be easily exposed surgically under anesthesia when reproductive organs (including ovary, oviduct, and part of the uterus) are pulled and exposed onto the dorsal skin. This study aimed to consider the suitability of adipose tissue as a target for manipulation, particularly for the grafting of cells or small-sized tissue sections due to its ease of handling. Subsequentl [...]

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

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

Patients with chronic kidney disease (CKD) have an increased risk of developing tuberculosis (TB) compared to those with normal renal function. The reasons for this are well described, but include impaired cellular immunity, a high incidence of co-morbid conditions as well as the concomitant use of immunosuppressive medications. Ethnicity as well as socio-economic factors also prevail. Expert guidelines recommend TB chemoprophylaxis in renal transplant recipients deemed at high risk – invariably those from ethnic m [...]

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

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

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

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

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

Background: Hepatocellular carcinoma (HCC) is a lethal tumor, for which liver resection and transplantation are the only potentially curative treatments. No prospective, randomized study has compared survival in patients with compensated cirrhosis after the two operations Methods: Decision analysis modeling is an objective method to quantify risks and benefits. This study aimed to use decision analysis with a Markov model to estimate the impact of liver transplant and surgical resection on survival for patients wit [...]

by 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 Christine A. Beamish  and Omaima M. sabek

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

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

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

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

Since 2018 The American Society of Transplant has recommended that Hepatitis C Virus seropositive positive, non-viremic donors (HCVAb+/NAT-) be considered non-infectious and safe for transplantation. This report describes clinical outcomes and HCV serological and virological outcomes following lung transplantation (LTx) utilizing such donors. This retrospective cohort study describes seven HCVAb+/NAT- donors used for bilateral LTx. Donor information was sourced from the national organ donation service and recipient [...]

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

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

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

by 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 Masahiro Sato  , Emi Inada  , Shingo Nakamura  and Issei Saitoh

Received: 28 March 2018;  Published: 02 August 2018;  doi: 10.21926/obm.transplant.1803016

Background: Transplantation of isolated islets is one of the most powerful approaches to cure insulin-dependent (type I) diabetes mellitus (IDDM). Currently, the most widely used transplantation strategy is percutaneous perfusion into the liver via the portal vein. However, this approach has several drawbacks and is often limited by the large number of islets required and hypoxic damage to the grafts. Methods: In this article, we posit intrapancreatic parenchymal cell transplantation (IPPCT) as a promisin [...]

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 Mouna Daldoul  , Rim Charfi  , Khouloud Ferchichi  , Mouna Ben Sassi  , Syrine Ben Hammamia  , Fatma Medhioub  , Emna Gaies  , Rym Enneifer  , Hanene Eljebari  , Anis Klouz  , Riadh Daghfous  and Sameh Trabelsi

Received: 20 August 2024;  Published: 13 December 2024;  doi: 10.21926/obm.transplant.2404228

A high intra and interindividual pharmacokinetics variability characterize Tacrolimus. Data regarding factors influencing its pharmacokinetics and pharmacodynamics in liver transplantation are limited. This study aimed to assess tacrolimus therapeutic response, pharmacokinetics and adherence in liver transplant recipients. The study was conducted at the Clinical Pharmacology Department for 12 years, from January 2009 to March 2021. We included liver transplant patients treated with tacrolimus referred to our depart [...]

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

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

Background: Normothermic machine perfusion (NMP) utilises 1.2-1.5L of donor blood (DB) with a target perfusate haematocrit of 25% to reanimate the donor heart. Limitations to current practise include small donor size and donor anaemia which can impact on the recovery of these hearts. Furthermore, in donation after circulatory death (DCD), blood collection may delay delivery of preservation solutions resulting in longer warm ischaemic times for the heart and other organs. Banked blood (BB) is a potential alternative [...]

by 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 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 Sheri Tran  and Mark M Fuster

Received: 16 July 2017;  Published: 12 September 2017;  doi: 10.21926/obm.transplant.1703004

The risk for developing a variety of malignancies is significantly elevated in the setting of lung transplantation. Malignancy remains among the three major causes of death in post-transplant recipients, and the relatively high risk of cancer development as well as metastatic aggression pose special threats to this population due to the need for continued immunosuppression. A variety of risks such as tobacco use and inflammatory lung diseases that led to the lung pathology prompting lung transplantation, in additio [...]

by Katerina G. Oikonomou  and Sarah Taimur

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

In non-endemic regions of the world, human T-cell lymphotropic virus type-1 (HTLV-1) is an uncommon pathogen in the transplant host, but can be associated with significant morbidity and mortality. Careful assessment for risk factors, targeted screening and heightened awareness of the clinical presentation of HTLV-1 associated disease is necessary for timely recognition and management in the transplant host. The use of antiretroviral agents in the management of symptomatic disease due to HTLV-1 remains controversial [...]

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

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

We report a case of thrombotic microangiopathy (TMA) diagnosed in the kidney allograft of a 59-year-old woman who had developed plasmacytoma type monomorphic posttransplant lymphoproliferative disorder (PTLD) 30 years after a simultaneous pancreas and kidney transplant. This report demonstrates a rare etiology of TMA in a kidney allograft occurring in association with PTLD-associated monoclonal gammopathy. The main teaching points are: 1) PTLD may be considered in the work-up of a new TMA in the immunosuppressed po [...]

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

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

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

by 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 Pål Dag Line

Received: 07 April 2017;  Published: 11 April 2017;  doi: 10.21926/obm.transplant.1701001

by Aniruddha Bhattacharyya  , Lee R. Friedman  , Beje S. Thomas  and Coleman I. Smith

Received: 29 August 2021;  Published: 18 October 2021;  doi: 10.21926/obm.transplant.2104154

End Stage Renal Disease is becoming more prevalent in the United States of America, with demand for kidney transplant exceeding the available organ supply. A novel method to increase the donor pool has been to consider transplanting organs from deceased patients who have had Hepatitis C Virus (HCV) or Human Immunodeficiency Virus (HIV) infections. Transplants with HCV infected kidneys are becoming more prevalent, due to increased organ supply due to increased mortality from injection opioid use. Similarly, deceased [...]

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

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

Background: Cardiac allograft vasculopathy (CAV) remains a major obstacle to long-term heart allograft survival. A number of studies show that immune mechanisms are involved in CAV. Using non-invasive cellular MRI (CMRI) to explore indicators of CAV lesions and characterize its development could provide new insights into the target immune cells that are responsible for the progression of CAV and reveal early markers of the disease before irreversible changes occur. Methods and Results: Rat heart transplant allograf [...]

by 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 Maria Irene Bellini  , Joseph Ayathamattam  and Paul Elliot Herbert

Received: 19 October 2018;  Published: 19 November 2018;  doi: 10.21926/obm.transplant.1804026

Obesity is on the rise and the number of end stage renal disease patients who are obese parallel this trend. There is no universally accepted guideline for wait-listing end stage renal disease obese patients in order to reduce surgical complications and improve survival of the kidney graft. Criteria for acceptance are variable among transplant centres, as do post-transplant policies. Careful risk assessment to maximise the benefits of the limited organ donor resource must be undertaken prior to waitlist an obese ki [...]

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 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 Naoaki Sakata  , Gumpei Yoshimatsu  and Shohta Kodama

Received: 15 January 2019;  Published: 03 April 2019;  doi: 10.21926/obm.transplant.1902059

Total pancreatectomy (TP) is performed for not only malignant pancreatic diseases but also benign disease such as chronic pancreatitis or pancreatic injury. However, because this surgery involves removal of the whole pancreas, both exocrine and endocrine pancreatic functions are abolished, significantly impairing the nutritional statuses of patients as well as having other detrimental outcomes. Thus, especially in benign cases additional treatment to recover endocrine function is recommended, as permanent endocrine [...]

by Nicholas J. Geraghty  , Amal Elhage  , Peter Cuthbertson  , Debbie Watson  and Ronald Sluyter

Received: 06 June 2022;  Published: 06 September 2022;  doi: 10.21926/obm.transplant.2203166

Allogeneic hematopoietic stem cell transplantation is a curative therapy for hematological malignancies, but its efficacy is limited by graft-versus-host disease (GVHD). This life-threatening disorder develops when donor (graft) immune cells cause inflammatory damage to recipient (host) tissues. The immune cell receptor channel P2X7 and its ligand adenosine 5’-triphosphate (ATP) have been implicated in GVHD pathogenesis. Therefore, this signaling axis represents a potential therapeutic target. This study aime [...]

by David J. Ross

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

by Sigal Shaklai  , Meital Grafi-Cohen  , Orli Sharon  , Gabi Shefer  , Dalia Somjen  and Naftali Stern

Received: 17 April 2019;  Published: 27 August 2019;  doi: 10.21926/obm.transplant.1903082

Background: Estradiol 17-beta (E2) enhances the function and survival of pancreatic beta-cells, but its clinical use has been questioned due to concerns regarding oncogenic potential and feminizing effects in males. The G-protein coupled estrogen receptor (GPER), expressed in pancreatic islets, exhibits estrogenic beta-cell protective effects without the feminizing effects of the nuclear ERs. Here, we examine the outcome of selective activation of the three estrogen receptors ERα, ERβ, and GPER on rep [...]

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 [...]