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 int [...]

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 imp [...]

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 [...]

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 addre [...]

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:< [...]

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 w [...]

by Yi-nan Guo  , Michael Grzelak  and Byoung Chol Oh

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

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

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 lymphoc [...]

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 el [...]

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 cirr [...]

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 f [...]

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 [...]

by Sylvaine You  and Lucienne Chatenoud

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

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

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 [...]

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 resi [...]

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

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

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