September 23: Recent Transplant News
Monday, September 23, 2013
Renal Ischemia-Reperfusion Injury Amplifies the Humoral Immune Response
Journal of the American Society of Nephrology
Renal transplant recipients who experience delayed graft function have increased risks of rejection and long-term graft failure. Ischemic damage is the most common cause of delayed graft function, and although it is known that tissue inflammation accompanies renal ischemia, it is unknown whether renal ischemia affects the production of antibodies by B lymphocytes, which may lead to chronic humoral rejection and allograft failure. Read more.
The safety and efficacy of acute graft-versus-host disease prophylaxis with a higher target blood concentration of cyclosporine around 500 ng/mL
Clinical Transplantation (login required)
Cyclosporine is the most widely used immunosuppressive agent for the prevention of acute graft-versus-host disease. In a previous report, the incidence of acute GVHD was decreased by increasing the target blood concentration of CsA during a continuous infusion from 300 to 500 ng/mL without excessive toxicities. To confirm these results, researchres retrospectively analyzed 69 patients who received a continuous infusion of CsA at a higher target CsA level between 450 and 550 ng/mL (CsA500 group) and compared the clinical outcome with 29 patients who received CsA with a lower target concentration between 250 and 350 ng/mL (CsA300 group). Read more.
The use of transient elastography and non-invasive serum markers of fibrosis in pediatric liver transplant recipients
Pediatric Transplantation (login required)
The use of non-invasive markers to diagnose liver allograft fibrosis is not well established in children after LTx. TE, FT and ELF score were performed in 117 liver-transplanted children and 336 healthy controls. Liver biopsy was available in 36 children. Results of histology and non-invasive markers were compared using correlation coefficient or Mann–Whitney U-test as appropriate. Read more.
Crossmatch-positive liver transplantation in patients receiving thymoglobulin-rituximab induction
Transplantation (login required)
Positive crossmatch (CM) in liver transplantation (LT) is associated with worse outcomes. Role of induction immunosuppression in this setting remains to be studied. In this study, 1,000 consecutive LT patients receiving rabbit antithymocyte globulin /-rituximab induction were studied. Pretransplantation sera of 55 CM-positive (CM ) patients were tested for C1q-fixing donor-specific antibodies (DSA). Diagnosis of antibody-mediated rejection required presence of diffuse vascular C4d expression on liver biopsies. Read more.
A prospective controlled study of kidney donors: Baseline and 6-month follow-up
American Journal of Kidney Diseases
Most previous studies of living kidney donors have been retrospective and have lacked suitable healthy controls. Needed are prospective controlled studies to better understand the effects of a mild reduction in kidney function from kidney donation in otherwise healthy individuals. Read more.
Alcohol and substance abuse in solid-organ transplant recipients
Transplantation (login required)
This review focuses on alcohol and substance abuse in the context of solid-organ transplantation. Alcohol and substance abuse are common and may lead to a need for solid-organ transplantation and may also contribute to significant physical and psychologic problems that impact upon the recipient. Damaging levels of alcohol intake can occur in the absence of dependence. Alcohol or substance abuse after transplantation is associated with poor medication compliance and this may increase risk of graft loss. Read more.
Managing renal transplant ischemia reperfusion injury: novel therapies in the pipeline
Clinical Transplantation (login required)
Ischemia reperfusion injury (IRI) is an early, non-specific inflammatory response that follows perfusion of warm blood into a cold asanguinous organ following transplantation. The occurrence of IRI may have a pivotal impact on acute and long-term renal allograft function. Initially, IRI contributes to delayed graft function (DGF), a term typically defined as the need for dialysis within one week after renal transplantation. DGF frequently leads to prolonged hospital stay, increased healthcare costs and potentially worse prognosis. Read more.
Trial: Improving outcomes of renal transplant recipients with behavioral adherence contracts
American Journal of Transplantation (login required)
The objective of this randomized controlled trial was to assess the effects of a 1-year behavioral contract intervention on immunosuppressant therapy (IST) adherence and healthcare utilizations and costs among adult renal transplant recipients (RTRs). The sample included adult RTRs who were at least 1 year posttransplant, taking tacrolimus or cyclosporine and served by a specialty pharmacy. Read more.