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Open Access

ISSN 2577-5820

© 2019 by the authors; CC BY 4.0 licence

OBM Transplantation , Volume 3 , Issue 1 (2019)

Pages: 394

Published: November 2019

(This book is a printed edition that was published in OBM Transplantation)

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Cover story: The revisions to the U.S. kidney allocation system (KAS) in 2014 were substantial, including broader distribution of kidneys for CPRA 99% and 100% candidates; back-dating of waiting time to the start of dialysis; and incorporating kidney/recipient longevity matching.  We present transplant trends through 4 years post-implementation, focusing on stabilization of bolus effects, kidney discard rates, and geographic disparities.  View this paper.

Volume 3,Issue 1

Open Access Case Report

Secondary Antibody Deficiency in a Heart Recipient with Systemic Aspergillosis

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

Abstract

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

Open Access Case Report

Prolonged and Resistant Cutaneous Infection in Newly Transplanted Renal Patient

Received: 18 October 2018;  Published: 07 March 2019;  doi: 10.21926/obm.transplant.1901057

Abstract

We present a case of a renal transplant patient with surgical wound infection 20 1days after kidney transplant.

Open Access Research Article

The Contribution of Psychotherapists to Patient Care in Multidisciplinary Heart Transplantation Care Teams

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

Abstract

Background: The participation of mental health professionals in multidisciplinary care teams for heart transplantation has advanced to international standard practice. The contribution of mental health interventions to patient outcomes in this setting have not been the subject of systematic study. Methods: This paper uses a case study for an initial exploration of how psychotherapists contribute to multidisciplinary decisionmaking and care in transplant teams before, during, and after transplan [...]

Open Access Review

Islet Identity in Transplantation Procedures: The Intersection of Cellular Maturity and Function

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

Abstract

Islet transplantation is a promising technique for millions of patients with 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 have led to a broad investigation of global influences on islet biology, not least of all, characterization of mature, functional cellular identity and maintenance o [...]

Open Access Review

Role of Procalcitonin in Management of Infection in Solid Organ Transplantation Recipients: Review

Received: 23 December 2018;  Published: 01 March 2019;  doi: 10.21926/obm.transplant.1901054

Abstract

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. F [...]

Open Access Case Report

Candida auris and Heart Transplantation. Preoperative Attitude.

Received: 15 October 2018;  Published: 27 February 2019;  doi: 10.21926/obm.transplant.1901053

Abstract

In recent years, several agencies have issued warnings about the spread of Candida auris infections, a multi-resistant yeast that is associated with serious infections and with mortality rates as high as 70% with a mortality rate that can reach 70%. This problem is especially serious in patients who are candidates for transplantation, who will receive intense immunosuppression. There are no established criteria on the relevance of this colonization or on when the transplant should be contraindic [...]

Open Access Review

Advances in Human Islet Processing: Manufacturing Steps to Achieve Predictable Islet Outcomes from Research Pancreases

Received: 15 October 2018;  Published: 26 February 2019;  doi: 10.21926/obm.transplant.1901052

Abstract

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 digestio [...]

Open Access Research Article

Aspiration of Gastrointestinal Material and Induction of Fibronectin Expression in Lung Transplant Recipients: Implications for Early Airway Remodeling

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

Abstract

Background: Gastroesophageal reflux disease has been associated with allograft dysfunction in lung transplant (LTX) recipients. While the mechanisms are unclear it is postulated that microaspiration of gastrointestinal material (GIM) leads to inflammation and airway remodeling that culminates in obliterative bronchiolitis. Expression of the glycoprotein fibronectin has been shown to be an early marker of lung fibroproliferative disease, thus, its induction could suggest a causal mechanism for [...]

Open Access Review

New Frontiers in Solid Organ Transplantation from Donors with Human Immunodeficiency Virus, Hepatitis C Virus Infection, and Multidrug Resistant Organisms

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

Abstract

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

Open Access Editorial

Sex and Gender Issues in Heart Transplantation

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

Abstract

Sex and gender issues in heart transplantation

Open Access Review

Tuberculosis Screening and Treatment in Solid Organ Transplantation

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

Abstract

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 sensiti [...]

Open Access Review

Challenges in Diagnosis and Management of Nontuberculous Mycobacteria in Solid Organ Transplantation

Received: 30 November 2018;  Published: 01 February 2019;  doi: 10.21926/obm.transplant.1901047

Abstract

Non-tuberculous 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.

Open Access Perspective

Solid Organ Transplantation in Older Adults. Infectious and Other Age-Related Considerations

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

Abstract

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 aged 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 ove [...]

Open Access Case Report

Isolated Hepatic Mucormycosis in the Early Post-Transplant Period: A Case Report and Literature Review

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

Abstract

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 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 favorable outcome with surgical resection, a course of liposomal amphotericin B combined with micafungin, and [...]

Open Access Review

Innate Immune Determinants of Graft-Versus-Host Disease and Bidirectional Immune Tolerance in Allogeneic Transplantation

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

Abstract

The success of organ and tissue transplantation from a healthy donor to a disease individual (allo-­‐ transplantation) is regulated via the immune systems of donor and recipient. To minimize deleterious immune reactivity between donor and recipient, the major obstacle in transplantation is to find a genetic match. Developing a state of specific non-­‐reactivity between donor and recipient, while maintaining the salutary effects of immune function in the recipient, is c [...]

Open Access Review

Targeting Acute Islet Inflammation to Preserve Graft Mass and Long-Term Function

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

Abstract

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 gr [...]

Open Access Review

Where’s Waldo? Extrahepatic Site Options for Islet Transplantation

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

Abstract

The current predominant location for allo- and auto-transplantation of islet cells is into the liver via the portal venous system. Despite the relative success of this site over the last several decades, further study has 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 [...]

Open Access Research Article

KAS Turns Four: The State of Deceased Donor Kidney Allocation in the U.S.

Received: 14 December 2018;  Published: 22 January 2019;  doi: 10.21926/obm.transplant.1901041

Abstract

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 Se [...]

Open Access Review

Parvovirus B19 Infection in Solid Organ Transplantation: Report of A Case and A Review

Received: 05 November 2018;  Published: 20 January 2019;  doi: 10.21926/obm.transplant.1901040

Abstract

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, secondary infection, or reactivation. The clinical presentation of primary infection depends on age, the presence of a hematologic condition, and immune status. It is an uncommon infection in solid organ transplant (SOT) recipients that has atypical features, usually presenting with pure red cell aplasia which is refractory to e [...]

Open Access Review

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

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

Abstract

Solid organ transplantation (SOT) is increasingly employed worldwide to treat several diseases causing either acute and chronic organ failure. Recipients of SOT are at 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 previously acquired latent infection. The globalization and the increase of international travel poses a risk for exposure to infections such as Chagas diseas [...]

Open Access Review

A Tale of Two Flaviviruses: West Nile Virus and Zika Virus in Solid Organ Transplantation

Received: 02 November 2018;  Published: 08 January 2019;  doi: 10.21926/obm.transplant.1901038

Abstract

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 that has become endemic in the US since its arrival in 1999 and Zika virus that recently spread across the Americas. These events demonstrate the speed with which a vector-born pathogen can disseminate when introduced into a susceptible population [...]
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