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The following reflects new findings and outcomes in medical research as presented at major medical meetings and published peer-reviewed medical journals. In this section members can view reports from important congresses as well as summaries of some recently published journal articles. Please let us know if you have a particular area of interest you would like to see covered. MEDICAL FRONTIERS - 2010 Congress of the European Renal Association and European Dialysis and Transplant Association (ERA-EDTA) Controlling Hyperphosphatemia in Patients with Chronic Kidney DiseaseMunich, Germany / June 25-28, 2010 Munich - Even between non-calcium-containing agents, phosphate binders used in dialysis patients appear to differ substantially. While these differences are now being closely evaluated for their influence on outcome, the attention generated by these comparisons may have more immediate importance for drawing attention to an acute need for more aggressive serum phosphorus (SP) control. Despite guidelines, surveys suggest that a large proportion of dialysis patients continue to have SP levels (...) Read more... JOURNAL CLUB - Transplantation Immunosuppression for Kidney Transplant Recipients: Evidence-based KDIGO Practice GuidelinesJune 2010 Based on The KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients.
PRIORITY PRESS - American Transplant Congress 2010 Improving Long-term Outcomes in Kidney Transplant RecipientsSan Diego, California / May 1-5, 2010 San Diego - The calcineurin inhibitors (CNIs) have long been the anchor of transplant immunosuppression, leading to low acute rejection rates in the short term. However, short-term gains have had little impact on long-term graft survival, partly because of the nephrotoxic effects associated with CNI maintenance. In an effort to preserve renal function, strategies have been used to either eliminate or at least minimize CNI exposure, key among them being early conversion to mammalian target (...) Read more... PRIORITY PRESS - 30th Annual Meeting of the International Society of Heart and Lung Transplantation Vasodilation to Reverse Complications Pre- and Post-heart TransplantationChicago, Illinois / April 21-24, 2010 Chicago - Phosphodiesterase type-5 (PDE-5) is abundantly expressed in the lungs. By selectively inhibiting the PDE-5 enzyme, PDE-5 inhibitors promote the accumulation of intracellular cyclic guanosine monophosphate, thereby enhancing nitric oxide-mediated effects. Because nitric oxide is a potent pulmonary vasodilator, PDE-5 inhibitors indirectly lead to relaxation of the blood vessels in the lung and decrease pulmonary pressure. Patients with advanced heart failure who are heart (...) Read more... PRIORITY PRESS - 36th Annual Meeting of the European Group for Blood and Bone Marrow Transplantation (EBMT) Progress in Infection Management of Allogeneic Stem Cell RecipientsVienna, Austria / March 21-24, 2010 Vienna - In the last 10 years, widespread use of allogeneic hematopoietic stem cell transplantation has decreased the risk of recurrence in patients with aggressive hematological malignancies. However, the associated conditioning and immunosuppressive regimens have given rise to extremely neutropenic patients who are at risk of a range of opportunistic infections or reactivation of infectious processes. On recovery from neutropenia, patients may suffer graft-vs.-host disease (also (...) Read more... American Journal of Transplantation Volume 9 Issue 4 Pages 657 - 660 Primum Non Nocere: Is Chronic Kidney Disease Staging Appropriate in Living Kidney Transplant Donors?Y. Barria,b,c, T. Parker IIIc, B. Kapland The aphorism of Primum non Nocere (‘first do no harm’) was introduced to guide physicians in making difficult and potentially hazardous decisions. The application of estimating equations for glomerular filtration rate (GFR) and classification schema for chronic kidney disease (CKD) has inadvertently led to ‘labeling’ of many living donors as having CKD postdonation. This review examines this issue and its possible consequences. Although complete long-term studies are lacking, it appears that (...) Read more... American Journal of Transplantation Volume 9 Issue 4, Pages 844 - 852 Outcomes of Simultaneous Heart–Kidney Transplant in the US: A Retrospective Analysis Using OPTN/UNOS DataJ. Gill a,b , T. Shah c , I. Hristea a , D. Chavalitdhamrong a , B. Anastasi a , S. K. Takemoto c and S. Bunnapradist a,* ABSTRACT Simultaneous heart–kidney transplantation (SHK) remains uncommon in the US. We examined outcomes of SHK compared to heart transplant alone (HTA) and deceased donor kidney transplant (DDKT). Data from OPTN/UNOS heart and kidney data bases were used to identify 16 710 HTA, 263 SHK transplants and 68 833 DDK transplants between 1998 and 2007. Outcomes included patient survival (PS), acute cardiac and renal rejection and renal graft survival (rGS). The adjusted risk of death was 44% (...) Read more... PRIORITY PRESS - American Transplant Congress 2009 Preserving Organ Function with Non-CNI-Based Immunosuppressive RegimensBoston, Massachusetts / May 30-June 3, 2009 Boston - Recognizing that calcineurin inhibitors (CNIs) may be nephrotoxic and/or diabetogenic, immunosuppressive protocols that minimize exposure to CNIs have gained acceptance in a variety of transplantation settings. Studies discussed here at the ATC on kidney and liver transplant recipients indicate that mTOR inhibition is a viable replacement for CNI immunosuppression, preserving renal function in both patient populations without increasing the risk of graft loss or patient mortality. (...) Read more... PRIORITY PRESS - American Transplant Congress 2009 Outcomes in Kidney Transplant Recipients: Focus on Diabetes and BK-associated NephropathyBoston, Massachusetts / May 30-June 3, 2009 Boston - Short-term equivalency has been demonstrated for calcineurin inhibitors (CNIs) in widespread use today for prevention or treatment of graft rejection. Differences begin to emerge as outcomes are assessed over the longer term, including a greater propensity for new-onset diabetes after transplantation and development of BK-associated nephropathy or BK-induced viruria/viremia one year post-transplant. These complications could affect function and survival of the donor graft and, in (...) Read more... PRIORITY PRESS - American Transplant Congress 2009 Immunosuppression in Liver Transplant RecipientsBoston, Massachusetts / May 30-June 3, 2009 Boston - Patients with hepatitis C (HCV) who undergo liver transplantation typically experience less favourable patient and graft survival compared with non-HCV liver transplant recipients, primarily because HCV frequently recurs, damaging the new liver in the process. Achieving a sustained virological response to therapy significantly improves survival for HCV transplant recipients and measures that facilitate that response should be considered. As confirmed here at the ATC, new-onset (...) Read more... PRIORITY PRESS - American Transplant Congress 2009 Preservation of Long-term Renal Function in Transplant Patients: Role of Once-daily CNI DosingBoston, Massachusetts / May 30-June 3, 2009 Boston - Findings from a 10-year follow-up of renal transplant patients originally randomized in a comparison of the two calcineurin inhibitors (CNIs) suggest that CNI-sparing regimens are not necessarily essential for better long-term preservation of kidney function. They also suggest that the nephrotoxic potential of the two CNIs is variable, as are differences in new-onset diabetes after transplantation. A twice-daily, tacrolimus-based regimen is well established in the management of (...) Read more... PRIORITY PRESS - 29th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation Immunosuppression in Heart Transplant Patients at High Risk for Poor OutcomesParis, France / April 22-25, 2009 Paris - The field of heart transplantation was revolutionized in the 1970s by the introduction of safer and more effective immunosuppressive regimens that significantly increased the chances that cardiac graft recipients could survive for one or more years post-transplant. The typical triple-drug regimen consists of a corticosteroid, an antimetabolite and a calcineurin inhibitor (CNI), either cyclosporine or, more recently, tacrolimus. These agents together repress the immune response that (...) Read more... MEDICAL FRONTIERS - 35th Annual Meeting of the European Group for Blood and Marrow Transplantation Secondary Prevention of Invasive Fungal Infections in Stem-cell Transplant PatientsGöteborg, Sweden / March 29-April 1, 2009 Göteborg - The risk of recurrence of a previous invasive fungal infection (IFI) or acquisition of a new one is a major obstacle to the success of stem-cell transplantation (SCT). These infections are increasing in frequency and the majority of them are now due to Aspergillus species. Historically, mortality rates from these infections have been high, but are now decreasing with earlier diagnosis and more effective therapy. A recent recategorization of data from the 2002 Global Comparative (...) Read more... Transplant International Volume 22 Issue 2, Pages 144 - 152 Autoimmune liver diseases and recurrence after orthotopic liver transplantation: what have we learned so far?Tim C. M. A. Schreuder 1,2 , Stefan G. Hübscher 3 and James Neuberger 1 1 Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK 2 Department of Gastroenterology and Hepatology, Liver Unit, VU Medical Centre, Amsterdam, the Netherlands ABSTRACT Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) may all recur after liver transplant. Diagnosis of rPBC is defined by histology; rAIH by serology, biochemistry and histology; rPSC by histology and/or imaging of the biliary tree and exclusion of other causes of nonanastomotic biliary strictures. Criteria for recurrent disease (RD) may differ from those used in similar disease in the native liver: frequent use of immunosuppressive (...) Read more... Transplantation Proceedings Volume 40, Issue 10, December 2008, Pages 3481-3484 Anemia After Renal Transplantation: An Underestimated ProblemU. Otta, M. Buscha, T. Steinerb and G. Wolfa, aDepartment of Internal Medicine III, Friedrich-Schiller-University, Jena, Germany bDepartment of Urology, Friedrich-Schiller-University, Jena, Germany Abstract In end-stage renal disease patients anemia is known to be an independent risk factor for cardiovascular disease and death. In a monocenter retrospective analysis, we investigated 207 stable patients (68 women/139 men) who underwent a first renal transplantation. Immunosuppressive therapy was performed with either cyclosporine plus mycophenolate mofetil, tacrolimus plus mycophenolate mofetil, or rapamycin plus mycophenolate mofetil; 43.5% of the patients were treated with steroids. (...) Read more... Transplantation Proceedings Volume 40, Issue 10, December 2008, Pages 3413-3417 Deceased Donor Kidney Transplantation in Elderly Patients: Is There a Difference in Outcomes?R.F. Saidia, P.T. Kennealeya, N. Eliasa, T. Kawaia, M. Hertla, M. Farrella, N. Goesb, C. Hartonob, N. Tolkoff-Rubinb, A.B. Cosimia and D.S.C. Koa, aDepartment of Surgery, Transplantation Unit, Massachusetts General Hospital, Boston, Massachusetts bDepartment of Surgery, Renal Unit, Massachusetts General Hospital, Boston, Massachusetts Introduction There is a paucity of data on long-term outcomes of older kidney recipients. Our aim was to compare the early and long-term outcomes of deceased donor kidney transplantation in patients aged ≥60 years with outcomes in younger recipients. Materials and Methods From 1998 to 2005, we performed 271 deceased donor kidney transplants. There were 76 recepients (28.1%) >60 years old. Older candidates were carefully selected based on their physiologic, cardiac, and performance status. (...) Read more... Journal of the American College of Cardiology Volume 52, Issue 8, 19 August 2008, Pages 587-598 The Changing Face of Heart TransplantationSharon A. Hunt MD, FACC , a, and François Haddad MD, FRCPCa It has been 40 years since the first human-to-human heart transplant performed in South Africa by Christiaan Barnard in December 1967. This achievement did not come as a surprise to the medical community but was the result of many years of early pioneering experimental work by Alexis Carrel, Frank Mann, Norman Shumway, and Richard Lower. Since then, refinement of donor and recipient selection methods, better donor heart management, and advances in immunosuppression have significantly (...) Read more... American Journal of Transplantation Volume 8 Issue 10, Pages 1972 - 1981 What’s Next in the PipelineF. Vincenti a,* and A. D. Kirk b a Professor of Clinical Medicine, University of California, San Francisco, Kidney Transplant Service, San Francisco, CA b Professor of Surgery, Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA The first decade of the new millennium has been disappointing for transplant therapeutics: no new immunosuppression agents have been approved. Several high profile drugs and biologics failed the rigors of clinical trials or had disappointing preclinical results (FTY720, FK778, anti-CDI54, anti-IL15, anti-CD28, R3421). Several challenges face the industry and clinical investigators in bringing novel drugs to the clinic including the difficulty in targeting new endpoints for toxicities or (...) Read more... Transplantation Proceedings Volume 40, Issue 6, July-August 2008, Pages 1823-1826 Evidence of Liver Histological Alterations in Apparently Healthy Individuals Evaluated for Living Donor Liver TransplantationO. Cuomoa, A. Perrellaa, D. Pisanielloa, G. Marinob and G. Di Costanzoc aDepartment of Laparascopic, Hepatic Surgery and Liver Transplant Unit, AORN, A. Cardarelli Hospital, Naples, Italy bHistopathology Unit, AORN, A. Cardarelli Hospital, Naples, Italy cHepatology Unit, AORN, A. Cardarelli Hospital, Naples, Italy. Background Living donor liver transplantation (LDLT) represents an important therapeutic option for patients with end-stage liver disease (ESLD). It has been reported that steatosis may be a serious problem in patients who donate a part of their liver. Liver biopsy represents an accepted method to assess the rate of steatosis and the possible risk to the donor. Nonetheless, some histological abnormalities have been documented in the specimens from potential donors. The aim of this study was (...) Read more... ABSTRACTS in PERSPECTIVE based on presentations from the American Transplant Congress 2008 Preserving Renal Function: Exploring Calcineurin Inhibitor-sparing Regimens in Renal Allograft RecipientsMay 30-June 4, 2008 / Toronto, Ontario EDITORIAL OVERVIEW
45th Annual Congress of the European Renal Association (ERA)/European Dialysis and Transplant Association (EDTA) Chronic Kidney Disease: New Strategies to Reduce Phosphate BurdenStockholm, Sweden / May 10-13, 2008 Stockholm - Disorders of mineral metabolism are linked to cardiovascular (CV) morbidity and mortality in patients with chronic kidney disease (CKD) who are on dialysis. Above all, hyperphosphatemia is associated with the development of CV disease, which accounts for nearly 50% of all deaths in the dialysis population. Moreover, recent studies demonstrate that changes in mineral homeostasis, including increased phosphate load, contribute to the pathogenesis of vascular calcification and CV (...) Read more... Transplantation Reviews Volume 21, Issue 4, October 2007, Pages 230-236 The process of donation after cardiac death: a US perspectiveAnthony M. D’Alessandro , a, aDepartment of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA Donation after cardiac death (DCD) has the potential to significantly increase the number of organ donors nationwide by at least 10%, which is the current goal of the National Organ Donation and Transplantation Collaboratives. Several organ procurement organizations in the United States currently exceed this goal with nearly 20% of their organ donors being DCD donors. With the Joint Commission on Accreditation of Healthcare Organizations asking all hospitals in the United States to have a (...) Read more... Transplantation Reviews Volume 21, Issue 4, October 2007, Pages 177-188 Strategies to optimize deceased organ donationRafael Matesanz , a, and Beatriz Dominguez-Gila Organ shortage is one of the main limitations to deal with in organ transplantation. Although the number of patients in the waiting list increases over time, the number of transplants performed does not increase or increases at a much lower rate because of the scarcity of organs to fulfil the demands. Several classic approaches have proven to have a limited or transient impact on the figures of organ donation. The sustained increase in deceased organ donation rates in Spain during the last (...) Read more... Transplantation Proceedings Volume 39, Issue 8, October 2007, Pages 2516-2518 Donor Liver Dysfunction: Application of a New Scoring System to Identify the Marginal DonorB.H. Ferraz-Neto , a, , M.P.V.C. Zurstrassena, R. Hidalgoa, L.E.P. Fonsecaa, T.D.B. Mottaa, F.L. Pandulloa, M.B. Rezendea, S.P. Meira-Filhoa, J.R. Sáa and R.C. Afonsoa aAlbert Einstein Hospital, São Paulo, Brazil. Livers from marginal donors are increasingly used for transplantation due to the shortage of donor organs. The definition of a marginal donor remains unclear; prediction of organ function is a challenge. In the literature the use of steatotic livers has been associated with poor liver function or even primary dysfunction of the allograft. Tekin et al created a scoring system that classifies a donor as marginal or nonmarginal, using a mathematical model based on donor age and steatosis (...) Read more... 40th Annual Meeting and Scientific Exhibition of the American Society of Nephrology Hyperphosphatemia and the Dialysis Patient: Focus on Reducing CalcificationSan Francisco, California / November 2-5, 2007 San Francisco - Elevated phosphorus levels occurring at kidney failure are associated with increased vascular calcification and cardiovascular events. Presently, in dialysis patients, hyperphosphatemia is usually managed with phosphate binder therapies. Pediatric patients with chronic kidney disease, mainly transplant recipients, require more vigilant correction of mineral abnormalities in order to improve lifelong outcomes. While more than 58% of Canadian dialysis patients achieve Kidney (...) Read more... 13th Congress of the European Society for Organ Transplantation Simplifying Immunosuppression in Post-transplant Patient ManagementPrague, Czech Republic / September 29-October 3, 2007 Prague - Despite recent advances in short-term patient and graft survival following organ transplantation, there has not been a parallel improvement in long-term outcomes. Ten-year graft survival rates remain low at 40% to 60%. Although chronic rejection is multifaceted, studies demonstrate a clear association between patient non-adherence to post-transplant immunosuppression and late graft loss. Opinion leaders believe it may be possible, therefore, to prevent graft rejection and increase (...) Read more... Transplantation Proceedings Volume 39, Issue 6, July-August 2007, Pages 1820-1822 Renal Grafts From Elderly Donors: Histological Studies and Long-Term ResultsO. Rossettib, S. Soldanob, P. Asenib, , , V. Colombob, E. Rosellia, A. De Gasperib and C.V. Sansaloneb a2 Servizio Anestesia Rianimazione e Trapianti Addominali, AO Ospedale Niguarda Ca Granda, Milan, Italy bRenal Trasplant Surgery, AO Ospedale Niguarda Ca Granda, Milan, Italy. To satisfy the increasing requests for renal grafts, elderly donors are increasingly accepted for kidney transplant at many centers. The main unresolved question is the long-term effect on graft survival of potential histological lesions due to donor age. We present a prospective histological study performed from January 1997 to December 2001 on 184 consecutively transplanted renal grafts in which the only criterion for graft acceptance was a normal value of serum creatinine upon admission (...) Read more... American Journal of Transplantation Volume 7 Issue 8 Page 1961-1967, August 2007 Nephrectomy After Transplant Failure: Current Practice and OutcomesO. JohnstonaaDivisions of Nephrology, C. RoseaaDivisions of Nephrology, D. LandsbergaaDivisions of Nephrology, W. A. GourlaybbUrology University of British Columbia, St. Paul’s Hospital, Vancouver, B.C., Canada and J. S. Gilla,c,*aDivisions of NephrologycDivision of Nephrology, Tufts-New England Medical Center, Boston, MA*Corresponding author: John S. Gill, jgill@providencehealth.bc.ca Abstract The role of transplant nephrectomy after transplant failure is uncertain. We report the use and consequences of transplant nephrectomy among 19 107 transplant failure patients between 1995 and 2003 in the United States. Among 3707 patients with early transplant failure (graft survival 12 m), nephrectomy was performed in 56%, and was associated with an increased risk of death (HR 1.13, 95% CI 1.01–1.26). In contrast, among 15 400 patients with late transplant failure (graft survival (...) Read more... American Journal of Transplantation Volume 7 Issue 8 Page 1907-1916, August 2007 Effects of Cyclosporine on Transplant Tolerance: The Role of IL-2H. G. Kanga, aHarvard Medical School, Transplant Research Center, Beth Israel Deaconess Medical Center, Boston, MA These authors contributed equally to this work. D. Zhanga, aHarvard Medical School, Transplant Research Center, Beth Israel Deaconess Medical Center, Boston, MA Abstract Allograft transplant outcome, rejection or tolerance, depends upon striking a balance between the pertinent cytopathic and regulatory T cells. The drug cyclosporine is a widely used immunosuppressive agent among transplant recipients. Previous studies have demonstrated that cyclosporine blocks apoptosis of activated T cells and the ability of costimulation blockade based regimens to create peripheral transplant tolerance. We now test the hypothesis that the mechanism by which (...) Read more... Transplantation Proceedings Volume 39, Issue 5, June 2007, Pages 1287-1300 Medication Adherence in Chronic Disease: Issues in Posttransplant ImmunosuppressionR. Hansena, , , R. Seifeldinb and L. Noea Poor medication adherence is a widespread problem that undermines the potential benefits of medical treatment. Typical adherence rates among chronic disease patients are approximately 50%, and these low adherence rates have a substantial economic impact, estimated at $100 to $300 billion annually. Nonadherence to immunosuppressants among transplant recipients is surprisingly frequent, and the consequences are serious. Among adult renal transplant patients, the median rate of nonadherence is (...) Read more... Transplant International Volume 20 Issue 7 Page 608-615, July 2007 Evaluating the accuracy of functional biomarkers for detecting histological changes in chronic allograft nephropathySerdar Yilmaz1,21 Division of Transplantation, University of Calgary, Calgary, AB, Canada2 Southern Alberta Transplant Program, University of Calgary, Calgary, AB, Canada, Ipek Isik1,2,31 Division of Transplantation, University of Calgary, Calgary, AB, Canada2 Southern Alberta Transplant Program, University of Calgary, Calgary, AB, Canada3 Department of Pathology, University of Calgary, Calgary, AB, Canada, Marjan Afrouzian33 Department of Pathology, University of Calgary, Calgary, AB, Canada, Mauricio Monroy1,21 Division of Transplantation, University of Calgary, Calgary, AB, Canada2 Southern Alberta Transplant Program, University of Calgary, Calgary, AB, Canada, Aylin Sar1,2,31 Division of Transplantation, University of Calgary, Calgary, AB, Canada2 Southern Alberta Transplant Program, University of Calgary, Calgary, AB, Canada3 Department of Pathology, University of Calgary, Calgary, AB, Canada, Hallgrimur Benediktsson33 Department of Pathology, University of Calgary, Calgary, AB, Canada and Kevin McLaughlin2,42 Southern Alberta Transplant Program, University of Calgary, Calgary, AB, Canada4 Division of Nephrology, University of Calgary, Calgary, AB, Canada, The most common cause of late kidney transplant failure is chronic allograft nephropathy (CAN). Much research has focused on identifying biomarkers (or correlates) that would predict subsequent CAN and allow timely intervention. Functional biomarkers such as serum creatinine and estimated glomerular filtration rate (eGFR) have been widely adopted, even though they have not been rigorously evaluated as surrogate markers. This study evaluated serum creatinine and eGFR for predicting the early (...) Read more... 44th European Renal Association/European Dialysis and Transplant Association Annual Congress Balancing Needs and Concerns of Dialysis Patients: Simplified Regimens, Enhanced Patient ComplianceBarcelona, Spain / June 21-24, 2007 Barcelona - About one-third of patients with any chronic condition fail to adhere to their medical regimen as prescribed. Non-adherence is a variable behaviour and is rooted in a patient’s pre-existing set of beliefs about how important a treatment might be for them personally balanced against concerns about the long-term consequences of that therapy. Addressing individual “necessity vs. concerns” issues is therefore key to improving compliance. However, practical barriers to compliance, (...) Read more... American Journal of Transplantation Volume 7 Issue 7 Page 1808Issue 7 - 1814 - July 2007 Value of Posttransplant Antibody Tests in the Evaluation of Patients with Renal Graft DysfunctionJ. C. Scornika,*aDepartment of Pathology, University of Florida College of Medicine, Gainesville, FL*Corresponding author: Juan C. Scornik, scornik@ufl.edu, G. GuerrabbDepartment of Medicine, Division of Nephrology, University of Florida College of Medicine, Gainesville, FL, J. D. ScholdbbDepartment of Medicine, Division of Nephrology, University of Florida College of Medicine, Gainesville, FL, T. R. SrinivasbbDepartment of Medicine, Division of Nephrology, University of Florida College of Medicine, Gainesville, FL, D. DragunccDepartment of Nephrology, Intensive Care Medicine Campus Virchow Clinic and Center for Cardiovascular Research, Charite University Medicine Berlin, Berlin, Germany and H.-U. Meier-KrieschebbDepartment of Medicine, Division of Nephrology, University of Florida College of Medicine, Gainesville, FL Posttransplant HLA antibodies correlate with C4d positive rejection and decreased graft survival. However, the diagnostic value of various antibody tests in the management of patients presenting with graft dysfunction is uncertain. Whether all or some patients should be tested, how often, what antibodies to test for and how to interpret results in presensitized or transfused patients, are issues still unresolved. We tested for HLA and non-HLA antibodies by flow cytometry assays in 103 (...) Read more... American Journal of Transplantation Volume 7 Issue 7 Page 1763Issue 7 - 1769 - July 2007 Prophylactic Bisphosphonate Treatment Prevents Bone Fractures After Liver TransplantationM. Bodingbauera,*aDivision of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria*Corresponding author: Martin Bodingbauer, martin.bodingbauer@meduniwien.ac.at, T. WekerleaaDivision of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria, B. PakrahbbDepartment of Neurosurgery, KA Rudolfstiftung, Vienna, Austria, P. RoschgerccLudwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 4th Medical epartment Hanusch Hospital, Vienna, Austria, M. Peck-RadosavljevicddDepartment of Internal Medicine IV, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria, G. SilberhumeraaDivision of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria, S. GramppeeDepartment of Radiology, Division of Osteoradiology, Medical University of Vienna, Austria, S. RockenschaubaaDivision of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria, G. BerlakovichaaDivision of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria, R. teiningeraaDivision of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria, K. KlaushoferccLudwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 4th Medical Department Hanusch Hospital, Vienna, Austria, R. OberbauerffDepartment of Internal Medicine III, Division of Nephrology, Medical University of Vienna, and KH Elisabethinen, Linz, Austria A randomized controlled prospective open-label single center trial was performed. At the time of transplantation patients were randomly assigned to one of two treatment arms: The study group of 47 patients received zoledronic acid (ZOL, 8 infusions at 4 mg during the first 12 months after LT), calcium (1000 mg/d) and vitamin D (800 IE/d). The control group consisted of 49 patients who received calcium and vitamin D at same doses (CON). The incidence of bone fractures or death was predefined (...) Read more... Transplantation Reviews Volume 21, Issue 2, April 2007, Pages 107-118 Review: chemokines in transplantationErik Schaddea, and Stuart J. Knechtle , a aDepartment of Surgery, University of Wisconsin–Madison, Division of Transplantation, Madison, WI, USA The alloimmune response in solid organ transplantation is characterized by antigen presentation, activation of the recipient’s immune system, and an effector response. Chemokines are chemotactic cytokines and play a role in all 3 components of the alloimmune response. Early studies showed an effectiveness of chemokine receptor blockade in experimental transplant models; chemokine receptor blockers will become more widely available because of their development for other applications. This (...) Read more... Transplantation Reviews Volume 21, Issue 2, April 2007, Pages 65-76 Management of late, recurrent, and resistant cytomegalovirus in transplant patientsRobin K. Avery , a, aDepartment of Infectious Disease and Transplant Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA The timing and incidence of post-transplant cytomegalovirus (CMV) infections have changed in the era of prophylaxis and preemptive therapy. Late, recurrent, and ganciclovir-resistant CMV syndromes continue to be challenges to clinical management. Recent articles relating to solid-organ transplantation on the topic of CMV occurring after prophylaxis, CMV recurrence, CMV-specific immune reconstitution, and antiviral-resistant CMV were reviewed with particular attention to issues of risk (...) Read more... Transplant InternationalXenotransplantationTransplantation ProceedingsTransplantationCell TransplantationAmerican Journal of TransplantationTransplant Nurses AssociationNational Institute of TransplantationTransplantation SocietyInternational Society for Heart and Lung TransplantationInternational Transplant Coordinators SocietyMulti-Organ Transplant ProgramSurviving Transplantation: A Personal GuideBone marrow transplantation InfonetAmerican Society for Blood and Marrow TransplantationBone marrow transplantationCanadian Blood and Marrow Transplant GroupCanadian Association of TransplantationAssociation of Organ Procurement OrganizationsEuropean Journal of Oncology Nursing Volume 11, Supplement 1, 2007, Pages S3-S9 Management of oral mucositis at European transplantation centresRebecca Stonea, , , Carin M.J. Pottingb, , Simon Clarec, , Mary Uhlenhoppd, , Michelle Daviese, , Arno Mankf, , Barry Quinng, and the research subgroup of the European Group for Blood and Marrow Transplantation Nurses Group (EBMT-NG) Oral mucositis (OM), which occurs in many patients with hematologic malignancies treated with high-dose therapy and stem cell transplantation, is associated with substantial clinical, economic, and quality-of-life (QOL) consequences. It has been associated with an increased need for total parenteral nutrition and opioid analgesics, prolonged hospital stays, and increased risk of infection. The research subgroup of the European Group for Blood and Marrow Transplantation Nurses Group surveyed (...) Read more... Transfus Med Hemother 2007;34:182-187 Biomarkers in Transplantation Medicine: Prediction of Pharmacodynamic Drug EffectsM.J. Barten; J.F. Gummert Department of Cardiac and Thoracic Surgery, University Hospital Jena, Friedrich-Schiller University Jena, Germany Conventional therapeutic drug monitoring based on measuring of blood concentrations (pharmacokinetic) is important in the clinical management of immunosuppressive therapy in transplantation medicine. Since rejection or infection occurs at irregular drug concentrations, immunosuppressive drug therapy is often empiric and prophylactic in nature. In addition, blood immunosuppressant levels are only indirect predictors of the pharmacologic effects on immune cells (pharmacodynamic) because, due (...) Read more... Transplantation Proceedings Volume 39, Issue 4, May 2007, Pages 837-841 Effect of the Interval Between Organ Donor Brain Death and Organ Harvesting on Kidney Graft Function After TransplantationM. Gunera, A. Pirata, , , P. Zeyneloglua, P. Karaaslana, S. Sevmisb, T. Colakc and G. Arslana aDepartment of Anesthesiology, Baskent University Faculty of Medicine, Ankara, Turkey bDepartment of General Surgery, Baskent University Faculty of Medicine, Ankara, Turkey cDepartment of Internal Medicine, Baskent University Faculty of Medicine, Ankara, Turkey. Abstract We hypothesized that providing a longer resuscitation period (>12 hours) for a brain-dead organ donor (BDOD) to attenuate the detrimental effects of sympathetic discharge that occur during this event would improve graft function. We reviewed the medical records of patients who had received a kidney transplant from a BDOD between November 2001 and June 2006. The patients were divided into two groups according to whether the interval between the brain death of the organ donor and (...) Read more... Transplantation Proceedings Volume 39, Issue 4, May 2007, Pages 829-834 Donor Outcome After Living Liver Donation: A Single-Center ExperienceH. Khalaf , a, , M. Al-Sofayana, Y. El-Sheikha, H. Al-Bahilia, M. Al-Sagheira and M. Al-Sebayela aDepartment of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Objectives To objectively evaluate outcomes after living donor hepatectomy. Patients and method Between November 2002 and August 2006, a total of 44 procedures were performed (35 right, eight left, and one aborted after surgical incision). The Clavien classification was used to record surgical complications as follows: grade I, alterations from the ideal postoperative course not requiring specialized pharmacological or surgical treatment; grade II, complications requiring specialized (...) Read more... Transplantation. 83(10):1337-1340, May 27, 2007. Living Donor Liver Transplantation With Reduced Monosegments for Neonates and Small Infants.Ogawa, Kohei 1,3; Kasahara, Mureo 2; Sakamoto, Seisuke 1; Ito, Takashi 1; Taira, Kaoru 1; Oike, Fumitaka 1; Ueda, Mikiko 1; Egawa, Hiroto 1; Takada, Yasutsugu 1; Uemoto, Shinji 1 Abstract: Background. In pediatric living donor liver transplantation, left lateral segment or monosegmental graft is used to overcome size discrepancies between adult donors and pediatric recipients. For neonates and extremely small infants, however, problems related to large-for-size graft are sometimes encountered even when using such grafts. The reduced monosegmental graft, in which the caudal part of the monosegmental graft is resected, has been introduced to address this problem. (...) Read more... Transplantation. 83(10):1308-1315, May 27, 2007. Probrain Natriuretic Peptide and C-Reactive Protein as Markers of Acute Rejection, Allograft Vasculopathy, and Mortality in Heart Transplantation.Arora, Satish 1,6; Gullestad, Lars 1; Wergeland, Ragnhild 2; Simonsen, Svein 1; Holm, Torbjorn 1; Hognestad, Aina 1; Ueland, Thor 3; Geiran, Odd 4,5; Andreassen, Arne 1 Abstract: Background. N-terminal probrain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) are useful in risk stratification of patients with congestive heart failure. They could also be markers of distinctly altered hormonal and immunological milieus, but the combined prognostic value of these biomarkers in heart transplant (HTx) recipients has not been assessed previously. Methods. We sought to assess the individual and combined value of NT-proBNP and CRP as markers of acute (...) Read more... Nephrology Dialysis Transplantation 2007 22(6):1730-1737 Parathyroidectomy after successful kidney transplantation: a single centre studyPieter Evenepoel1, Kathleen Claes1, Dirk R. Kuypers1, Frans Debruyne2 and Yves Vanrenterghem1 1Department of medicine, Division of Nephrology and 2Department of Ear–Nose–Throat and Head and Neck Surgery, University Hospital Leuven, B-3000 Leuven, Belgium Background. Successful kidney transplantation is believed to cure secondary hyperparathyroidism, but persistent disease has emerged in a significant number of allograft recipients. A parathyroidectomy is ultimately required in some of these patients. To gain insight into the incidence, risk factors and consequences of parathyroidectomy in patients with a functioning renal graft, we performed a retrospective case-controlled study. Methods. Charts of 1743 recipients of a kidney allograft, (...) Read more... Transplant Infectious DiseaseVolume 9 Issue 2 Page 114 - June 2007 Infections associated with ventricular assist devices: epidemiology and effect on prognosis after transplantationD.H. Monkowski11Section of Infectious Diseases, , P. Axelrod11Section of Infectious Diseases, , T. Fekete11Section of Infectious Diseases, , T. Hollander22Section of Cardiology, , S. Furukawa33Department of Cardiothoracic Surgery, Temple University School of Medicine and Hospital, Philadelphia, Pennsylvania, USA, R. Samuel11Section of Infectious Diseases, 1Section of Infectious Diseases, 2Section of Cardiology, 3Department of Cardiothoracic Surgery, Temple University School of Medicine and Hospital, Philadelphia, Pennsylvania, USA Background. Ventricular assist devices (VADs) can be used as a bridge to orthotopic heart transplantation (OHT) in people with severe congestive heart failure. Although they can be inserted for an indefinite time period (unlike balloon pumps), they do carry a substantial risk of infection. We studied the epidemiology, microbiology, and consequences of infection in patients with VADs who ultimately had cardiac transplantation. Methods. Records of VAD-supported patients at our institution (...) Read more... American Journal of Transplantation Volume 7 Issue 6 Page 1442 - June 2007 Intercellular Transfer of MHC and Immunological Molecules: Molecular Mechanisms and Biological SignificanceL. A. SmythaaDepartment of Nephrology and Transplantation, Immunoregulation, Thomas Guy House, Kings College London, Guy’s Hospital, London B. AfzaliaaDepartment of Nephrology and Transplantation, Immunoregulation, Thomas Guy House, Kings College London, Guy’s Hospital, London, J. TsangaaDepartment of Nephrology and Transplantation, Immunoregulation, Thomas Guy House, Kings College London, Guy’s Hospital, London, G. LombardiaaDepartment of Nephrology and Transplantation, Immunoregulation, Thomas Guy House, Kings College London, Guy’s Hospital, London and R. I. Lechlera*aDepartment of Nephrology and Transplantation, Immunoregulation, Thomas Guy House, Kings College London, Guy’s Hospital, London*Corresponding author: Robert I. Lechler, robert.lechler@kcl.ac.uk aDepartment of Nephrology and Transplantation, Immunoregulation, Thomas Guy House, Kings College London, Guy’s Hospital, London The intercellular transfer of many molecules, including the major histocompatibility complexes (MHC), both class I and II, costimulatory and adhesion molecules, extracellular matrix organization molecules as well as chemokine, viral and complement receptors, has been observed between cells of the immune system. In this review, we aim to summarize the findings of a large body of work, highlight the molecules transferred and how this is achieved, as well as the cells capable of acquiring (...) Read more... International Transplant Skin Cancer Collaborative (ITSCC)The Society for Surgery of the Alimentary Tract, Inc.Society American Gastrointestinal Endoscopic SurgeonsInternational Liver Transplantation SocietyInternational Association for the Study of the LiverHepatitis B FoundationHepatitis Foundation InternationalEuropean Association for the Study of the LiverAsian Pacific Association for the Study of the LiverAmerican Society of TransplantationAmerican Society of Transplant SurgeonsAmerican Transplant Congress 2007 Low-dose Immunosuppressive Regimens: Lessons from SYMPHONYSan Francisco, California / May 5-9, 2007 San Francisco - The large multicentre SYMPHONY study was carried out in 1645 de novo renal transplant recipients. A standard immunosuppressive regimen containing the calcineurin inhibitor cyclosporine, mycophenolate mofetil and steroids was compared with three experimental low-dose regimens given in combination with the same two agents following daclizumab induction. Results at one year demonstrated improved efficacy with the low-dose tacrolimus regimen over the other treatment arms for (...) Read more... American Transplant Congress 2007 Calcineurin Inhibitor and Steroid Regimens: Update on Sparing or Avoidance in High and Low-risk Transplant RecipientsSan Francisco, California / May 5-9, 2007 Editorial Overview:
33rd Annual Meeting of the European Group for Blood and Marrow Transplantation Targeted Therapy in Lymphoid Malignancies: The Changing Face of TransplantationLyon, France / March 25-28, 2007 Lyon - Treatment of non-Hodgkin’s lymphoma generally involves chemotherapy. Autologous or allogeneic stem cell transplantation is often considered in patients who are refractory to chemotherapy. Despite intensive research in previous decades, prognosis had only slightly improved, but the recent advent of monoclonal antibodies has had a significant impact on approaches to disease management and patient survival. Delegates here learned of the role of monoclonal antibodies at different stages (...) Read more... 33rd Annual Meeting of the European Group for Blood and Marrow Transplantation Update on Antifungal Treatment Strategies in Stem Cell TransplantationLyon, France / March 25-28, 2007 Lyon - Patients with hematological malignancies who undergo stem cell transplantation (SCT) are at high risk of developing invasive fungal infections such as aspergillosis. Although mortality in patients with SCT has decreased in recent years, in large part because of better management of these infections, there is still much room for improvement. During the scientific sessions here this week, delegates learned how the echinocandin caspofungin is a useful addition to the therapeutic options (...) Read more... 12th Annual Update on Cardiopulmonary Bypass Transfusion Medicine in Cardiac Surgery: Towards Implementation of a Blood Conservation ProgramWhistler, British Columbia / March 18-23, 2007 Whistler - There is an urgent need to minimize the use of all blood products in cardiac surgery, speakers here agreed, not only because blood is increasingly scarce and costly, but because transfusion itself is also associated with significant medical risks, including a increased risk in mortality. In Ontario, comprehensive blood management programs in which patients at risk for excessive bleeding are identified and treated prior to surgery have been shown to significantly reduce blood use. (...) Read more... Canadian Society of Transplantation Annual Meeting Balancing Efficacy and Toxicity: Best Practice Immunosuppressive StrategiesBanff, Alberta / March 15-18, 2007 Banff - The goal of post-transplantation management is to provide effective immunosuppression to avoid rejection and minimize long-term toxicity. One way to achieve these goals is to use the lowest possible doses of immunosuppressive agents. Recent results from the SYMPHONY study demonstrated that low-dose tacrolimus provides effective immunosuppression and is associated with the least degree of toxicity compared with low-dose cyclosporine, low-dose sirolimus or normal-dose cyclosporine. (...) Read more... 43rd European Renal Association/European Dialysis and Transplant Association Congress Setting the Stage for Improved Chronic Kidney Disease OutcomesGlasgow, United Kingdom / July 15-18, 2006 Glasgow - The annual mortality rate for patients on dialysis in Canada is approximately 15%. It is now known that treating chronic kidney disease patients on dialysis with calcium-based phosphate binders can lead to cardiac calcification. Preliminary research suggests that therapy with non-calcium phosphate binders such as sevelamer may improve outcomes. The Dialysis Clinical Outcomes Revisited trial data raised the hypothesis that treating older dialysis patients with sevelamer rather than (...) Read more... 43rd Congress of the European Renal Association/European Dialysis and Transplant Association Controlling Phosphorus Levels and Improving Compliance in Dialysis PatientsGlasgow, United Kingdom / July 15-18, 2006 Glasgow - When undergoing hemodialysis, almost all patients develop elevated serum phosphorus levels and require a phosphate-binding agent to keep levels under control. While both calcium-containing phosphate binders and sevelamer, a non-calcium-containing binder, have been widely used to achieve Kidney Disease Outcomes Quality Initiative targets for serum phosphorus, all current formulations are associated with a high pill burden. The non-calcium-containing phosphate binder lanthanum (...) Read more... 10th Conference of the Canadian Blood and Marrow Transplant Group CML Standard of Care: Reviewing the Updated RecommendationsEdmonton, Alberta / April 21-24, 2006 Edmonton - In patients with Philadelphia chromosome-positive chronic myeloid leukemia (CML), the tyrosine kinase inhibitior (TKI) imatinib has become the gold standard of therapy. Long-term results from IRIS (International Randomized Trial of Interferon vs STI571) with first-line imatinib in chronic-phase CML patients continue to show a high rate of response. More than four years after randomization, patients who achieved a good early response to imatinib continue to do exceptionally well, (...) Read more... 10th Biennial Meeting of the Canadian Blood and Marrow Transplant Group Expanding Therapeutic Options for Chronic Myeloid LeukemiaEdmonton, Alberta / April 21-24, 2006 Edmonton - The arrival of imatinib as a targeted therapeutic option for chronic myeloid leukemia (CML) has been a highly encouraging development for the prognosis for this disease, and for patients who achieve a good early response to first-line therapy, who are likely to maintain that response for a number of years to come. Nevertheless, resistance to imatinib does occur, especially in the later stages of the disease, at which point other therapeutic options need to be considered. Because (...) Read more... 26th Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation New Directions in Calcineurin InhibitionMadrid, Spain / April 5-8, 2006 Madrid - Calcineurin inhibitors (CIs) have been the cornerstone of immunosuppressive therapy for more than two decades. While improvements in transplant outcomes with the use of CIs have been very impressive, these agents are associated with a number of side effects such as renal insufficiency. According to experts here, rejection is no longer the main issue in heart transplantation and attention has shifted to a more intelligent use of immunosuppressive treatment. The application of (...) Read more... 7th International Conference on New Trends in Immunosuppression and Immunotherapy Immunosuppression and Malignancy: Directions for Positive ChangeBerlin, Germany / February 16-19, 2006 Berlin - The recurrence and development of cancer are among the most serious complications of immunosuppressive therapy in human organ transplantation patients. The calcineurin inhibitors (CNIs) cyclosporine and tacrolimus have been associated in varying degrees with the development of de novo cancers and/or the recurrence of neoplastic tumours and metastasis. International experts in organ transplantation at this meeting concurred that clinical strategies are needed to reduce the risks of (...) Read more... |
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