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Samraj, Annie N., Ryan Morse, Niklas Krumm, Monica B. Pagano, John R. Hess et Hamilton Tsang. « Genetic Testing to Resolve the Source of Hemolytic Antibody in Solid Organ Transplantation ». American Journal of Clinical Pathology 152, Supplement_1 (11 septembre 2019) : S4. http://dx.doi.org/10.1093/ajcp/aqz112.007.
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Abstract Introduction Antibody-mediated hemolysis arising in the face of solid organ transplant can be devastating. Some degree of passenger lymphocyte syndrome is said to occur in up to 10% of ABO mismatched renal transplants, 40% of ABO mismatched liver transplants, and 70% of ABO mismatched heart-lung transplants, a reflection of the number of memory B-cells transplanted with the organ. Passenger lymphocyte syndrome is less common with minor antigens but can still be severe. Materials and Methods A series of patients developed immune hemolytic anemia after solid organ transplantation. Conventional serologic testing was performed using tube and solid-phase testing. Molecular testing was performed using gene-chip array. Results In patients receiving a minor antigen mismatched organ transplant and multiple allogenic red cell transfusions, serologic methods proved insufficient to resolve the source of minor blood group antibodies that arose in the aftermath of transplant. Genetic testing was able to clearly resolve donor and recipient types. Conclusions Passenger lymphocyte syndrome after mismatched organ transplantation is not rare. The mixtures of organ donor, recipient, and other transfused RBCs profoundly limit the usefulness of serologic testing. Genetic assignment of minor blood types to donor and recipient can guide therapy and inform prognosis.
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Borović, Vladan, Saša Borović, Vida Drąsutė et Dejan Rančić. « SECURE ORGAN TRANSPLANT INFORMATION SYSTEM ». Facta Universitatis, Series : Automatic Control and Robotics 17, no 1 (26 novembre 2018) : 1. http://dx.doi.org/10.22190/fuacr1801001b.
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The heart of a modern and efficient information system is a computer database that can be accessed from all over the world. The system demands a strong protection and cryptography, due to a large number of threats in the electronic era. In the well organized transplant programs, all transplantation centers have access to the central computer database. In this important database, the transplantation centers enter information of their recipients along with the recipient profile and the donor profile. This is the basic principle of making the best match between donated organ and recipient. This paper elaborates the SetNet information system with potential criminal activities and malpractice regarding central computer database.
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Coleman-Musser, Lori, Kristine Nelson et Roger Durand. « Discard Rates and Transplant Outcomes in Organs Recovered from Older Donors ». Journal of Transplant Coordination 7, no 4 (décembre 1997) : 190–94. http://dx.doi.org/10.1177/090591999700700406.
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The number of donors aged 60 years and over has increased. This study examined discard rates and transplant outcomes in organs recovered from older donors. Data were obtained using a standard tool for donors aged 60 years and older during 1993 and 1994 and included demographics, medical history, use of vasopressors, renal/liver function studies, organ disposition, biopsy findings, and recipient organ function. Of 58 kidneys recovered, 24 were transplanted, 26 were used for research, and 8 were discarded. Of 14 livers recovered, 11 were transplanted, 1 was used for research, and 2 were discarded. Sixty-three percent of kidney recipients had immediate function; 79% at 30 days. Nine liver recipients had immediate function; 6 at 30 days, with 1 graft lost. Results show that kidneys and livers can be transplanted from older donors with positive outcomes. Factors such as medical history, use of vasopressors, and organ function studies may help predict organ disposition and function.
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Suddaby, Elizabeth C., Margaret J. Schaeffer, Lori E. Brigham et Timothy R. Shaver. « Analysis of Organ Donors in the Peripartum Period ». Journal of Transplant Coordination 8, no 1 (mars 1998) : 35–39. http://dx.doi.org/10.1177/090591999800800108.
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This study was a retrospective review of 252 brain-dead potential donors from 1990 to 1996, including 5 organ donors in the peripartum period. The purpose of the study was to determine the effects of pregnancy on organ donor management and recipient outcome. Case analysis of 5 pregnant donors identified problems with hemodynamic stability and electrolyte abnormalities, including hypernatremia, hyperchloremia, and hypocalcemia. In addition, blood glucose was frequently elevated. Two donors were treated for diabetes insipidus. All 5 donors produced organs for 20 transplant recipients. Five heart recipients (including 1 heart-lung), 4 liver recipients, 4 kidney recipients, and 4 pancreas-kidney recipients have reported excellent outcomes. The use of organs from brain-dead organ donors in the peripartum period has minimal impact on donor management and recipient outcome.
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Mathes, David, Scott Stoll Graves, George E. Georges, Christian Kuhr, Jeff Chang, Tiffany Butts et Rainer Storb. « Long-Term Tolerance to Kidney Allografts After Induced Rejection of Donor Hematopoietic Chimerism in a Preclinical Canine Model. » Blood 120, no 21 (16 novembre 2012) : 2991. http://dx.doi.org/10.1182/blood.v120.21.2991.2991.
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Abstract Abstract 2991 Allogeneic hematopoietic cell transplantation provides a reliable method for inducing tolerance towards solid organ grafts. However, this procedure can result in graft-versus-host disease (GVHD) thereby limiting its application. Here we test the hypothesis that mixed chimerism can be intentionally reverted to host hematopoiesis without rejection of a kidney graft. Recipient dogs were given 2 Gy total body irradiation (TBI) before and a short course of immunosuppression after marrow infusion from dog leukocyte antigen-identical littermates. All dogs achieved stable mixed chimerism. After a mean of 20 weeks, one cohort of dogs received kidney transplants from their respective marrow donors. Subsequently, recipients were reconditioned with 2 Gy TBI and given autologous granulocyte-colony stimulating factor-mobilized leukocytes (recipient leukocyte infusion) that had been collected before marrow transplant. Dogs receiving a second TBI and recipient leukocyte infusion without a kidney transplant rejected their donor hematopoietic graft within 3 weeks. Dogs that received kidney grafts, followed by a second TBI and recipient leukocyte infusion, rejected their marrow graft without rejecting their transplanted kidneys for periods greater than one year. Mixed chimerism may be clinically reverted to 100% recipient without rejection of a kidney allograft. This model has potential applications in understanding the mechanism of split tolerance. This finding may have application towards minimizing the risk of GVHD in solid organ transplant patients given hematopoietic cell transplantation from HLA-identical donors. Disclosures: No relevant conflicts of interest to declare.
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Lalwani, Jaya, Lokesh Kumar, Rameshwar . et Jagadeesan M. « A rare case of mucormycosis in heart transplantation ». International Journal of Advances in Medicine 9, no 11 (26 octobre 2022) : 1143. http://dx.doi.org/10.18203/2349-3933.ijam20222671.
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Mucormycosis is the third most common invasive fungal infection with a high mortality rate seen in immunocompromised patients. It is an increasingly well-reported invasive fungal infection that affects recipients of solid-organ transplant. The incidence of mucormycosis in patients with heart transplants ranges from 0 to 0.6%. We reported a case of mucormycosis in a young heart transplant male recipient.
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Rao, Nitesh N., Chris Wilkinson, Mark Morton, Greg D. Bennett, Graeme R. Russ, Patrick T. Coates et Shilpa Jesudason. « Successful pregnancy in a recipient of an ABO-incompatible renal allograft ». Obstetric Medicine 12, no 1 (7 mars 2018) : 42–44. http://dx.doi.org/10.1177/1753495x17745390.
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Kidney transplantation restores fertility in patients with end-stage renal disease, with many successful pregnancies after kidney transplantation being reported. However, there are little data regarding pregnancy in women transplanted under modern-era desensitisation protocols that utilise rituximab, plasma exchange and intravenous immunoglobulin, including ABO-incompatible transplants. Pregnancies in ABO-incompatible recipients can pose new challenges from an immunological perspective. Here, we report a case of successful pregnancy using in vitro fertilisation, in a renal transplant recipient who underwent desensitisation two years prior, that included use of rituximab and plasma exchange to receive an ABO-incompatible transplant from her husband and subsequent father of the baby. We believe this was the first case of successful pregnancy after ABO-incompatible kidney transplantation in Australia and New Zealand. This case also highlights the difficulties faced in conception following transplantation and demonstrates that in vitro fertilisation utilising ovulation induction can be successfully utilised for conception in this cohort. This recipient also had gestational diabetes, worsening renal function and preterm delivery which are important complications often seen in pregnancies of solid organ transplant recipients.
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Stine, Jonathan G., Neeral Shah et Curtis Argo. « Immunosuppressed Solid Organ Transplant Recipient ». Gastroenterology 146, no 2 (février 2014) : 345–590. http://dx.doi.org/10.1053/j.gastro.2013.09.045.
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Rojas Vasquez, Marta, Anthea Peters, Raymond Lai, Curtis Mabilangan, Burton Catherine et Jutta Preiksaitis. « Epidemiology of Post-Transplant Lymphoproliferative Disorders in Children with Solid Organ Transplant over 34 Years of a Single Center Experience ». Blood 134, Supplement_1 (13 novembre 2019) : 1602. http://dx.doi.org/10.1182/blood-2019-125344.
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Background Post-Transplant lymphoproliferative disorders (PTLD) are a heterogeneous group of lymphoid neoplasms following solid organ transplantation (SOT) caused by uncontrolled lymphoproliferation often induced by Epstein Barr Virus (EBV) due to the lack of cytotoxic T cell response resulting from immunosuppression. A pre-emptive intervention strategy for PTLD prevention was implemented in our center in 2002 for all EBV-mismatched SOT recipients consisting in close monitoring of the viral load and consideration for early intervention (Ex; reduction of immunosuppression) in addition to universal antiviral prophylaxis (implemented in 1990). We aim to describe the incidence and risk factors for PTLD in children with SOT, including all transplant types, at a single center over 34 years. We also aim to analyze the impact of a pre-emptive PTLD prevention program. Material and methods All patients younger than 18 years of age who received SOT at the University of Alberta Hospital/Stollery Children's Hospital from January 1st, 1984 to December 31st, 2018 were included. Donor and recipient baseline data (age, sex, donor living status, date and type of transplant, EBV and cytomegalovirus serostatus) were extracted from a prospective database. Retrospective chart review was performed for PTLD cases along with expert pathology review (when tissue available). Local Ethics Board was obtained. Statistical analyses were performed using SPSS software version 25 and R version 3.3.3. Results Characteristics of the study population, immunosuppression regimen used by transplant program and specific immunosuppression for PTLD cases are summarized in table 1, 2 and 3 respectively. PTLD characteristics were compared based on the time of presentation of PTLD ≤1 year, 1 to 5 years and >5 years (table 4). Most of the cases with PTLD presented with primary involvement in multiple sites followed by lymph nodes, gastro-intestinal tract, allograft, tonsils/adenoids and other sites. Advance staging (III-IV) was present in 71% of cases. The incidence rate of PTLD for the whole group was 0.82/100 Person-year (Figure 1 A). The incidence rate peaked at 1-year post-transplant and had a decreasing trend in the following years post-transplant, with no cases beyond 12 years post-transplant (Figure 1 B). The cumulative incidence was the highest for the multi-visceral transplants followed by thoracic, liver and kidney transplants (Figure 1C). Univariate analysis showed children younger than 5 years at transplant had 5-fold higher risk of PTLD compared to children ≥ 10 years of age at transplant. Donors ≤ 5 years of age at transplant, showed 3-fold higher risk PTLD comparing to older donors. Liver transplant had 2.8-fold and thoracic transplants had 5-fold higher risk of PTLD comparing to kidney transplants, no significant risk was associated with multi-visceral group (only 1 case in the cohort). EBV seronegative recipient was associated with 2.6-fold higher risk of PTLD comparing to EBV seropositive recipient. Era prior to implementation of pre-emptive intervention had 3-fold risk of PTLD comparing to era post implementation. Patients transplanted at 1.1 - 5 years of age was an independent risk factor associated with PTLD in multivariate analysis (table 3) SOT recipients showed EBV seroconversion with age (Figure 3A). PTLD based on EBV Donor Recipient (DR) serostatus showed more cases D positive R negative (D+R-) in the first-year comparing to D negative Recipient negative (D-R-), D-R- cases increased between 1-5 years equivalent to D+R-, beyond 5 years D+R- decreased with no D-R- cases (Figure 3B). D-R- serostatus had the highest probability of PTLD followed by D+R- (Figure 3 C). Eleven (24%) out of 45 patients with PTLD presented with PTLD relapse. Seven (5.6%) out of 125 deaths of SOT were secondary to PTLD. PTLD was the most common cause of death in the PTLD group (50%) followed by graft failure/rejection. Conclusions Incidence of PTLD peaked in the first-year post-transplant and decreased overtime with increase incidence in thoracic and multi-visceral transplants. Risk factors for PTLD included patients transplanted at younger age, younger donors, thoracic and liver transplants and EBV seronegativity in the recipient. A pre-emptive intervention strategy for PTLD prevention implemented in 2002 decreased the risk of PTLD. Disclosures No relevant conflicts of interest to declare.
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Nambiar, Puja H., Brianna Doby, Aaron A. R. Tobian, Dorry L. Segev et Christine M. Durand. « Increasing the Donor Pool : Organ Transplantation from Donors with HIV to Recipients with HIV ». Annual Review of Medicine 72, no 1 (27 janvier 2021) : 107–18. http://dx.doi.org/10.1146/annurev-med-060419-122327.
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Implementation of the HIV Organ Policy Equity (HOPE) Act marks a new era in transplantation, allowing organ transplantation from HIV+ donors to HIV+ recipients (HIV D+/R+ transplantation). In this review, we discuss major milestones in HIV and transplantation which paved the way for this landmark policy change, including excellent outcomes in HIV D–/R+ recipient transplantation and success in the South African experience of HIV D+/R+ deceased donor kidney transplantation. Under the HOPE Act, from March 2016 to December 2018, there were 56 deceased donors, and 102 organs were transplanted (71 kidneys and 31 livers). In 2019, the first HIV D+/R+ living donor kidney transplants occurred. Reaching the full estimated potential of HIV+ donors will require overcoming challenges at the community, organ procurement organization, and transplant center levels. Multiple clinical trials are ongoing, which will provide clinical and scientific data to further extend the frontiers of knowledge in this field.
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Said, Manal El. « Infections in the solid-organ transplant recipients ». Ukrainian Journal of Nephrology and Dialysis, no 2(70) (13 avril 2021) : 64–76. http://dx.doi.org/10.31450/ukrjnd.2(70).2021.08.
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The advancement in the field of transplant has led to the increasing number of solid-organ transplant recipients (SOTRs). This success leads to novel confronts in communicable infections, which are compound by the emergence of newly contagious and antimicrobial drugs resistant microorganisms. The prevention of infections is a cornerstone of any modern solid organ transplantation program. Understanding the fundamentals of these infections with early detection is crucial for improving the outcomes of such patients and lowers the probable extra complications. The probability of critical infections in SOTRs is established by relations between the patient’s epidemiological exposures and the net condition of immune repression. A timeline was formed to build up a discrepancy diagnosis of infection in SORTs. The improvement in screening, the investigations including imaging and molecular techniques and prophylactic intervention protocols, has made it promising to limit the penalty of infections and act towards better patient endurance. Pre-transplant screening of the prospective organ donor and recipient provides a chance to evaluate the viability and wellbeing of transplantation, to decide the prophylaxis and protective approaches developed post-transplant, to find out and entirely treat active infection in the possible recipient proceeding to transplant, to renovate the vaccination condition of the potential recipient.
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Pfundstein, Joann. « Aspergillus Infections among Solid Organ Transplant Recipients : A Case Study ». Journal of Transplant Coordination 7, no 4 (décembre 1997) : 187–89. http://dx.doi.org/10.1177/090591999700700405.
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Infection remains a major cause of morbidity and mortality among transplant recipients. Aspergillus infections in particular are associated with a high mortality rate. The diagnosis of Aspergillus among transplant recipients may be difficult, because many patients have multiple complications. This article presents a case of Aspergillus in a heart transplant recipient. The discussion provides an overview of the presentation, diagnosis, and treatment of Aspergillus infections.
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Gregoire, J. R. « Immune hemolytic anemia after renal transplantation secondary to ABO-minor-mismatch between the donor and recipient. » Journal of the American Society of Nephrology 4, no 5 (novembre 1993) : 1122–26. http://dx.doi.org/10.1681/asn.v451122.
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A 52-yr-old man developed immune hemolytic anemia approximately 2 wk after receiving an ABO-minor-mismatch renal transplant. When a Group O organ is transplanted into a non-O recipient or a non-AB organ is transplanted into a Group AB recipient, hemolysis can occur and has been attributed to a form of graft-versus-host disease in which donor plasma cells carried along with the graft produce red blood cell antibodies. In this case, the diagnosis was confirmed when an antibody screen indicated that the organ recipient's serum agglutinated panel red blood cells of the recipient's ABO group. This type of hemolysis usually occurs 1 to 2 wk after transplantation, is limited in duration, and can be severe. If transfusion is required, blood of donor type should be used.
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Bahr, Nathan C., Katherine Janssen, Joanne Billings, Gabriel Loor et Jaime S. Green. « Respiratory Failure due to Possible Donor-DerivedSporothrix schenckiiInfection in a Lung Transplant Recipient ». Case Reports in Infectious Diseases 2015 (2015) : 1–5. http://dx.doi.org/10.1155/2015/925718.
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Background. De novo and donor-derived invasive fungal infections (IFIs) contribute to morbidity and mortality in solid organ transplant (SOT) recipients. Reporting of donor-derived IFIs (DDIFIs) to the Organ Procurement Transplant Network has been mandated since 2005. Prior to that time no systematic monitoring of DDIFIs occurred in the United States.Case Presentation. We report a case of primary graft dysfunction in a 49-year-old male lung transplant recipient with diffuse patchy bilateral infiltrates likely related to pulmonarySporothrix schenckiiinfection. The organism was isolated from a bronchoalveolar lavage on the second day after transplantation. Clinical and radiographic responses occurred after initiation of amphotericin B lipid formulation.Conclusion. We believe that this was likely a donor-derived infection given the early timing of theSporothrixisolation after transplant in a bilateral single lung transplant recipient. This is the first case report of sporotrichosis in a lung transplant recipient. Our patient responded well to amphotericin induction therapy followed by maintenance therapy with itraconazole. The implications of donor-derived fungal infections andSporothrixin transplant recipients are reviewed. Early recognition and management of these fungi are essential in improving outcomes.
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Savitch, Stephanie, Robin Gilmore et Denetta L. Dowler. « An Investigation of the Psychological and Psychosocial Challenges Faced by Post-Transplant Organ Recipients ». Journal of Applied Rehabilitation Counseling 34, no 3 (1 septembre 2003) : 3–9. http://dx.doi.org/10.1891/0047-2220.34.3.3.
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Organ transplantation offers to some terminally ill people the opportunity to have their lives extended with the gift of an organ(s). Following transplantation, the organ recipient is given extensive medical care, but the psychological, psychosocial, and occupational needs of the person are rarely addressed. This study identified and defined these emotional and occupational challenges and presents the current and prospective role of the Rehabilitation Counselor. Fifty-four organ transplant recipients completed a two-page questionnaire covering the post-transplant experience. Analysis of the results identified the challenges faced by the recipients post-transplant as well as the need for counseling during the first year following the transplant procedure.
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Sunjaya, Angela Felicia, et Anthony Paulo Sunjaya. « Combating Donor Organ Shortage : Organ Care System Prolonging Organ Storage Time and Improving the Outcome of Heart Transplantations ». Cardiovascular Therapeutics 2019 (1 avril 2019) : 1–7. http://dx.doi.org/10.1155/2019/9482797.
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Introduction. Cardiovascular diseases are the number one cause of death globally contributing to 37% of all global deaths. A common complication of cardiovascular disease is heart failure, where, in such cases, the only solution would be to conduct a heart transplant. Every 10 minutes a new patient is added to the transplant waiting list. However, a shortage of human donors and the short window of time available to find a correct match and transplant the donors’ heart to the recipient means that numerous challenges are faced by the patient even before the operation could be done, reducing their chances of living even further. Methods. This review aims to evaluate the application of the Organ Care System (OCSTM) in improving the efficiency of heart storage based on journal articles obtained from PubMed, Elsevier Clinical Key, and Science Direct. Results. Studies have shown that OCS is capable of extending the ischemic time 120 minutes longer than conventional methods without any detrimental effect on the recipient nor donor’s safety. Based on the PROTECT I and PROCEED II study, 93% of transplantation recipients using the OCS system passed through the 30-day mortality period. Discussion. OCS is able to prolong the ischemic time of donors’ hearts by perfusing the organ at 34°C in a beating state, potentially reducing the detrimental effect of cold storage and providing additional assessment options. Another clear advantage is the implanting surgeon can assess the quality of the donor heart before surgery as well as providing a time safety buffer in unanticipated circumstances that will reduce the mortality risk of transplant recipients.
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Piatti, Gabriella. « Pre-Transplant Screening for Latent Adenovirus in Donors and Recipients ». Open Microbiology Journal 10, no 1 (2 février 2016) : 4–11. http://dx.doi.org/10.2174/1874285801610010004.
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Human adenoviruses are frequent cause of slight self-limiting infections in immune competent subjects, while causing life-threatening and disseminated diseases in immunocompromised patients, particularly in the subjects affected by acquired immunodeficiency syndrome and in bone marrow and organ transplant recipients. Here, infections interest lungs, liver, encephalon, heart, kidney and gastro enteric tract. To date, human adenoviruses comprise 51 serotypes grouped into seven species, among which species C especially possesses the capability to persist in infected tissues. From numerous works, it emerges that in the recipient, because of loss of immune-competence, both primary infection, via the graft or from the environment, and reactivated endogenous viruses can be responsible for transplantation related adenovirus disease. The transplants management should include the evaluation of anti-adenovirus pre-transplant screening similar to that concerning cytomegalovirus. The serological screening on cytomegalovirus immunity is currently performed to prevent viral reactivation from grafts and recipient, the viral spread and dissemination to different organs and apparatus, and potentially lethal outcome.
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Sheikhalipour, Zahra, Vahid Zamanzadeh, Leili Borimnejad, Sarah E. Newton et Leila Valizadeh. « Muslim transplant recipients’ family experiences following organ transplantation ». Journal of Research in Nursing 24, no 5 (août 2019) : 291–302. http://dx.doi.org/10.1177/1744987118813671.
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Background Despite the importance of family and its relationship to positive transplant outcomes, little is known about family experiences following organ transplantation from the perspective of the transplant recipients. The literature is also devoid of information that describes the family experiences of Muslim transplant recipients. Aims The purpose of this study was to describe Muslim transplant recipients’ family experiences following organ transplantation. Methods A hermeneutical phenomenological approach was employed to determine the emergent themes present in the data. The sample was composed of 12 Muslim organ transplant recipients (heart, kidney and liver) living in Iran. Semi-structured interviews were conducted with each participant. Results The primary constitutive pattern that emerged from the interview data was ‘Altered Family Relationships’ and three themes: fear in relationships, abnormal relationships, and the family at the centre of organ transplant issues. Conclusions There are several important findings in this study, notably that Muslim transplant recipients describe their family experiences following organ transplantation as ‘altered’ and not as they were pre-transplant. More research is needed that focuses on the family experience post-transplant, and how Muslim transplant recipient families are impacted by the transplant experience.
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Halperin, Rabbi Mordechai. « Organ Transplants from Living Donors ». Israel Law Review 27, no 4 (1993) : 566–87. http://dx.doi.org/10.1017/s002122370001150x.
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I. Survey of Transplant TechniquesThe kidney is one of the few organs which today can be successfully transplanted from a living donor to an ailing recipient. A healthy donor can function satisfactorily with a single kidney; therefore the removal of one kidney for transplantation does not significantly endanger the donor's life. However, removal, or even partial removal, of other organs, such as the heart, lungs, or pancreas, will present a serious risk to the health and life of the donor.In addition to organs, skin, bone marrow, blood and other body parts can be transplanted from living donors.A. Kidney TransplantsThe kidneys function to regulate the body's electrolyte and water balance and eliminate various wastes. Severe kidney dysfunction endangers the patient's life, and requires treatment by dialysis or kidney transplant. Up until a decade ago, the life expectancy of patients treated by dialysis exceeded that of patients who underwent kidney transplants. Over the past decade, the life expectancy of patients who have undergone kidney transplants from deceased donors has increased to a point where it is now comparable with the life expectancy of patients on dialysis.
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Bektas, Neslihan. « Care of the organ transplant receiver : Review ». Journal of Surgery and Medicine 6, no 10 (29 octobre 2022) : 877–81. http://dx.doi.org/10.28982/josam.1063254.
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Organ transplantation is the process of replacing damaged/inoperative organs with healthy ones. Many parameters are considered in the decision-making process for this procedure. At first, compatibility parameters of the recipient individual and the donor should be evaluated. All laboratory values and tissue compatibility tests should be compared. The organ transplant coordinator shares the patient’s compliance information with the team. The recipient patient is informed of the match, and the process begins. Preparing the recipient for transplantation is as difficult as finding the appropriate organ. During the first stages, the individual is evaluated and meets with the entire transplant team. Everyone on the transplant team explains their roles and responsibilities. The patient can ask questions. Information is given about complications and negative care processes encountered after transplantation. Patients most often experience differences of opinion in religious and cultural dimensions. On the one hand, he/she wants to live; on the other hand, he/she thinks transplantation is a “sin”. These confusing thoughts can increase and be replaced by psychosocial issues. The transplant nurse initiates the patient’s rehabilitation process. This process is based on an immunosuppressive treatment plan to strengthen the patient’s immunity before transplantation. The transplantation plan provides guidance on transplant day, donor patient preparation, and organ safety. This review serves as a guide for recipient individual. This review study consists of specific sub-titles related to the subject.
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Pouch, Stephanie M., Shalika B. Katugaha, Wun-Ju Shieh, Pallavi Annambhotla, William L. Walker, Sridhar V. Basavaraju, Jefferson Jones et al. « Transmission of Eastern Equine Encephalitis Virus From an Organ Donor to 3 Transplant Recipients ». Clinical Infectious Diseases 69, no 3 (29 octobre 2018) : 450–58. http://dx.doi.org/10.1093/cid/ciy923.
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Abstract Background In fall 2017, 3 solid organ transplant (SOT) recipients from a common donor developed encephalitis within 1 week of transplantation, prompting suspicion of transplant-transmitted infection. Eastern equine encephalitis virus (EEEV) infection was identified during testing of endomyocardial tissue from the heart recipient. Methods We reviewed medical records of the organ donor and transplant recipients and tested serum, whole blood, cerebrospinal fluid, and tissue from the donor and recipients for evidence of EEEV infection by multiple assays. We investigated blood transfusion as a possible source of organ donor infection by testing remaining components and serum specimens from blood donors. We reviewed data from the pretransplant organ donor evaluation and local EEEV surveillance. Results We found laboratory evidence of recent EEEV infection in all organ recipients and the common donor. Serum collected from the organ donor upon hospital admission tested negative, but subsequent samples obtained prior to organ recovery were positive for EEEV RNA. There was no evidence of EEEV infection among donors of the 8 blood products transfused into the organ donor or in products derived from these donations. Veterinary and mosquito surveillance showed recent EEEV activity in counties nearby the organ donor’s county of residence. Neuroinvasive EEEV infection directly contributed to the death of 1 organ recipient and likely contributed to death in another. Conclusions Our investigation demonstrated EEEV transmission through SOT. Mosquito-borne transmission of EEEV to the organ donor was the likely source of infection. Clinicians should be aware of EEEV as a cause of transplant-associated encephalitis.
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Flattery, Maureen P. « Incidence and Treatment of Cancer in Transplant Recipients ». Journal of Transplant Coordination 8, no 2 (juin 1998) : 105–12. http://dx.doi.org/10.1177/090591999800800209.
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Solid organ transplantation has been an accepted mode of therapy for the treatment of end-stage organ diseases for many years. Recipients' survival, however, has been hindered by organ rejection and the comorbid diseases that develop as a result of immunosuppressive therapy. In particular, organ transplant recipients have an increased risk of developing cancer de novo after transplantation. Prevalence ranges from 4 to 18% with an average incidence of 6%. Data submitted to the Cincinnati transplant tumor registry have revealed that cancers prevalent in the general population exhibited no increase in rate and may even show a slight decline in the transplant population. Length of survival after transplantation is associated with the likelihood of having cancer; the longer the recipient survives, the greater the chance. The actuarial risk among 124 cardiac transplant recipients was 2.7+/-1.9% at 1 year and 25.6+/-11% at 5 years. This article will review the current literature on the incidence and treatment of cancer in solid organ transplant recipients.
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Alkhunaizi, Ahmed M., Ali M. Bazzi, Ali A. Rabaan et Elwaleed A. Ahmed. « FusariumInfection in a Kidney Transplant Recipient Successfully Treated with Voriconazole ». Case Reports in Infectious Diseases 2018 (7 août 2018) : 1–4. http://dx.doi.org/10.1155/2018/3128081.
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Fusariuminfections in solid-organ transplant recipients are rare and carry high mortality. We report a case of a kidney transplant recipient who developed infection withFusariumspecies. The patient received treatment with oral voriconazole for five months with good response.
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Baldi, S., M. Rapellino, E. Ruffini, A. Cavallo et M. Mancuso. « Atypical mycobacteriosis in a lung transplant recipient ». European Respiratory Journal 10, no 4 (1 avril 1997) : 952–54. http://dx.doi.org/10.1183/09031936.97.10040952.
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Although mycobacterial infections are more frequent in lung transplant recipients than in other solid organ recipients only occasional reports of infection from atypical Mycobacteria have been reported in patients receiving lung transplantation. We present a case of pleural and cutaneous infection due to Mycobacterium fortuitum in a double-lung transplant recipient. The infection was rapidly responsive to therapy with a two drug regimen and no reduction of immunosuppression was necessary.
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Subodh, K. Regmi, Jiang Song et A. Warlick Christopher. « De-Novo Genitourinary Neoplasms in Transplant Recipients : The Present and Future ». Cancer Medicine Journal 3, no 1 (30 juin 2020) : 10–22. http://dx.doi.org/10.46619/cmj.2020.3-1016.
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The risk of genitourinary cancers following transplantation is increased following majority of solid organ transplants but is best described following renal transplantation. Increasing average age of the transplant recipient as well as increases in post- transplant survival increases the risk of these malignancies. The risk of Kidney cancer is the highest following most solid organ transplants, whereas prostate cancer risk is lower than the general population in multiple large population-based studies. The etiology of increased risk of cancer following transplant is multifactorial with the predominant influence of immunosuppression and direct toxicity of immunosuppressants, however, the significance of end stage disease particularly in the causation of renal cancer in renal transplant recipients is undeniable. Modifications in immunosuppression regimens as well as changes in the standard treatment principles of some cancers may require changes in the management of some post-transplant malignancies. Standard screening guidelines have not been established but screening for renal tumors in renal transplant recipients is the only widely studied entity. Further work is needed to prepare the urologic oncological community with this once rare population group and standardized recommendations need to be established for screening and for the use of new age cancer therapeutics like immunotherapy.
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Kontoyiarmis, Dimitrios P., et Robert H. Rubin. « INFECTION IN THE ORGAN TRANSPLANT RECIPIENT ». Infectious Disease Clinics of North America 9, no 4 (décembre 1995) : 811–22. http://dx.doi.org/10.1016/s0891-5520(20)30703-0.
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Lentine, Krista L., John D. Peipert, Tarek Alhamad, Yasar Caliskan, Beatrice P. Concepcion, Rachel Forbes, Mark Schnitzler et al. « Survey of Clinician Opinions on Kidney Transplantation from Hepatitis C Virus Positive Donors : Identifying and Overcoming Barriers ». Kidney360 1, no 11 (3 septembre 2020) : 1291–99. http://dx.doi.org/10.34067/kid.0004592020.
Texte intégralRésumé :
BackgroundTransplant practices related to use of organs from hepatitis C virus–infected donors (DHCV+) is evolving rapidly.MethodsWe surveyed US kidney transplant programs by email and professional society LISTSERV postings between July 2019 and January 2020 to assess attitudes, management strategies, and barriers related to use of viremic (nucleic acid testing positive [NAT+]) donor organs in recipients who are not infected with HCV.ResultsStaff at 112 unique programs responded, representing 54% of US adult kidney transplant programs and 69% of adult deceased donor kidney transplant volume in 2019. Most survey respondents were transplant nephrologists (46%) or surgeons (43%). Among the responding programs, 67% currently transplant DHCV antibody+/NAT− organs under a clinical protocol or as standard of care. By comparison, only 58% offer DHCV NAT+ kidney transplant to recipients who are HCV−, including 35% under clinical protocols, 14% as standard of care, and 9% under research protocols. After transplant of DHCV NAT+ organs to recipients who are uninfected, 53% start direct-acting antiviral agent (DAA) therapy after discharge and documented viremia. Viral monitoring protocols after DHCV NAT+ to HCV uninfected recipient kidney transplantation varied substantially. 56% of programs performing these transplants report having an institutional plan to provide DAA treatment if declined by the recipient’s insurance. Respondents felt a mean decrease in waiting time of ≥18 months (range, 0–60) justifies the practice. Program concerns related to use of DHCV NAT+ kidneys include insurance coverage concerns (72%), cost (60%), and perceived risk of transmitting resistant infection (44%).ConclusionsAddressing knowledge about safety and logistic/financial barriers related to use of DHCV NAT+ kidney transplantation for recipients who are not infected with HCV may help reduce discards and expand the organ supply.PodcastThis article contains a podcast at https://www.asnonline.org/media/podcast/K360/2020_11_25_KID0004592020.mp3
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Leek, Rachael, Erika Aldag, Iram Nadeem, Vikraman Gunabushanam, Ajay Sahajpal, David J. Kramer et Thomas J. Walsh. « Scedosporiosis in a Combined Kidney and Liver Transplant Recipient : A Case Report of Possible Transmission from a Near-Drowning Donor ». Case Reports in Transplantation 2016 (2016) : 1–7. http://dx.doi.org/10.1155/2016/1879529.
Texte intégralRésumé :
Scedosporium spp. are saprobic fungi that cause serious infections in immunocompromised hosts and in near-drowning victims. Solid organ transplant recipients are at increased risk of scedosporiosis as they require aggressive immunosuppression to prevent allograft rejection. We present a case of disseminated Scedosporium apiospermum infection occurring in the recipient of a combined kidney and liver transplantation whose organs were donated by a near-drowning victim and review the literature of scedosporiosis in solid organ transplantation.
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Dale, CH, P. Burns, M. McCutcheon, R. Hernandez-Alejandro et PJ Marotta. « Spontaneous Clearance of Hepatitis C after Liver and Renal Transplantation ». Canadian Journal of Gastroenterology 23, no 4 (2009) : 265–67. http://dx.doi.org/10.1155/2009/912848.
Texte intégralRésumé :
Spontaneous clearance of hepatitis C virus (HCV) is rare in immunocompromised patients, such as those who have undergone organ transplantation. It has been recognized that patients receiving liver transplantation for HCV-related disease have decreased graft and patient survival compared with those transplanted for other etiologies. There is a growing trend toward treating HCV recurrence aggressively after liver transplantation. For other organ transplant recipients with concurrent HCV, treatment is not often an option, given the high rates of graft rejection and loss secondary to interferon and its immunomodulatory effects. Although spontaneous clearance of HCV has been reported in recipients of solitary liver and renal transplants, a common factor arising in these cases has been previous exposure to interferon. To date, no reports of spontaneous clearance of HCV RNA have been reported in a multiorgan transplant recipient. A case of spontaneous clearance of HCV RNA in an immunocompromised patient, within five months of simultaneous liver and kidney retransplantation is described. Importantly, this patient had no previous exposure to interferon.
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Abu-Gazala, Samir, et Kim M. Olthoff. « Current Status of Living Donor Liver Transplantation in the United States ». Annual Review of Medicine 70, no 1 (27 janvier 2019) : 225–38. http://dx.doi.org/10.1146/annurev-med-051517-125454.
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Adult-to-adult living donor liver transplantation (LDLT) was introduced in response to the shortage of deceased donor liver grafts. The number of adult living donor transplants is increasing due to improved outcomes and increasing need. Advantages of LDLT include optimization of the timing of transplant, better organ quality, and lower rates of recipient mortality compared to staying on the wait list for deceased donor liver transplant. Donor safety remains the major focus when considering LDLT. Recent advancements have supported the increased use of LDLT to help decrease wait list death and improve long-term survival of transplant recipients.
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Mirza, Imran, Areej Almugairi et Susan Nahirniak. « Immune Thrombocytopenic Purpura Due to Passenger Donor Lymphocytes in Liver Transplantation ». Blood 112, no 11 (16 novembre 2008) : 4558. http://dx.doi.org/10.1182/blood.v112.11.4558.4558.
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Abstract Introduction: Thrombocytopenia is a frequent complication following solid organ transplant but previous reports suggest that the incidence of immune mediated thrombocytopenic purpura (ITP) following liver transplantation is low (0.7%). Although the mechanisms involved in post transplant thrombocytopenia are complex, the presence of alloantibody derived from passenger donor lymphocytes should be considered when severe thrombocytopenia is identified. Case presentation: Our case is a 58-year-old gentleman who underwent liver transplantation for end stage cirrhosis and hepatocellular carcinoma. His baseline pre-transplant platelet count was low at 83 ×109/L, but he postoperatively worsened to a platelet count of 5×109/L with bleeding sequelae. The liver donor was a 71-year-old previously healthy man who presented with severe thrombocytopenia (platelet count of 3 ×109/L) and hemorrhagic stroke, but no evidence of hematological pathology on bone marrow examination. As the donor history of presumptive ITP was known to the service, antiplatelet antibody assays on both the donor and recipient were performed using the ELISA based GTI-PAK12 kit (GTI Diagnostics, Waukesha, WI). Although there were no detectable antiplatelet antibodies in the organ recipient’s pre-transplant specimens, the immediate post-transplant specimen demonstrated reactivity in all three GPIIb/IIIa wells, corresponding to a stronger but identical reaction pattern in the organ donor. This suggested that the reactivity and subsequent worsening of the thrombocytopenia were secondary to antibodies produced by passenger donor lymphocytes in the transplanted liver. The transplant recipient was treated with corticosteroids, intravenous immune globulin and platelet transfusion with a return to his baseline platelet count and cessation of bleeding symptomatology five days later. Repeat platelet antibody testing in the organ recipient five weeks post-transplant revealed no detectable antiplatelet antibody reactivity, indicating lack of engraftment of the passenger donor lymphocytes. Conclusion: Passenger donor lymphocytes producing antiplatelet antibodies may be a contributing factor in post-transplant thrombocytopenia. Close monitoring and high clinical suspicion should be present when there is a history of immune/idiopathic thrombocytopenia in the organ donor.
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Wiltshire, Gareth, Nicola J. Clarke, Cassandra Phoenix et Carl Bescoby. « Organ Transplant Recipients’ Experiences of Physical Activity : Health, Self-Care, and Transliminality ». Qualitative Health Research 31, no 2 (30 octobre 2020) : 385–98. http://dx.doi.org/10.1177/1049732320967915.
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Physical activity (PA) is an important lifestyle component of long-term health management for organ transplant recipients, yet little is known about recipients’ experiences of PA. The purpose of this study was to shed light on this experience and to investigate the possible implications of PA in the context of what is a complex patient journey. Phenomenological analysis was used to examine interviews with 13 organ transplant recipients who had taken part in sporting opportunities posttransplantation. Findings illuminate how participants’ experiences of PA were commonly shaped by the transliminal nature of being an organ transplant recipient as well as a sense of duty to enact health, self-care, and donor-directed gratitude. This analysis underlines the potential role of PA in supporting organ transplant recipients’ attempts to live well following transplantation and makes novel connections between PA and our existing knowledge about challenges related to identity, survivorship, obligation, and patient empowerment.
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Grossi, Paolo Antonio. « Urban Spread of Flaviviruses : A New Challenge in Solid-organ Transplant Recipients ». Clinical Infectious Diseases 70, no 1 (11 mai 2019) : 149–51. http://dx.doi.org/10.1093/cid/ciz390.
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Abstract Yellow fever has never previously been reported in transplant recipients. The first reported case of yellow fever in a kidney transplant recipient in Brazil and the re-emergence of arboviruses in many areas of the world dictate the need of studies aimed to answer multiple unanswered questions.
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Condon, Annie Klebahn. « Notes from an Organ Recipient : Once is Enough ». Cambridge Quarterly of Healthcare Ethics 31, no 3 (juillet 2022) : 400–402. http://dx.doi.org/10.1017/s0963180121001092.
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AbstractIn this paper, the author describes her personal experiences with liver disease and the challenges both before and after receiving an organ transplant. She describes how organs are currently allocated and offers her perspective on what fairness entails in situations where organs fail and patients need multiple organs.
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Gautier, S. V., A. O. Shevchenko, O. M. Tsirulnikova, S. M. Khomyakov, O. N. Kotenko, V. E. Vinogradov, I. N. Abyzov et al. « COVID-19 in solid organ transplant recipients : initial report from national multicenter observational study «ROKKOR-recipient» ». Russian Journal of Transplantology and Artificial Organs 22, no 3 (6 octobre 2020) : 8–17. http://dx.doi.org/10.15825/1995-1191-2020-3-8-17.
Texte intégralRésumé :
We herein present our initial report from «ROKKOR-recipient», a national multicenter observational study. The prevalence, risk factors, clinical manifestations and outcomes of the novel coronavirus disease 2019 (COVID-19) in solid organ transplant recipients receiving immunosuppressive therapy were investigated. The study enrolled 251 COVID-19 patients (220 kidney recipients, 7 liver recipients, 1 liver-kidney recipient, and 23 heart recipients). The subjects came from 20 regions in Russia. The symptoms, clinical presentation, imaging and lab test results, therapy and outcomes of COVID-19 were described. It was established that solid organ transplant recipients with COVID-19 have a higher risk of developing adverse events. Predictors of adverse events include associated cardiovascular diseases, pulmonary diseases, diabetes, and kidney failure. Symptoms of the disease include dyspnea, rash and catarrhal signs, as well as initial low blood oxygen saturation (SpO2 <92%), leukocytosis (white blood cell count >10 × 109/L), elevated creatinine levels (>130 μmol/L) and a marked decrease in glomerular filtration rate, requiring hemodialysis. Performing organ transplant surgery in COVID-19 does not increase the risk of adverse events but could save the lives of waitlisted terminally ill patients.
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Friedman, Daniel, Sara Belga, Catherine Burton, Jutta Preiksaitis et Dima Kabbani. « 1754. Pre-Transplant Vaccination Rates in Solid-Organ Transplant Recipients ». Open Forum Infectious Diseases 6, Supplement_2 (octobre 2019) : S643—S644. http://dx.doi.org/10.1093/ofid/ofz360.1617.
Texte intégralRésumé :
Abstract Background Recipients of solid-organ transplants (SOT) are at increased risk of vaccine-preventable illnesses. Because of the immunosuppression administered following SOT, live vaccines are generally contraindicated post-SOT, and response to inactivated vaccines may be suboptimal. National and international guidelines recommend optimizing immunizations prior to SOT. We analyzed rates of vaccination for SOT candidates in a cohort of adult kidney and liver transplant recipients. Methods A retrospective chart review of adult kidney, kidney/pancreas (KP) and liver transplant recipients was conducted between 2014 and 2016. We calculated the rates of vaccinations of the following vaccines: pneumococcus, meningococcus, Hepatitis A and B, Haemophilus influenzae type B, measles, mumps, rubella, polio, tetanus, diphtheria and pertussis. Results 300 patients were included (147 kidney, 14 KP, 139 liver). Liver recipients were older (mean age 53 vs. 50; P = 0.028) and less likely to have had a previous transplant (5.8% vs. 21.1%; P < 0.001) or a living donor (15.8% vs. 32.3%, P = 0.01). Liver recipients were more likely to have been vaccinated against hepatitis A (106 [53.9%] vs. 28 [17.4%]; P < 0.001). Kidney and KP recipients were more likely to have received at least 1 dose of hepatitis B vaccine (138 [85.7%] vs. 91 [65.5%]; P < 0.001) or at least 1 dose of any of the pneumococcal vaccines (PSV23 94 [67.6%] vs. 92 [57.1%]; P = 0.062; PCV13 130 [80.7%] vs. 93 [66.9%]; P = 0.006; pneumococcal vaccine not clarified 47 [29.2%] vs. 14 [10.1%]; P < 0.001). No difference was observed with regards to other vaccines (Table 1). Being a kidney transplant recipient increased the odds of getting at least 1 dose of hepatitis B, tetanus/diphtheria/acellular pertussis (Tdap), measles, and pneumococcal vaccine (OR = 1.75, 95% CI [1.063–2.864]; P = 0.028) Conclusion In our cohort, kidney transplant recipients were more likely to have received pre-transplant vaccination. Despite the availability of local and international guidelines, vaccination in SOT candidates remains suboptimal and further study of barriers to implementation of these guidelines is warranted to inform future quality improvement initiatives. Disclosures All authors: No reported disclosures.
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Xie, Lola, Bartosz Jozwik, Phillip Weeks, L. Maximilian Buja, Robert Brown, Sriram Nathan, Keshava Rajagopal et al. « Treatment of Multiple Myeloma in a Heart Transplant Recipient ». Progress in Transplantation 27, no 1 (24 novembre 2016) : 65–68. http://dx.doi.org/10.1177/1526924816679842.
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Malignancy following solid organ transplant remains a significant threat to the survival of cardiac transplant recipients. Plasma cell dyscrasias including multiple myeloma have been encountered in this population, and medication treatments traditionally used to treat these disorders demonstrate immunomodulatory effects that may have implications on the transplanted allograft. Lenalidomide is an immunomodulatory agent that has been used to treat plasma cell disorders, including light-chain amyloidosis (AL) and multiple myeloma, and represents such a class of medications in which the risks and benefits in the solid organ transplant population remain to be fully elucidated. This report highlights a clinical practice issue where the treatment of a patient’s multiple myeloma with lenalidomide may have potentiated an episode of severe acute cellular rejection and further demonstrates the need for future investigation of the optimal treatment of plasma cell disorders including AL amyloidosis and multiple myeloma following solid organ transplantation.
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Sylvana, Yana, Michelle S, Hanna Wijaya, Yohanes Firmansyah et Laksanto Utomo. « The Ethical and Legal Consequences of Organ Donation ». Interdisciplinary Social Studies 1, no 4 (20 janvier 2022) : 455–64. http://dx.doi.org/10.55324/iss.v1i4.99.
Texte intégralRésumé :
Background: The transfer of all or part of a donor's body organ tissue to a recipient in the hopes of improving the recipient's quality of life is known as transplantation. Meanwhile, organs are important parts of the human body that are made up of a range of tissues that can maintain structure, vascularity, and the ability to conduct physiological functions.
Aim: Based on the title, this research aimed to review the ethical and legal consequences of organ donation in Indonesia.
Method: This research is a multidisciplinary research, which elaborates on the health sector with the main focus of discussion in the field of law. The type of research that was used in this journal research is normative legal research.
Findings: By assuring security, safety, volunteering, benefit, and fairness in organ transplant services for both donors and recipients, the Republic of Indonesia's Government Regulation No. 53 of 2021, governing the Transplantation of Organs and Body Tissues, was developed
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Chiang, Scott, Minh Chau Vu, Mychelle Nguyen, Ali Strocker, Stefan Horvath et Nina Shapiro. « Adenotonsillar Enlargement in Pediatric Organ Transplant Recipients : A Cross-Sectional Analysis ». Otolaryngology–Head and Neck Surgery 127, no 1 (juillet 2002) : 109–14. http://dx.doi.org/10.1067/mhn.2002.126476.
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OBJECTIVE: Our goal was to statistically correlate adenotonsillar hypertrophy (ATH) in the pediatric posttransplant population with potential risk factors and to monitor the progression of ATH over time. STUDY DESIGN AND SETTING: Participants were evaluated for ATH through a standardized 65-point questionnaire and an 8-point physical examination. They were also evaluated for current age, age at time of transplantation, type of organ transplant, gender, tacrolimus use, history of transplant rejection, Epstein-Barr virus (EBV) serology, and cytomegalovirus (CMV) serology. We evaluated 243 pediatric solid organ transplant recipients, with 116 patients undergoing repeat evaluation. RESULTS: A statistically significant negative correlation was noted between age at time of transplantation and both questionnaire scores ( P = 0.0075) and examination scores ( P = 0.013). A significant negative correlation was also seen between age at time of evaluation and questionnaire score ( P = 0.028) but not examination score ( P = 0.49). Recipient EBV seronegativity significantly increased questionnaire score ( P = 0.05). Liver transplant recipients also had a significantly higher questionnaire score than did kidney transplant recipients ( P = 0.0048). Gender, CMV recipient status, and tacrolimus (immunosuppressant) use did not significantly impact questionnaire or examination scores. Repeat evaluation of 116 patients after a 2-to 9-month interval did not demonstrate any significant increases in questionnaire scores. A statistically significant drop in examination scores was noted ( P = 0.003). CONCLUSIONS AND SIGNIFICANCE: These findings support previous reports in the literature that correlate EBV seronegativity, younger age at transplant, and liver versus kidney transplantation with increased incidence of PTLD.
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Zavascki, Alexandre Prehn, João Carlos Bienardt et Luiz Carlos Severo. « Paracoccidioidomycosis in organ transplant recipient : case report ». Revista do Instituto de Medicina Tropical de São Paulo 46, no 5 (octobre 2004) : 279–81. http://dx.doi.org/10.1590/s0036-46652004000500009.
Texte intégralRésumé :
Paracoccidioidomycosis is a common disease in Latin America but it is rare in organ transplant recipient patients. We report on a case of such mycosis in a renal transplant recipient. The patient presented with a large lung cavity on the left lower lobe, a rare radiological presentation of paracoccidioidomycosis. Unusual clinical and radiological manifestations of Paracoccidioides brasiliensis infection can occur in immunocompromised patients.
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Yager, Ashley, Sarah Khorsand, Ripple Chokshi et Sreekanth Cheruku. « Combined Thoracic and Abdominal Organ Transplantation : Special Considerations ». Seminars in Cardiothoracic and Vascular Anesthesia 24, no 1 (27 août 2019) : 84–95. http://dx.doi.org/10.1177/1089253219870631.
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Combined thoracic-abdominal organ transplants are infrequently performed procedures indicated for patients with failure of two or more transplantable organs. In this review, we discuss recipient selection, surgical considerations, anesthetic management, and outcomes associated with common combinations of thoracic-abdominal transplant operations. General principles regarding the postoperative care of these patients are also discussed. These procedures present a unique challenge requiring specialized knowledge, technical expertise, and leadership from the anesthesiology team throughout the perioperative period.
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Yadav, Anitha D., Yu-Hui Chang, Bashar A. Aqel, Thomas J. Byrne, Harini A. Chakkera, David D. Douglas, David C. Mulligan, Jorge Rakela, Hugo E. Vargas et Elizabeth J. Carey. « New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients : Analysis of the UNOS/OPTN Database ». Journal of Transplantation 2013 (2013) : 1–7. http://dx.doi.org/10.1155/2013/269096.
Texte intégralRésumé :
New onset diabetes after transplantation (NODAT) occurs less frequently in living donor liver transplant (LDLT) recipients than in deceased donor liver transplant (DDLT) recipients. The aim of this study was to compare the incidence and predictive factors for NODAT in LDLT versus DDLT recipients. The Organ Procurement and Transplant Network/United Network for Organ Sharing database was reviewed from 2004 to 2010, and 902 LDLT and 19,582 DDLT nondiabetic recipients were included. The overall incidence of NODAT was 12.2% at 1 year after liver transplantation. At 1, 3, and 5 years after transplant, the incidence of NODAT in LDLT recipients was 7.4, 2.1, and 2.6%, respectively, compared to 12.5, 3.4, and 1.9%, respectively, in DDLT recipients. LDLT recipients have a lower risk of NODAT compared to DDLT recipients (hazard ratio = 0.63 (0.52–0.75),P<0.001). Predictors for NODAT in LDLT recipients were hepatitis C (HCV) and treated acute cellular rejection (ACR). Risk factors in DDLT recipients were recipient male gender, recipient age, body mass index, donor age, donor diabetes, HCV, and treated ACR. LDLT recipients have a lower incidence and fewer risk factors for NODAT compared to DDLT recipients. Early identification of risk factors will assist timely clinical interventions to prevent NODAT complications.
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Mazilescu, Laura Ioana, Isabel Bernheim, Jürgen Treckmann et Sonia Radunz. « Donor, Recipient and Surgeon Sex and Sex-Concordance and their Impact on Liver Transplant Outcome ». Journal of Personalized Medicine 13, no 2 (1 février 2023) : 281. http://dx.doi.org/10.3390/jpm13020281.
Texte intégralRésumé :
(1) Background: Patient sex is associated with differential outcome of many procedures although the exact mechanisms remain unknown. Especially in transplant surgery, surgeon-patient sex-concordance is rarely present for female patients and outcome may be negatively affected. (2) Methods: In this single-center retrospective cohort study, recipient, donor, and surgeon sex were evaluated and short- and long-term outcome was analyzed with regards to sex and sex-concordance of patients, donors, and surgeons. (3) Results: We included 425 recipients in our study; 50.1% of organ donors, 32.7% of recipients, and 13.9% of surgeons were female. Recipient-donor sex concordance was present in 82.7% of female recipients and in 65.7% of male recipients (p = 0.0002). Recipient-surgeon sex concordance was present in 11.5% of female recipients and in 85.0% of male recipients (p < 0.0001). Five-year patient survival was comparable between female and male recipients (70.0% vs. 73.3%, p = 0.3978). Five-year patient survival of female recipients treated by female surgeons was improved without reaching significance (81.3% vs. 68.4%, p = 0.3621). (4) Conclusions: Female recipients and female surgeons are underrepresented in liver transplant surgery. Societal factors influencing outcome of female patients suffering from end-stage organ failure need to be further examined and acted upon to possibly improve the outcome of female liver transplant recipients.
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Nwabueze, Remigius N. « Proprietary interests in organs in limbo ». Legal Studies 36, no 2 (juin 2016) : 279–301. http://dx.doi.org/10.1111/lest.12108.
Texte intégralRésumé :
A host of activities jeopardise the safety of an excised organ: an organ transported across local, regional, state or national boundaries could be damaged or lost in transit. A thief might snatch the organ from the possession of the transplant team; a transplant surgeon could use the organ for the treatment of their relative or patient, a celebrity or an influential political figure, instead of transplanting the organ into the properly selected and designated recipient. Also, the organ could be damaged maliciously by a third party. Furthermore, a live donor might change their mind after the organ had been retrieved, or the intended recipient might die before a scheduled transplant, after the organ had been retrieved from a live donor. In the above cases, the organ is in a state of limbo, prompting an enquiry into the appropriate remedial responses of the law for a claimant. Non-proprietary remedies might be helpful in the above scenarios, but fail to provide the necessary continuing control. Accordingly, the first section of this paper considers whether positive law recognises the existence of proprietary interests in excised organs; absent such protection, this paper suggests that the law should recognise proprietary interests in excised organs.
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Chua, Alfred WY, Matthew J. Chua, Brian P. Harrisberg et Chandra M. Kumar. « Review of anaesthetic management for cataract surgery in transplant recipients ». Anaesthesia and Intensive Care 48, no 1 (janvier 2020) : 25–35. http://dx.doi.org/10.1177/0310057x19891737.
Texte intégralRésumé :
The prevalence of transplantation is on the increase worldwide. Corneal transplantation is the most common form of human donor transplantation. Transplantation of other organs and bone marrow is established treatment for various end-organ failure and many haematological conditions, respectively. Success and survival of these patients have increased with advances in immunosuppression. Unfortunately, these patients are susceptible to cataract formation as a consequence of immunosuppressive therapy and accelerated progression of several diseases. Topical anaesthesia and regional ophthalmic blocks are ideal for cataract surgery in cooperative adults. General anaesthesia may be required in children, for extremely anxious or claustrophobic adults and for complex surgery such as simultaneous cataract and corneal transplantation. The perioperative anaesthetic management of cataract surgery in a transplant recipient is no different to a standard technique in a healthy adult, but additional challenges are posed by the underlying pathology necessitating transplantation, function of the transplanted organ, physiological and pharmacological problems of allograft denervation, side-effects of immunosuppression, risk of infection and potential for rejection. This narrative review summarises optimal anaesthetic management in transplant recipients undergoing cataract surgery.
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Kirk, Julienne K., et Robert E. Dupuis. « Approaches to The Treatment of Hyperlipidemia in the Solid Organ Transplant Recipient ». Annals of Pharmacotherapy 29, no 9 (septembre 1995) : 879–91. http://dx.doi.org/10.1177/106002809502900911.
Texte intégralRésumé :
Objective: To review the literature investigating increased lipid concentrations in transplant recipients and the use of lipid-lowering agents in this population. Data Sources: Relevant articles were identified from a MEDLINE search using the terms transplantation, hyperlipidemia, immunosuppression, and therapy including diet, gemfibrozil, bile acid sequestrants, nicotinic acid, probucol, and hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors. Selected literature, including controlled studies, was used in this review. Study Selection: Articles published since 1970 pertaining to hyperlipidemia in solid organ transplant recipients. Emphasis was placed on clinical trials that investigated approaches to the treatment of hyperlipidemia in transplant recipients. Data Extraction: Original articles and reviews were obtained to select material pertinent to the objectives. Data Synthesis: Descriptions of lipid concentrations in the transplant patient and treatment approaches used, including potential complications, were reviewed. Conclusions: Hyperlipidemia is an important risk factor for coronary heart disease in the solid organ transplant patient. Treatment alternatives include diet modification and, in most cases, pharmacologic intervention that should be based on the type of hyperlipidemia. The HMG-CoA reductase inhibitors are effective agents in the treatment of hyperlipidemia in the transplant recipient and generally are used as single therapy in low dosages to minimize the risk of myositis or rhabdomyolysis.
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Ford, James B., Sanmann N. Jennifer, Kelly Erickson, Wendy J. Grant, Pamela A. Althof, Alan Langnas, Valerie Shostrom, Martin Bast, Timothy C. Greiner et Peter F. Coccia. « Utilizing Y Chromosome FISH to Determine the Origin of Post-Transplant Lymphoproliferative Disease in Solid Organ Transplant Recipients ». Blood 132, Supplement 1 (29 novembre 2018) : 5297. http://dx.doi.org/10.1182/blood-2018-99-119488.
Texte intégralRésumé :
Abstract Background: Post-Transplant Lymphoproliferative Disease (PTLD) is a heterogeneous disease that arises as a complication after solid organ transplants (SOT) and unusually after bone marrow transplants (BMT). PTLD is generally of recipient origin in SOT patients and donor origin in BMT patients. Knowing the cellular origin of PTLD may provide insight into tumorigenesis and potentially guide treatment options. Design/Methods: We identified gender mismatched SOT patients from our institutional databases who had PTLD tumor tissue for FISH analysis to determine the tumor origin (donor vs. recipient). From these samples, lesional and normal (when present) tissue was delineated by a hematopathologist (TG), and subsequent XY FISH studies were performed according to standard protocols for detection of the Y chromosome. Results: Thirty-one gender mismatched PTLD patients were examined (20 were pediatric patients <18 yrs old). Transplants were: 8 isolated liver (L), 7 kidney (K), 3 small bowel (SB), 6 L/SB, 4 L/SB/pancreas (P), 2 K/L and one L/K/P. Of the 31 patients: 25 were 100% recipient origin; 5/31 demonstrated mixed chimerism; and 1 was 100 % donor origin. Of the 6 patients with chimerism (3 children), the percentage of donor cells ranged between 23% and 100%. Three of 31 had PTLD in the allograft, with 2 of 3 demonstrating mixed chimerism. One was a 2 y.o. F 3 months after a SB transplant and the other a 10 m.o. M 12 months after a L/SB/P transplant. Of the 28 with tumor tissue at other sites, 3 had mixed chimerism: a 60 y.o. M 9 months after a K/L transplant; a 7 m.o. M 8 months after a L/SB transplant; and a 64 y.o. F 3 months after a L transplant. The single patient with 100 % donor chimerism was a 27 year old female 5 months after a L/SB transplant. The 6 chimeric patients developed PTLD on average earlier than the 25 patients of recipient origin (6.9 months vs. 18.1 months). Of the 20 pediatric patient, 12 had transplants including small bowel and 3/12 demonstrated mixed chimerism. Mortality rate was similar between pediatric and adult populations (40% and 45% respectively). Conclusion: As expected, the majority of patients in our series had tumors of recipient origin. However, 3/20 pediatric patients (15%) and 3/11 (27%) adult patients were chimeric in 23% to 100% of their tumor cells. Chimerism was more common in patients who received transplants that included L (4/5) and SB (3/5). Disclosures Ford: Novartis: Consultancy, Honoraria.
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Seneghini, M., V. Petermichl, R. Frei, C. Bucher, S. Baumann et P. Kohler. « Microsporidiosis in a solid organ transplant recipient ». International Journal of Infectious Diseases 108 (juillet 2021) : 18–19. http://dx.doi.org/10.1016/j.ijid.2021.04.084.
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