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A multistep, consensus-based approach to organ allocation in liver transplantation: Toward a 'blended principle model'
American Journal of Transplantation (login required)
Since Italian liver allocation policy was last revised (in 2012), relevant critical issues and conceptual advances have emerged, calling for significant improvements. We report the results of a national consensus conference process, promoted by the Italian College of Liver Transplant Surgeons (for the Italian Society for Organ Transplantation) and the Italian Association for the Study of the Liver, to review the best indicators for orienting organ allocation policies based on principles of urgency, utility and transplant benefit in the light of current scientific evidence.
ASTS Recognition Award nominations open
Has a faculty member, mentor, or peer had a positive influence on your career? Say thank you by nominating them for an ASTS Recognition Award!
Registration open for ASTS 2016 Winter Symposium
As more patients suffer due to the shortage of life-saving donor organs each year, ASTS is focusing its Winter Symposium on innovative science and effective public policy to combat this crisis. Register today to join us in Miami Jan. 14-17, 2016, to learn what is being done to save lives through expanding organ transplantation—and how you can help.
Spots still available for ASTS Leadership Development Program
There's still time to register for the 2015 Leadership Development Program Sept. 27-30. This course is the only one of its kind, combining specific case studies and expertise in transplantation with experts in leadership and organizational topics from Northwestern's Kellogg School of Management.
Declining liver graft quality threatens the future of liver transplantation in the United States
Liver Transplantation (login required)
National liver transplantation (LT) volume has declined since 2006, in part because of worsening donor organ quality. Trends that degrade organ quality are expected to continue over the next 2 decades. We used the United Network for Organ Sharing (UNOS) database to inform a 20-year discrete event simulation estimating LT volume from 2010 to 2030. Data to inform the model were obtained from deceased organ donors between 2000 and 2009. If donor liver utilization practices remain constant, utilization will fall from 78 percent to 44 percent by 2030, resulting in 2230 fewer LTs. If transplant centers increase their risk tolerance for marginal grafts, utilization would decrease to 48 percent. The institution of "opt-out" organ donation policies to increase the donor pool would still result in 1380 to 1866 fewer transplants.
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Surgeons smash records with pig-to-primate organ transplants
MIT Technology Review
With the financial aid of a biotechnology executive whose daughter may need a lung transplant, U.S. researchers have been shattering records in xenotransplantation, or between-species organ transplants. The researchers say they have kept a pig heart alive in a baboon for 945 days and also reported the longest-ever kidney swap between these species, lasting 136 days. The experiments used organs from pigs "humanized" with the addition of as many as five human genes, a strategy designed to stop organ rejection.
Glycemic stability through islet-after-kidney transplantation using an alemtuzumab-based induction regimen and long-term triple-maintenance immunosuppression
American Journal of Transplantation (login required)
Pancreatic islet transplantation is performed in a select group of patients with type 1 diabetes mellitus. Immunosuppressive regimens play an important role in long-term islet function. We aimed to investigate the efficacy of islet transplantation in patients with type 1 diabetes and a previous kidney transplantation using an alemtuzumab-based induction regimen and triple maintenance immunosuppression. Patients with type 1 diabetes, who had received a kidney transplant previously, were treated with alemtuzumab as induction therapy for their first islet transplantation and basiliximab induction therapy for subsequent islet transplantations. Maintenance immunosuppression consisted of triple immunosuppression (tacrolimus, mycophenolate mofetil, and prednisolone).
Improving access to kidney transplantation — Referral is not enough
Kidney transplantation is the optimal treatment for eligible patients with end-stage renal disease (ESRD), offering longer life expectancy and better quality of life compared with chronic dialysis treatment. However, only 13 percent of patients who develop ESRD join the deceased donor waitlist or receive a transplant from a live donor within one year, and many patients who lack access to kidney transplantation are predicted to have excellent post-transplant outcomes. Furthermore, pervasive disparities in access to kidney transplantation persist despite decades of recognition and efforts to improve equity in transplant access, with African Americans, Hispanics, women, older adults, patients of lower socioeconomic status or without private insurance, those living in high-poverty neighborhoods, and those receiving dialysis at a for-profit center less likely to undergo kidney transplantation.
High emergency lung transplantation: Dramatic decrease of waiting list death rate without relevant higher post-transplant mortality
Transplant International (login required)
Many candidates for lung transplantation (LT) die on the waiting list, raising the question of graft availability and strategy for organ allocation. We report the experience of the new organ allocation program, "High Emergency Lung Transplantation" (HELT), since its implementation in our center in 2007. Retrospective analysis of 201 lung transplant patients, of whom 37 received HELT from July 1, 2007 to May 31, 2012.
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Liver transplantation from living donors with Gilbert's syndrome is a safe procedure for both donors and recipients
Clinical Transplantation (login required)
Liver transplantation has become a favorable therapeutic option for patients with end-stage liver diseases. Gilbert's syndrome is a benign condition characterized by intermittent mild jaundice due to unconjugated hyperbilirubinemia. It is not obvious whether living-donor liver transplantation from a donor with GS could result in a normal outcome for both the recipient and the donor. We aimed to determine whether right lobe hepatectomy is a safe procedure for living donors with GS and LT recipients. Between September 2011 and March 2015, 305 LDLT procedures using right lobe grafts were performed at Atasehir Memorial Hospital, Istanbul, Turkey. Nineteen of 305 LT candidates who had been diagnosed with GS were included in the current study.
Predictors of ECD kidney transplant long-term outcomes identified
Renal & Urology News
Circulating donor-specific anti-HLA antibody (DSA) and longer cold ischemia time independently predict worse long-term transplantation outcomes among recipients of expanded criteria donor (ECD) kidneys, according to French investigators. In a large, prospective study, a team led by Alexandre Loupy, M.D., of the Paris Translational Research Centre for Organ Transplantation, Paris Descartes University, found that, compared with ECD kidney recipients who did not have circulating DSA on the day of transplantation (ECD/DSA-), recipients who did (ECD/DSA+) had significantly lower graft survival rates at 7 years (44 percent vs. 85 percent). Antibody mediated rejection was the main cause of graft loss in the ECD kidney recipients with circulating DSA, the researchers reported online in the British Medical Journal.
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