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As 2014 comes to a close, AST would like to wish its members, partners and other transplant professionals a safe and happy holiday season. As we reflect on the past year for the field, we would like to provide the readers of the AST eNews a look at the most accessed articles from the year. Our regular publication will resume Jan. 9.
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Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: Recommendations and future directions
American Journal of Transplantation
From Aug. 22, 2014: A consensus meeting was held in Vienna on Sept. 8–9, 2013, to discuss diagnostic and therapeutic challenges surrounding development of diabetes mellitus after transplantation. The International Expert Panel comprised 24 transplant nephrologists, surgeons, diabetologists and clinical scientists, which met with the aim to review previous guidelines in light of emerging clinical data and research. Recommendations from the consensus discussions are provided in this article. Although the meeting was kidney-centric, reflecting the expertise present, these recommendations are likely to be relevant to other solid organ transplant recipients.
Transplantation community sets a goal for increasing organ transplants over the next 5 years
AST
From Aug. 15, 2014: The Donation and Transplantation Community of Practice (DTCP) Strategic Planning Committee, comprising the community partner organizations listed below, and government participation from the Centers for Medicare and Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA), has been meeting since September 2012 to develop a strategic plan for improving donation and transplantation practices across the nation. Most recently, this group of committed individuals and organizations identified and approved the following collective goal: To increase the number of transplants each year by 1,000 over the next 5 years.
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The management of antibody-mediated rejection in the first presensitized recipient of a full-face allotransplant
American Journal of Transplantation
From May 9, 2014: Authors report on the management of the first full-face transplantation in a sensitized recipient with a positive preoperative crossmatch and subsequent antibody-mediated rejection (AMR). The recipient is a 45-year-old female who sustained extensive chemical burns, with residual poor function and high levels of circulating anti-HLA antibodies. With a clear immunosuppression plan and salvage options in place, a full-face allotransplant was performed using a crossmatch positive donor.
Disparities in access to kidney transplantation between donor service areas in Texas
American Journal of Transplantation
From Sept. 19, 2014: This study examined the current status of pronounced disparities in waiting times to kidney transplantation (KTx) within the state of Texas first documented more than a decade ago. The state's three, geographically contiguous donor service areas (DSAs) were compared for rates of deceased donor KTx within 3 years of listing as well as population base; waiting list size; number of dialysis patients; annual eligible deaths; number and size of acute care hospitals; organ procurement organization performance; correspondence between DSA of residence versus DSA of listing; and distribution of alternative local units (ALUs).
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First-in-human study of the safety and efficacy of TOL101 induction to prevent kidney transplant rejection
American Journal of Transplantation
From May 2, 2014: TOL101 is a murine IgM mAb targeting the αβ TCR. Unlike other T cell targets, the αβ TCR has no known intracellular signaling domains and may provide a nonmitogenic target for T cell inactivation. Authors report the 6-month Phase 2 trial data testing TOL101 in kidney transplantation. The study was designed to identify a dose that resulted in significant CD3 T cell modulation (<25 T cell/mm3), to examine the safety and tolerability of TOL101 and to obtain preliminary efficacy information.
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The UCLA Immunogenetics Center (UIC) provides comprehensive testing for organ and tissue transplantation. Transplant testing has a long history at UCLA. HLA typing was pioneered here in the 1960's. The development of the microcytoxicity test in 1964 marked the beginning of international testing and standardization of HLA typing. The UCLA Immunogenetics Center has retained its leadership position in HLA research, and in the development of accompanying diagnostic testing. MORE
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The new OPTN kidney allocation policy: Potential for inequitable access among highly sensitized patients
American Journal of Transplantation
From Dec. 5, 2014: In 2013, the Organ Procurement and Transplantation Network approved a new national kidney allocation scheme (KAS) for deceased donor (DD) transplantation. Among the many attributes of the new policy was the decision to proactively address organ allocation to highly sensitized patients, long recognized to be the most disadvantaged group on the waiting list. Beginning on Dec. 4, 2014, the new KAS will be implemented and candidates with calculated panel reactive antibody (cPRA) values of 98 percent, 99 percent and 100 percent will have the highest priority for local, regional and national sharing, respectively.
The role of donor-specific HLA alloantibodies in liver transplantation
American Journal of Transplantation
From March 28, 2014: The impact of donor-specific HLA alloantibodies on short- and long-term liver transplant outcome is not clearly defined. While it is clear that not all levels of allosensitization produce overt clinical injury, and that liver allografts possess some degree of alloantibody resistance, alloantibody-mediated adverse consequences are increasingly being recognized.
New national allocation policy for deceased donor kidneys in the United States and possible effect on patient outcomes
Journal of the American Society of Nephrology
From May 30, 2014: In 2013, the Organ Procurement and Transplantation Network in the United States approved a new national deceased donor kidney allocation policy that introduces the kidney donor profile index (KDPI), which gives scores of 0 percent –100 percent based on 10 donor factors. Kidneys with lower KDPI scores are associated with better post-transplant survival.
CD28 negative T cells: Is their loss our gain?
American Journal of Transplantation
From Oct. 31, 2014: CD28 is a primary costimulation molecule for T cell activation. However, during the course of activation some T cells lose this molecule and assume a CD28-independent existence. These CD28− T cells are generally antigen-experienced and highly differentiated. CD28− T cells are functionally heterogeneous. Their characteristics vary largely on the context in which they are found and range from having enhanced cytotoxic abilities to promoting immune regulation. Thus, CD28 loss appears to be more of a marker for advanced differentiation regardless of the cytotoxic or regulatory function being conducted by the T cell.
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