License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Transplant Research and Risk Management 2014:6 45–53 Transplant Research and Risk Management Dovepress
{"title":"Management of Candida infections in liver transplant recipients: current perspectives","authors":"P. Lingegowda, B. Tan","doi":"10.2147/TRRM.S38620","DOIUrl":"https://doi.org/10.2147/TRRM.S38620","url":null,"abstract":"License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Transplant Research and Risk Management 2014:6 45–53 Transplant Research and Risk Management Dovepress","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"18 1","pages":"45-53"},"PeriodicalIF":0.9,"publicationDate":"2014-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S38620","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liver transplantation remains the therapy of choice for patients with end-stage liver disease and in selected cases of hepatocellular carcinoma. While short-term allograft survival has improved significantly in recent years, there has been little improvement in long-term survival after liver transplantation. A growing body of evidence on factors influencing the long-term outcomes and the safety profiles of existing immunosuppressive agents after liver transplant points to a need to continue searching for alternative strategies. The calcineurin inhibitors (CNIs) (cyclosporine and tacrolimus) currently represent the backbone of most immunosuppressor regimens. They have had a revolutionary effect on the overall success of transplantation, as is reflected in greatly reduced rates of acute rejection. However, the CNIs have significant toxici - ties that produce renal dysfunction, cardiovascular disease, and other unwanted effects, such as malignancies. The recognition of these risk factors has sparked interest in regimens that limit exposure to CNIs. Nowadays, the use of immunosuppressive drugs with different mechanisms of action, which allow for a reduction or avoidance of CNIs, is common. Everolimus, which belongs to the mammalian target-of-rapamycin inhibitor family and is best known for its use in kidney and heart transplantation, has recently been approved for liver transplantation. This overview discusses the emerging evidence on the role of everolimus in the prevention of rejection after liver transplantation, in de novo transplants, conversion regimens, or as a rescue therapy. In addition, some of the most relevant and current clinical problems related to everolimus in this field are discussed.
{"title":"The role of mTOR inhibitors in the prevention of organ rejection in adult liver transplant patients: a focus on everolimus","authors":"T. Casanovas","doi":"10.2147/TRRM.S40152","DOIUrl":"https://doi.org/10.2147/TRRM.S40152","url":null,"abstract":"Liver transplantation remains the therapy of choice for patients with end-stage liver disease and in selected cases of hepatocellular carcinoma. While short-term allograft survival has improved significantly in recent years, there has been little improvement in long-term survival after liver transplantation. A growing body of evidence on factors influencing the long-term outcomes and the safety profiles of existing immunosuppressive agents after liver transplant points to a need to continue searching for alternative strategies. The calcineurin inhibitors (CNIs) (cyclosporine and tacrolimus) currently represent the backbone of most immunosuppressor regimens. They have had a revolutionary effect on the overall success of transplantation, as is reflected in greatly reduced rates of acute rejection. However, the CNIs have significant toxici - ties that produce renal dysfunction, cardiovascular disease, and other unwanted effects, such as malignancies. The recognition of these risk factors has sparked interest in regimens that limit exposure to CNIs. Nowadays, the use of immunosuppressive drugs with different mechanisms of action, which allow for a reduction or avoidance of CNIs, is common. Everolimus, which belongs to the mammalian target-of-rapamycin inhibitor family and is best known for its use in kidney and heart transplantation, has recently been approved for liver transplantation. This overview discusses the emerging evidence on the role of everolimus in the prevention of rejection after liver transplantation, in de novo transplants, conversion regimens, or as a rescue therapy. In addition, some of the most relevant and current clinical problems related to everolimus in this field are discussed.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"6 1","pages":"31-43"},"PeriodicalIF":0.9,"publicationDate":"2014-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S40152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Transplant Research and Risk Management 2014:6 23–30 Transplant Research and Risk Management Dovepress
{"title":"Next-generation calcineurin inhibitors in development for the prevention of organ rejection","authors":"O. Gheith, T. Al-Otaibi, H. Mansour","doi":"10.2147/TRRM.S35875","DOIUrl":"https://doi.org/10.2147/TRRM.S35875","url":null,"abstract":"License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Transplant Research and Risk Management 2014:6 23–30 Transplant Research and Risk Management Dovepress","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"6 1","pages":"23-30"},"PeriodicalIF":0.9,"publicationDate":"2014-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S35875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rabbit anti-thymocyte globulin (rATG) has proven benefit as induction therapy in renal transplant recipients, achieving reduced acute rejection rates and better short-term allograft function, with slightly higher rates of complications such as infections and malignancy. Compared with other agents, the most benefit from rATG induction has been observed in renal transplant recipients at high immunologic risk for rejection. However, in special populations, such as pediatrics, the elderly, and hepatitis C-positive and human immunodeficiency virus-positive renal transplant recipients, additional information is needed to delineate the absolute benefit of rATG induction compared with other induction agents. Selection of rATG as the choice of induction therapy in renal transplant recipients should be guided by a cost-effective approach in balancing efficacy, safety, and cost. This review summarizes the published literature on efficacy, safety, and cost of rATG induction in renal transplantation.
{"title":"Rabbit anti-thymocyte globulin induction in renal transplantation: review of the literature","authors":"L. Andress, Anjali Gupta, N. Siddiqi, K. Marfo","doi":"10.2147/TRRM.S36734","DOIUrl":"https://doi.org/10.2147/TRRM.S36734","url":null,"abstract":"Rabbit anti-thymocyte globulin (rATG) has proven benefit as induction therapy in renal transplant recipients, achieving reduced acute rejection rates and better short-term allograft function, with slightly higher rates of complications such as infections and malignancy. Compared with other agents, the most benefit from rATG induction has been observed in renal transplant recipients at high immunologic risk for rejection. However, in special populations, such as pediatrics, the elderly, and hepatitis C-positive and human immunodeficiency virus-positive renal transplant recipients, additional information is needed to delineate the absolute benefit of rATG induction compared with other induction agents. Selection of rATG as the choice of induction therapy in renal transplant recipients should be guided by a cost-effective approach in balancing efficacy, safety, and cost. This review summarizes the published literature on efficacy, safety, and cost of rATG induction in renal transplantation.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"6 1","pages":"9-21"},"PeriodicalIF":0.9,"publicationDate":"2014-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S36734","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Colvin-adams, Nonyelum Harcourt, R. Leduc, Ganesh Raveendran, Y. Sonbol, R. Wilson, D. Duprez
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Ltd, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Ltd. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Transplant Research and Risk Management 2014:6 1–7 Transplant Research and Risk Management Dovepress
{"title":"Heart transplantation and arterial elasticity","authors":"M. Colvin-adams, Nonyelum Harcourt, R. Leduc, Ganesh Raveendran, Y. Sonbol, R. Wilson, D. Duprez","doi":"10.2147/TRRM.S43847","DOIUrl":"https://doi.org/10.2147/TRRM.S43847","url":null,"abstract":"License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Ltd, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Ltd. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Transplant Research and Risk Management 2014:6 1–7 Transplant Research and Risk Management Dovepress","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"6 1","pages":"1-7"},"PeriodicalIF":0.9,"publicationDate":"2013-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S43847","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Ltd, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Ltd. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Transplant Research and Risk Management 2013:5 33–39 Transplant Research and Risk Management Dovepress
{"title":"Update on laparoscopic/robotic kidney transplant: A literature review","authors":"B. He, J. Hamdorf","doi":"10.2147/TRRM.S50234","DOIUrl":"https://doi.org/10.2147/TRRM.S50234","url":null,"abstract":"License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Ltd, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Ltd. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Transplant Research and Risk Management 2013:5 33–39 Transplant Research and Risk Management Dovepress","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"5 1","pages":"33-39"},"PeriodicalIF":0.9,"publicationDate":"2013-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S50234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Correspondence: Amit Sharma Hume-Lee Transplant Center, Virginia Commonwealth University, PO Box 980057, Richmond, VA 23298-0057, USA Tel +1 804 828 8485 Fax +1 804 828 4858 Email asharma@mcvh-vcu.edu Abstract: Pediatric kidney transplantation is the preferred treatment for children with end-stage renal disease. The most common indications for transplantation in children are renal developmental anomalies, obstructive uropathy, and focal segmental glomerulosclerosis. Living donor kidney transplants are often performed pre-emptively and offer excellent graft function. Policy changes in deceased-donor kidney allocation have increased the proportion of such transplants in pediatric recipients. Adequate pretransplant workup along with evaluation of urologic abnormalities is imperative in achieving good outcomes. Overall, patient and graft outcomes after kidney transplantation have improved, with five-year deceased donor and living donor graft survivals of 78.8% and 84.3%, respectively. Improvements in induction and maintenance immunosuppression have contributed to the gradual improvement in outcomes. Unique challenges in pediatric recipients include increased graft thrombosis, adverse growth, and abnormal development relating to immunosuppression, increased rejection due to nonadherence, increased susceptibility to opportunistic infections, and post-transplant malignancy. This review focuses on the current practices and outcomes in pediatric kidney transplantation in North America. We discuss the indications for transplantation, the evaluation process, some key surgical and immunologic considerations, and the common risk factors for graft dysfunction.
{"title":"Pediatric kidney transplantation: a review","authors":"Amit Sharma, R. Ramanathan, M. Posner, R. Fisher","doi":"10.2147/TRRM.S34043","DOIUrl":"https://doi.org/10.2147/TRRM.S34043","url":null,"abstract":"Correspondence: Amit Sharma Hume-Lee Transplant Center, Virginia Commonwealth University, PO Box 980057, Richmond, VA 23298-0057, USA Tel +1 804 828 8485 Fax +1 804 828 4858 Email asharma@mcvh-vcu.edu Abstract: Pediatric kidney transplantation is the preferred treatment for children with end-stage renal disease. The most common indications for transplantation in children are renal developmental anomalies, obstructive uropathy, and focal segmental glomerulosclerosis. Living donor kidney transplants are often performed pre-emptively and offer excellent graft function. Policy changes in deceased-donor kidney allocation have increased the proportion of such transplants in pediatric recipients. Adequate pretransplant workup along with evaluation of urologic abnormalities is imperative in achieving good outcomes. Overall, patient and graft outcomes after kidney transplantation have improved, with five-year deceased donor and living donor graft survivals of 78.8% and 84.3%, respectively. Improvements in induction and maintenance immunosuppression have contributed to the gradual improvement in outcomes. Unique challenges in pediatric recipients include increased graft thrombosis, adverse growth, and abnormal development relating to immunosuppression, increased rejection due to nonadherence, increased susceptibility to opportunistic infections, and post-transplant malignancy. This review focuses on the current practices and outcomes in pediatric kidney transplantation in North America. We discuss the indications for transplantation, the evaluation process, some key surgical and immunologic considerations, and the common risk factors for graft dysfunction.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"5 1","pages":"21-31"},"PeriodicalIF":0.9,"publicationDate":"2013-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S34043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Correspondence: Theodore G Liou 26 North Mario Capecchi Drive, Salt Lake City, Utah 84132, USA Tel +1 801 581 7806 Fax +1 801 585 3355 Email ted.liou@utah.edu Abstract: Patients with end-stage chronic obstructive pulmonary disease (COPD) comprise the largest single lung disease group undergoing transplantation. Selection of appropriate candidates requires consideration of specific clinical characteristics, prognosis in the absence of transplantation, and likely outcome of transplantation. Increased availability of alternatives to transplantation for end-stage patients and the many efforts to increase the supply of donor organs have complicated decision making for selecting transplant candidates. Many years of technical and clinical refinements in lung transplantation methods have improved survival and quality of life outcomes. Further advances will probably come from improved selection methods for the procedure. Because no prospective trial has been performed, and because of confounding and informative censoring bias inherent in the transplant selection process in studies of the existing experience, the survival effect of lung transplant in COPD patients remains undefined. There is a lack of conclusive data on the impact of lung transplantation on quality of life. For some patients with end-stage COPD, lung transplantation remains the only option for further treatment with a hope of improved survival and quality of life. A prospective trial of lung transplantation is needed to provide better guidance concerning survival benefit, resource utilization, and quality of life effects for patients with COPD.
通信:Theodore G Liou 26 North Mario Capecchi Drive, Salt Lake City, Utah 84132, USA Tel +1 801 581 7806 Fax +1 801 585 3355 Email ted.liou@utah.edu摘要:终末期慢性阻塞性肺疾病(COPD)患者是接受移植的最大的单一肺部疾病群体。选择合适的候选者需要考虑特定的临床特征、未移植的预后和可能的移植结果。终末期患者移植替代方案的增加以及增加供体器官供应的许多努力使选择移植候选人的决策变得复杂。多年来，肺移植技术和临床方法的改进提高了生存率和生活质量。进一步的进步可能来自于改进的手术选择方法。由于没有进行前瞻性试验，并且由于现有经验研究中移植选择过程中固有的混淆和信息审查偏倚，肺移植对COPD患者的生存影响仍不明确。关于肺移植对生活质量的影响，目前缺乏结论性的数据。对于一些终末期慢性阻塞性肺病患者，肺移植仍然是进一步治疗的唯一选择，有望改善生存和生活质量。需要一项肺移植的前瞻性试验来更好地指导COPD患者的生存获益、资源利用和生活质量影响。
{"title":"Lung transplantation for chronic obstructive pulmonary disease","authors":"T. Liou, S. Raman, B. Cahill","doi":"10.2147/TRRM.S10765","DOIUrl":"https://doi.org/10.2147/TRRM.S10765","url":null,"abstract":"Correspondence: Theodore G Liou 26 North Mario Capecchi Drive, Salt Lake City, Utah 84132, USA Tel +1 801 581 7806 Fax +1 801 585 3355 Email ted.liou@utah.edu Abstract: Patients with end-stage chronic obstructive pulmonary disease (COPD) comprise the largest single lung disease group undergoing transplantation. Selection of appropriate candidates requires consideration of specific clinical characteristics, prognosis in the absence of transplantation, and likely outcome of transplantation. Increased availability of alternatives to transplantation for end-stage patients and the many efforts to increase the supply of donor organs have complicated decision making for selecting transplant candidates. Many years of technical and clinical refinements in lung transplantation methods have improved survival and quality of life outcomes. Further advances will probably come from improved selection methods for the procedure. Because no prospective trial has been performed, and because of confounding and informative censoring bias inherent in the transplant selection process in studies of the existing experience, the survival effect of lung transplant in COPD patients remains undefined. There is a lack of conclusive data on the impact of lung transplantation on quality of life. For some patients with end-stage COPD, lung transplantation remains the only option for further treatment with a hope of improved survival and quality of life. A prospective trial of lung transplantation is needed to provide better guidance concerning survival benefit, resource utilization, and quality of life effects for patients with COPD.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"54 1","pages":"1-20"},"PeriodicalIF":0.9,"publicationDate":"2013-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S10765","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Dare, A. Phillips, M. Chu, A. Hickey, A. Bartlett
Correspondence: Adam Bartlett New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand Tel +64 21 241 4647 Fax +64 9 375 4345 Email a.bartlett@auckland.ac.nz Background: Hepatic steatosis is increasingly encountered among organ donors. Currently, there is no consensus guideline as to the type or degree of donor steatosis considered acceptable for liver transplantation (LT), and little is known about local practices in this area. The aim of this survey was to evaluate current clinical practices amongst liver transplant surgeons in Australia and New Zealand (ANZ) in the evaluation and use of steatotic donor livers in LT. Methods: An anonymous online twelve-question survey was emailed to all practicing LT surgeons in ANZ (n = 23) in January 2010. Results: The response rate was 83%. Estimated prevalence of steatosis in donor livers was between 40% and 60%. In determining suitability for LT, 90% of respondents reported rejecting organs with “severe” steatosis based on visual and palpation grounds alone. A total of 68% sought further histological assessment if the donor liver looked bad and there were risk factors for steatosis. The majority of respondents performed only one biopsy of the liver (79%), using hematoxylin and eosin staining for fat assessment (53%). There was wide variation in the upper limit of steatosis considered to be acceptable for LT (40%–80% steatosis). A total of 21% of respondents still considered microvesicular steatosis a risk factor for primary graft nonfunction. Conclusion: This survey highlights the significant variation in the appraisal and use of steatotic grafts by LT surgeons in ANZ. Accurate evaluation and judicious use of mild and moderately steatotic grafts is required if we are to utilize the available donor pool best.
{"title":"Appraisal of donor steatosis in liver transplantation: a survey of current practice in Australia and New Zealand","authors":"A. Dare, A. Phillips, M. Chu, A. Hickey, A. Bartlett","doi":"10.2147/TRRM.S33407","DOIUrl":"https://doi.org/10.2147/TRRM.S33407","url":null,"abstract":"Correspondence: Adam Bartlett New Zealand Liver Transplant Unit, Level 15, Support Building, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand Tel +64 21 241 4647 Fax +64 9 375 4345 Email a.bartlett@auckland.ac.nz Background: Hepatic steatosis is increasingly encountered among organ donors. Currently, there is no consensus guideline as to the type or degree of donor steatosis considered acceptable for liver transplantation (LT), and little is known about local practices in this area. The aim of this survey was to evaluate current clinical practices amongst liver transplant surgeons in Australia and New Zealand (ANZ) in the evaluation and use of steatotic donor livers in LT. Methods: An anonymous online twelve-question survey was emailed to all practicing LT surgeons in ANZ (n = 23) in January 2010. Results: The response rate was 83%. Estimated prevalence of steatosis in donor livers was between 40% and 60%. In determining suitability for LT, 90% of respondents reported rejecting organs with “severe” steatosis based on visual and palpation grounds alone. A total of 68% sought further histological assessment if the donor liver looked bad and there were risk factors for steatosis. The majority of respondents performed only one biopsy of the liver (79%), using hematoxylin and eosin staining for fat assessment (53%). There was wide variation in the upper limit of steatosis considered to be acceptable for LT (40%–80% steatosis). A total of 21% of respondents still considered microvesicular steatosis a risk factor for primary graft nonfunction. Conclusion: This survey highlights the significant variation in the appraisal and use of steatotic grafts by LT surgeons in ANZ. Accurate evaluation and judicious use of mild and moderately steatotic grafts is required if we are to utilize the available donor pool best.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"4 1","pages":"31-37"},"PeriodicalIF":0.9,"publicationDate":"2012-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/TRRM.S33407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68494997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Chavlovski, G. Knoll, T. Ramsay, S. Hiremath, D. Zimmerman
Correspondence: Deborah Zimmerman Home Hemodialysis, Ottawa Hospital, Riverside Campus, 1967 Riverside Dr, Ottawa, ON K0A 2Z0, Canada Tel +1 613 738 8400 ext 82534 Fax +1 613 738 8337 Email dzimmerman@ottawahospital.on.ca Background: In patients with end-stage renal disease, use of vitamin D and calcium-based phosphate binders have been associated with progression of vascular calcification that might have an impact on renal transplant candidacy. Our objective was to examine management of mineral metabolism in patients wait-listed for renal transplant and to determine the impact on cardiac perfusion imaging. Methods: Data was collected retrospectively on patients wait-listed for a renal transplant (n = 105), being either active (n = 73) or on hold (n = 32). Demographic data, medications, serum concentrations of calcium, phosphate, parathyroid hormone, and cardiac perfusion imaging studies were collected from the electronic health record. Chi-square and Student’s t-tests were used to compare active and on-hold patients as appropriate. Logistic regression was used to examine variables associated with worsening cardiac imaging studies. Results: The wait-listed patients were of mean age 56 ± 14 years and had been on dialysis for 1329 ± 867 days. On-hold patients had received a significantly greater total dose of calcium (2.35 ± .94 kg versus 1.49 ± 1.52 kg; P = 0.02) and were more likely to have developed worsening cardiovascular imaging studies (P = 0.03). Total doses of calcium and calcitriol were associated with worsening cardiovascular imaging studies (P = 0.05). Conclusion: Patients on hold on the renal transplant waiting list received higher total doses of calcium. A higher total dose of calcium and calcitriol was also associated with worsening cardiovascular imaging. Time on dialysis before transplant has been associated with worse post-transplant outcomes, and it is possible that the total calcium and calcitriol dose received contributed to these inferior outcomes.
{"title":"Retrospective review of bone mineral metabolism management in end-stage renal disease patients wait-listed for renal transplant","authors":"Anna Chavlovski, G. Knoll, T. Ramsay, S. Hiremath, D. Zimmerman","doi":"10.2147/TRRM.S33577","DOIUrl":"https://doi.org/10.2147/TRRM.S33577","url":null,"abstract":"Correspondence: Deborah Zimmerman Home Hemodialysis, Ottawa Hospital, Riverside Campus, 1967 Riverside Dr, Ottawa, ON K0A 2Z0, Canada Tel +1 613 738 8400 ext 82534 Fax +1 613 738 8337 Email dzimmerman@ottawahospital.on.ca Background: In patients with end-stage renal disease, use of vitamin D and calcium-based phosphate binders have been associated with progression of vascular calcification that might have an impact on renal transplant candidacy. Our objective was to examine management of mineral metabolism in patients wait-listed for renal transplant and to determine the impact on cardiac perfusion imaging. Methods: Data was collected retrospectively on patients wait-listed for a renal transplant (n = 105), being either active (n = 73) or on hold (n = 32). Demographic data, medications, serum concentrations of calcium, phosphate, parathyroid hormone, and cardiac perfusion imaging studies were collected from the electronic health record. Chi-square and Student’s t-tests were used to compare active and on-hold patients as appropriate. Logistic regression was used to examine variables associated with worsening cardiac imaging studies. Results: The wait-listed patients were of mean age 56 ± 14 years and had been on dialysis for 1329 ± 867 days. On-hold patients had received a significantly greater total dose of calcium (2.35 ± .94 kg versus 1.49 ± 1.52 kg; P = 0.02) and were more likely to have developed worsening cardiovascular imaging studies (P = 0.03). Total doses of calcium and calcitriol were associated with worsening cardiovascular imaging studies (P = 0.05). Conclusion: Patients on hold on the renal transplant waiting list received higher total doses of calcium. A higher total dose of calcium and calcitriol was also associated with worsening cardiovascular imaging. Time on dialysis before transplant has been associated with worse post-transplant outcomes, and it is possible that the total calcium and calcitriol dose received contributed to these inferior outcomes.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"4 1","pages":"25-30"},"PeriodicalIF":0.9,"publicationDate":"2012-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68495136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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