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Korus M, Cruchley E, Calic M, Gold A, Anthony SJ, Parekh RS, Stinson JN. Assessing the acceptability and efficacy of teens taking charge: Transplant-A pilot randomized control trial. Pediatr Transplant 2020; 24:e13612. [PMID: 31743564 DOI: 10.1111/petr.13612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/17/2019] [Accepted: 09/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescents who have undergone SOT are at heightened risk for graft failure. This pilot randomized controlled trial aimed to determine the feasibility and obtain preliminary estimates of efficacy of the online TTC program. METHODS TTC is a web-based self-management program for adolescent SOT patients. Participants-kidney or liver transplant candidates or recipients-were enrolled over a 2-year period and randomized to either an intervention group that accessed TTC or a control group that did not access the program. Outcome measures included feasibility, how much the program was utilized, and pre- and post-intervention health-related outcomes evaluating self-management, self-efficacy, mood, use of healthcare services, and knowledge. Semi-structured interviews were conducted with participants post-intervention. RESULTS Forty-two participants were enrolled in the study. Participants in the intervention group expressed that they enjoyed learning about other teens' experiences, but reported barriers to accessing the site, such as being too busy, computer being too slow, and not being able to access the site on their mobile device. Time spent using the website was low for the majority of participants. Patients less than 1-year post-transplant accessed TTC more than patients who had their transplant for longer. No significant differences were found for health-related outcomes between groups. CONCLUSIONS No differences in health-related outcomes were found between groups. Further studies that examine barriers to engagement with web-based education tools are warranted.
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Affiliation(s)
- Moira Korus
- Center for Transplant and Regenerative Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Cruchley
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Masa Calic
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anna Gold
- Center for Transplant and Regenerative Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Samantha J Anthony
- Center for Transplant and Regenerative Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Social Work, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rulan S Parekh
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Relaxin Positively Influences Ischemia-Reperfusion Injury in Solid Organ Transplantation: A Comprehensive Review. Int J Mol Sci 2020; 21:ijms21020631. [PMID: 31963613 PMCID: PMC7013572 DOI: 10.3390/ijms21020631] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/07/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023] Open
Abstract
In recent decades, solid organ transplantation (SOT) has increased the survival and quality of life for patients with end-stage organ failure by providing a potentially long-term treatment option. Although the availability of organs for transplantation has increased throughout the years, the demand greatly outweighs the supply. One possible solution for this problem is to extend the potential donor pool by using extended criteria donors. However, organs from such donors are more prone to ischemia reperfusion injury (IRI) resulting in higher rates of delayed graft function, acute and chronic graft rejection and worse overall SOT outcomes. This can be overcome by further investigating donor preconditioning strategies, graft perfusion and storage and by finding novel therapeutic agents that could reduce IRI. relaxin (RLX) is a peptide hormone with antifibrotic, antioxidant, anti-inflammatory and cytoprotective properties. The main research until now focused on heart failure; however, several preclinical studies showed its potentials for reducing IRI in SOT. The aim of this comprehensive review is to overview currently available literature on the possible role of RLX in reducing IRI and its positive impact on SOT.
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Tontus HO. Educate, Re-educate, Then Re-educate: Organ Donation-centered Attitudes Should Be Established in Society. Transplant Proc 2019; 52:3-11. [PMID: 31898938 DOI: 10.1016/j.transproceed.2019.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objectives of the study are to evaluate knowledge and attitudes toward organ and tissue donation, to pursue a deeper understanding of attitudes toward organ donation, and to gain an understanding of the underlying, personal reasoning for the desired action in organ donation among the adult population. METHODS Four thousand people were interviewed who were selected by the simple random sample type. A survey was conducted by voluntary, face-to-face interviews using a printed 25-item questionnaire form presented to street-recruited individuals over 18 years of age. RESULTS In the study, where male/female distribution was represented equally, the majority of participants consisted of young and middle-aged, primary school graduates between the ages of 25 to 44 years. Although 91.1% of the respondents stated that they support organ donation, only 75.3% stated they wanted to donate organs. Organ donation-centeredness rates were low in those who did not finish a primary school education, people with a low household income, and those ≥65 years age group. A majority of the respondents (91.2%) were found to be against financial incentives for organ donation. Although 91.4% of the participants stated that organ donation is important if the recipient is a relative, this ratio decreased to 86.7% for a nonrelative. In our study, the level of accepting an organ as a recipient from an unknown person was 9.1% higher than the rate of willingness to donate to an unknown person. Surprisingly, despite 84% saying their religion is not against organ donation, 38.4% of the respondents cited religious concerns as the main reason for unwillingness and 58% of them indicated that they were reluctant to donate organs due to religious beliefs. CONCLUSIONS It is important to know that it is not certain that anyone who is hypothetically in favor of organ donation will donate when faced with a real choice. Increasing the number of donors is the most important issue in order to benefit more patients in transplantation, which has achieved a very important success level through serious efforts. The majority of Turkey's population know about organ donation, support transplantation, and would be willing to donate their organs. Most of the respondents find it religiously correct and believe that it is an acceptable lifesaving procedure. However, a high percentage did not know how to donate, and they indicated that the information available on the subject is insufficient. Mass media campaigns and educational activities could resolve this matter and increase organ donation. According to the results of our study, when considering the number of patients who died while waiting for transplantation, organ donation awareness projects that are focused on converting knowledge to behavior are believed to be very critical. It is important to provide organ donation-oriented training at every educational level.
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Affiliation(s)
- H Omer Tontus
- Molecular Biology & Genetics Department, Istanbul Technical University, Faculty of Science and Letters, ITU Ayazaga Campus, Istanbul, Turkey.
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Payne K, Popat S, Lipshultz LI, Thirumavalavan N. The Prevalence and Treatment of Erectile Dysfunction in Male Solid Organ Transplant Recipients. Sex Med Rev 2019; 9:331-339. [PMID: 31859242 DOI: 10.1016/j.sxmr.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a prevalent and under-recognized complaint among male solid organ transplant recipients. Most research on this topic has focused on kidney transplant recipients alone. In this review, we integrate current research on ED across all types of solid organ transplant recipients and assess the success of current methods of ED treatment in transplant populations. AIM To review the current literature addressing the prevalence and treatment of ED in the male solid organ transplant population. METHODS A literature search was conducted using PubMed to identify relevant studies. Search terms included "organ transplant" and "erectile dysfunction." Titles and abstracts were reviewed for relevance. References from identified articles were also searched and included, if appropriate. MAIN OUTCOME MEASURES Review of peer-reviewed literature. RESULTS The prevalence of ED among transplant recipients is higher than that in the general population: 39.8-86.2% in liver transplant recipients, 54-66% in renal transplant recipients, 71-78% in heart transplant recipients, and 79% in simultaneous pancreas-kidney transplant recipients. Phosphodiesterase-5 inhibitors have up to 80% efficacy in treating ED in kidney transplant recipients. Intracavernosal injections have been used with success rates of 60-70% in cardiac and renal transplant recipients. Penile prostheses have also been shown to be safe and effective across transplant types. A low incidence of infection has been reported in several case series, although there is concern for an increased rate of mechanical complications in pelvic organ transplant recipients. Accordingly, placement of a two-piece or malleable prosthesis or ectopic reservoir placement with a three-piece inflatable prosthesis is suggested in this population. CONCLUSION ED is highly prevalent among male solid organ transplant recipients and should be routinely screened in this population. Current modalities of ED treatment used in the general population are safe and effective in solid organ transplant recipients, although success rates are often lower than those in the general population. Payne K, Popat S, Lipshultz LI, et al. The Prevalence and Treatment of Erectile Dysfunction in Male Solid Organ Transplant Recipients. Sex Med Rev 2021;9:331-339.
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Affiliation(s)
| | - Shreeya Popat
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Nannan Thirumavalavan
- Urology Institute, University Hospitals/Case Western Reserve University School of Medicine, Cleveland, OH.
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Pek JH, Ho VK, Ng WS, Kabir T, Tiah L, Koh Y. Missed opportunities for organ donation in patients with intracranial haemorrhage at the emergency department: A single-centre study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105819868487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The demand for transplantable organs has increased in Singapore. However, organ donation has been consistently lower than international standards. Donation after brain death (DBD) most commonly follows intracranial haemorrhage (ICH). Objective: Our aim was to identify missed opportunities for organ donation among those who presented to the Emergency Department (ED) and died following ICH. Methods: A retrospective study was carried out for all cases of ICH presenting to the ED from 1 January 2013 to 31 December 2017. The patients’ medical records were reviewed for identification of potential donors and actualisation of organ donation. Results: There were 615 cases of ICH, with a mortality rate of 6.0%. Among those who died, 28 (75.7%) died in the Intensive Care Unit (ICU) and nine (24.3%) patients had withdrawal of care in the ED. Thirty patients (81.1%) were potential donors but organ donation was actualised in only three (8.1%) patients. Thirteen organs, as well as heart valves and iliac vessels were retrieved from the organ donors for transplantation. Conclusion: There were missed opportunities for organ donation. EDs have an important role to play in the national organ donation programme by identifying potential donors for organ donation and considering admitting these patients to ICU to facilitate organ donation.
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Affiliation(s)
- Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Vui Kian Ho
- Department of Intensive Care Medicine, Sengkang General Hospital, Singapore
| | - Wei Sheng Ng
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Tousif Kabir
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Ling Tiah
- Accident and Emergency Department, Changi General Hospital, Singapore
| | - Yexin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
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Brigham MD, Milgroom A, Lenco MO, Tudor T, Kent JD, LaMoreaux B, Johnson RJ, Mandell BF, Hadker N, Francis K, Sanchez H, Radeck LP, Li JW. Prevalence of Gout in the Surviving United States Solid Organ Transplantation Population. Transplant Proc 2019; 51:3449-3455. [PMID: 31733798 DOI: 10.1016/j.transproceed.2019.08.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/30/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Although incidence and survival are frequent topics within the solid organ transplantation (SOT) literature, the size of the surviving SOT population is not well known. Existing studies of gout in patients with SOT have focused on the incident SOT population. This analysis was performed to characterize the prevalent SOT population and the prevalence of gout within it. METHODS This study includes the 2017 United States (US) population size of recipients of kidney, heart, liver, and lung transplants that was estimated by combining primary transplant recipient cohort sizes (1988-2017) with previously published survival rates for each annual cohort's time since transplantation (0-29 years). Gout among prevalent patients with SOT was assessed using Medicare and commercial claims. RESULTS A total of 637,231 US patients received a primary kidney (393,953), liver (142,186), heart (66,637), or lung (34,455) transplant between 1988 and 2017. An estimated 356,000 (55.8%) recipients were alive in 2017 (233,000 kidney; 78,700 liver; 29,300 heart; 14,700 lung). Gout was identified in 11% of prevalent patients with SOT in 2016. Higher rates of gout were seen in recipients of kidney (13.1%) and heart (12.7%) compared to recipients of liver (6.7%) and lung (5.6%) (P < .0001 in both datasets). Active diagnosed gout prevalence in the US population without a SOT history was 1.1% in 2016. CONCLUSIONS Hundreds of thousands of US patients are living with a transplanted organ today and these numbers are likely to increase. In patients with SOT, gout is a frequent comorbidity of which physicians should be aware. This study suggests a markedly higher rate of gout among transplant recipients compared to the general US population.
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Affiliation(s)
- Mark D Brigham
- Trinity Partners LLC, Waltham, Massachusetts, United States
| | | | | | - Thilan Tudor
- Trinity Partners LLC, Waltham, Massachusetts, United States
| | - Jeffrey D Kent
- Horizon Pharma USA Inc, Medical Affairs, Lake Forest, Illinois, United States
| | - Brian LaMoreaux
- Horizon Pharma USA Inc, Medical Affairs, Lake Forest, Illinois, United States
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Aurora, Colorado, United States
| | | | - Nandini Hadker
- Trinity Partners LLC, Waltham, Massachusetts, United States
| | - Kevin Francis
- Trinity Partners LLC, Waltham, Massachusetts, United States
| | - Herman Sanchez
- Trinity Partners LLC, Waltham, Massachusetts, United States
| | | | - Justin W Li
- Trinity Partners LLC, Waltham, Massachusetts, United States.
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57
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Berry KN, Daniels N, Ladin K. Should Lack of Social Support Prevent Access to Organ Transplantation? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:13-24. [PMID: 31647757 DOI: 10.1080/15265161.2019.1665728] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Transplantation programs commonly rely on clinicians' judgments about patients' social support (care from friends or family) when deciding whether to list them for organ transplantation. We examine whether using social support to make listing decisions for adults seeking transplantation is morally legitimate, drawing on recent data about the evidence-base, implementation, and potential impacts of the criterion on underserved and diverse populations. We demonstrate that the rationale for the social support criterion, based in the principle of utility, is undermined by its reliance on tenuous evidence. Moreover, social support requirements may reinforce transplant inequities, interfere in patients' personal relationships, and contribute to biased and inconsistent listing procedures. As such, accommodating the needs of patients with limited social support would better balance ethical commitments to equity, utility, and respect for persons in transplantation. We suggest steps for researchers, transplantation programs, and policymakers to improve fair use of social support in transplantation.
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Chen YT, Lee WS, Tsai CA, Fan WC, Wu PF, Wang FD. Incidence of and risk factors for cryptococcosis in kidney transplant recipients in Taiwan-A nationwide population-based study. Int J Infect Dis 2019; 88:154-158. [PMID: 31449926 DOI: 10.1016/j.ijid.2019.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the long-term incidence of cryptococcosis in kidney transplant recipients (KTRs) and to analyze its risk factors. METHODS This retrospective population-based cohort study analyzed data obtained from Taiwan's National Health Insurance Research Database for KTRs during 2000-2012 and matched cohorts. Both populations were followed until death, development of cryptococcosis, or December 2013. RESULTS A total of 4,933 KTRs and 49,930 matched patients were included. The cryptococcosis incidence rates for the KTR cohort and matched cohort were 10.59 and 0.4 per 10,000 person-years, respectively. The hazard ratio for cryptococcosis among KTRs was 26.65 (p<0.001); and 43.77 (p<0.001) for cryptococcosis affecting the central nervous system (CNS). The Kaplan-Meier method confirmed an elevated cumulative incidence of cryptococcosis among KTRs (1.00% vs. 0.04%). Predictors for cryptococcosis were advanced age (OR 1.39, 95% CI 1.02-1.89, P=0.038) and cancer (OR 2.63, 95% CI 1.22-5.67, P=0.013), but not the use of any particular class of immunosuppressants. CONCLUSIONS KTRs are at dramatically higher risk of developing cryptococcosis, especially with CNS involvement, relative to a non-KTR matched cohort. Older KTRs and those with cancer are at even higher risk of developing cryptococcosis.
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Affiliation(s)
- Yung-Tai Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Nephrology, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
| | - Wen-Sen Lee
- Division of Infectious Disease, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Che-An Tsai
- Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Chien Fan
- Divisionof Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ping-Feng Wu
- Divisionof Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Der Wang
- Divisionof Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Tong C, Xia J, Xie B, Li M, Du F, Li C, Li Y, Shan Z, Qi Z. Immunogenicity analysis of decellularized cardiac scaffolds after transplantation into rats. Regen Med 2019; 14:447-464. [PMID: 31070505 DOI: 10.2217/rme-2018-0139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: Cardiac extracellular matrix (cECM) scaffolds are promising biomaterials for clinical applications. Our aim is to determine the immunogenicity of decellularized scaffolds from different sources for use as artificial organs during organ transplantation. Materials & methods: We transplanted Lewis rats with syngeneic (Lewis rat cECM), allogeneic (BN rat cECM) or xenogeneic (hamster cECM) decellularized cardiac scaffolds. Acute vascular and cellular rejection was quantified by immunohistochemistry and immune cell infiltration. Results: BN rat and hamster hearts were rejected following transplantation. BN and hamster cECMs had similarly low immunogenicity compared with Lewis rat cECMs and did not lead to increased rejection. Conclusion: We found that scaffolds from all sources did not induce vascular or cellular rejection and exhibited low immunogenicity.
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Affiliation(s)
- Cailing Tong
- School of Life Science, Xiamen University, Fujian, 361102, China.,Organ Transplantation Institute, Medical College, Xiamen University, Fujian, 361102, China.,Key Laboratory of Organ & Tissue Regeneration, Fujian Province, Fujian, 61102, China
| | - Junjie Xia
- Organ Transplantation Institute, Medical College, Xiamen University, Fujian, 361102, China.,Key Laboratory of Organ & Tissue Regeneration, Fujian Province, Fujian, 61102, China
| | - Baiyi Xie
- Organ Transplantation Institute, Medical College, Xiamen University, Fujian, 361102, China.,Key Laboratory of Organ & Tissue Regeneration, Fujian Province, Fujian, 61102, China
| | - Minghui Li
- Organ Transplantation Institute, Medical College, Xiamen University, Fujian, 361102, China.,Key Laboratory of Organ & Tissue Regeneration, Fujian Province, Fujian, 61102, China
| | - Feifei Du
- Organ Transplantation Institute, Medical College, Xiamen University, Fujian, 361102, China.,Key Laboratory of Organ & Tissue Regeneration, Fujian Province, Fujian, 61102, China
| | - Cheng Li
- Organ Transplantation Institute, Medical College, Xiamen University, Fujian, 361102, China.,Key Laboratory of Organ & Tissue Regeneration, Fujian Province, Fujian, 61102, China
| | - Yaguang Li
- Organ Transplantation Institute, Medical College, Xiamen University, Fujian, 361102, China.,Key Laboratory of Organ & Tissue Regeneration, Fujian Province, Fujian, 61102, China
| | - Zhonggui Shan
- Department of Cardiac Surgery, The First Affiliated Hospital of Xiamen University, Fujian, 361003, China
| | - Zhongquan Qi
- Organ Transplantation Institute, Medical College, Xiamen University, Fujian, 361102, China.,Key Laboratory of Organ & Tissue Regeneration, Fujian Province, Fujian, 61102, China
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Abstract
IMPACT STATEMENT Over the past several decades, ex vivo perfusion has emerged as a promising technology for the assessment, preservation, and recovery of donor organs. Many exciting pre-clinical findings have now been translated to clinical use, and successful transplantation following ex vivo perfusion has been achieved for heart, lung, and liver. While machine perfusion provides distinct advantages over traditional cold preservation, many challenges remain, including that of long-term (multi-day) ex vivo support. Here, we provide an overview of the current status of ex vivo machine perfusion in the pre-clinical and clinical setting and share our perspective on the future direction of the field.
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Affiliation(s)
- Meghan Pinezich
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
- Department of Medicine, Columbia University, New York NY 10032, USA
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Jiang X, Jiang W, Cai J, Su Q, Zhou Z, He L, Lai K. Characterizing Media Content and Effects of Organ Donation on a Social Media Platform: Content Analysis. J Med Internet Res 2019; 21:e13058. [PMID: 30860489 PMCID: PMC6434401 DOI: 10.2196/13058] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/11/2019] [Accepted: 03/03/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The lack of organ donors has become a barrier for the development of organ transplantation programs, and many countries are currently facing a severe shortage of deceased organs. Media campaigns on social media have the potential to promote organ donation. However, little is known about what kind of media content is the most appropriate for this purpose. OBJECTIVE This study aimed to analyze media posts regarding organ donation on Weibo, a social media platform, and to identify the media themes that are most advantageous in promoting public awareness and attitudes concerning organ donation. METHODS Based on 16 million social media users' posts randomly extracted from January 1 to December 31, 2017, 1507 reposts of 141 distinct media posts relevant to organ donation were found. We analyzed the media posts' themes and examined their effects in promoting public awareness about organ donation by comparing the number of reposts and comments they prompted. The themes' impact on attitude toward organ donation was gauged using the comments indicating support and intentions for organ donation. RESULTS Overall, 5 major themes were identified from the media posts, among which "organ donation behaviors" constituted the highest proportion (58/141, 41.13%). However, themes of "statistical descriptions of organ donation" and "meaningfulness of donation" were the most influential in promoting awareness on organ donation: approximately 3 of 10 commenters for the former theme and 2 of 10 commenters for the latter expressed intentions to become organ donors. These two themes, along with "meaningfulness of organ donation for society," a subtheme of "meaningfulness of donation," were the most effective for evoking support and intentions for donation. CONCLUSIONS A discrepancy was revealed between the media themes that were the most salient on the media agenda and those that were the most effective in increasing organ donation awareness and intentions on social media. These findings provide guidance for campaigns on organ donation. The results also suggest the potential of campaigns on social media for promoting prosocial health behaviors and highlight the importance of strategic message design for serving this goal.
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Affiliation(s)
- Xiaoya Jiang
- School of Communication and Design, Sun Yat-Sen University, Guangzhou, China
| | - Wenshi Jiang
- Intelligence Sharing for Life Science Research Institute, Shenzhen, China
| | - Jiawei Cai
- Intelligence Sharing for Life Science Research Institute, Shenzhen, China
| | - Qingdong Su
- 923 Hospital of Chinese People's Liberation Army, Nanning, China
| | - Zhigang Zhou
- The First People's Hospital of Kunming, Kunming, China
| | - Lingnan He
- School of Communication and Design, Sun Yat-Sen University, Guangzhou, China.,Guangdong Key Laboratory for Big Data Analysis and Simulation of Public Opinion, Guangzhou, China
| | - Kaisheng Lai
- School of Journalism and Communication, Jinan University, Guangzhou, China
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Bezinover D, Saner F. Organ transplantation in the modern era. BMC Anesthesiol 2019; 19:32. [PMID: 30832567 PMCID: PMC6399965 DOI: 10.1186/s12871-019-0704-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/25/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Dmitri Bezinover
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Fuat Saner
- Department of General-, Visceral- and Transplantation Surgery, Essen University Medical Center, Hufelandstr 55, 45147, Essen, Germany
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63
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Boudreau G, Carli C, Lamarche C, Rulleau C, Bonnaure G, Néron S, Delisle JS. Leukoreduction system chambers are a reliable cellular source for the manufacturing of T-cell therapeutics. Transfusion 2018; 59:1300-1311. [DOI: 10.1111/trf.15121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Gabrielle Boudreau
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Cédric Carli
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Caroline Lamarche
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Caroline Rulleau
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
| | - Guillaume Bonnaure
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
- Medical Affairs and Innovation; Héma-Québec; Québec Québec Canada
| | - Sonia Néron
- Medical Affairs and Innovation; Héma-Québec; Québec Québec Canada
- Department of Biochemistry, Microbiology and Bio-informatics; Université Laval; Québec Québec Canada
| | - Jean-Sébastien Delisle
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
- Hematology-Oncology Division; Hôpital Maisonneuve-Rosemont; Montréal Québec Canada
- Department of Medicine; Université de Montréal; Montreal Québec Canada
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Sen A, Callisen H, Libricz S, Patel B. Complications of Solid Organ Transplantation: Cardiovascular, Neurologic, Renal, and Gastrointestinal. Crit Care Clin 2018; 35:169-186. [PMID: 30447778 DOI: 10.1016/j.ccc.2018.08.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Despite improvements in overall graft function and patient survival rates after solid organ transplantation, complications can lead to significant morbidity and mortality. Cardiovascular complications include heart failure, arrhythmias leading to sudden death, hypertension, left ventricular hypertrophy, and allograft vasculopathy in heart transplantation. Neurologic complications include stroke, posterior reversible encephalopathy syndrome, infections, neuromuscular disease, seizure disorders, and neoplastic disease. Acute kidney injury occurs from immunosuppression with calcineurin inhibitors or as a result of graft failure after kidney transplantation. Gastrointestinal complications include infections, malignancy, mucosal ulceration, perforation, biliary tract disease, pancreatitis, and diverticular disease. Immunosuppression can predispose to infections and malignancy.
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Affiliation(s)
- Ayan Sen
- Department of Critical Care Medicine, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Hannelisa Callisen
- Department of Critical Care Medicine, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Stacy Libricz
- Department of Critical Care Medicine, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Bhavesh Patel
- Department of Critical Care Medicine, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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66
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Cajanding R. Immunosuppression following organ transplantation. Part 1: mechanisms and immunosuppressive agents. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2018; 27:920-927. [PMID: 30187798 DOI: 10.12968/bjon.2018.27.16.920] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Solid organ transplantation has revolutionised medical care by providing a definitive cure for a wide spectrum of end-stage medical conditions. This treatment, however, does not come without complications and poses the risks of rejection, life-threatening infection, malignancies and recurrent organ failure, with significant impacts on patient outcomes. One of the major challenges involved in optimising post-transplant outcomes is managing the immune system's response to the transplanted graft and preventing organ rejection. This is mainly accomplished through the use of immunosuppressant agents, which have become a mainstay of treatment for a majority of post-transplant patients. This article, the first of two parts, discusses the concept of immunosuppression and its importance in the care of patients who have received an organ transplant. It focuses on the pathophysiologic mechanisms involved in transplant rejection and discusses the pharmacologic aspects of immunosuppression and its implications for patient care.
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Affiliation(s)
- Ruff Cajanding
- Staff Nurse, Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
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67
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Brett KE, Ritchie LJ, Ertel E, Bennett A, Knoll GA. Quality Metrics in Solid Organ Transplantation: A Systematic Review. Transplantation 2018; 102:e308-e330. [PMID: 29557915 PMCID: PMC7228649 DOI: 10.1097/tp.0000000000002149] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/20/2017] [Accepted: 01/14/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The best approach for determining whether a transplant program is delivering high-quality care is unknown. This review aims to identify and characterize quality metrics in solid organ transplantation. METHODS Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from inception until February 1, 2017. Relevant full text reports and conference abstracts that examined quality metrics in organ transplantation were included. Two reviewers independently extracted study characteristics and quality metrics from 52 full text reports and 24 abstracts. PROSPERO registration: CRD42016035353. RESULTS Three hundred seventeen quality metrics were identified and condensed into 114 unique indicators with sufficient detail to be measured in practice; however, many lacked details on development and selection, were poorly defined, or had inconsistent definitions. The process for selecting quality indicators was described in only 5 publications and patient involvement was noted in only 1. Twenty-four reports used the indicators in clinical care, including 12 quality improvement studies. Only 14 quality metrics were assessed against patient and graft survivals. CONCLUSIONS More than 300 quality metrics have been reported in transplantation but many lacked details on development and selection, were poorly defined, or had inconsistent definitions. Measures have focused on safety and effectiveness with very few addressing other quality domains, such as equity and patient-centeredness. Future research will need to focus on transparent and objective metric development with proper testing, evaluation, and implementation in practice. Patients will need to be involved to ensure that transplantation quality metrics measure what is important to them.
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Affiliation(s)
- Kendra E Brett
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lindsay J Ritchie
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Ertel
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexandria Bennett
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Greg A Knoll
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Fontana F, Massari M, Giovannini L, Alfano G, Cappelli G. Knowledge and Attitudes Toward Organ Donation in Health Care Undergraduate Students in Italy. Transplant Proc 2018; 49:1982-1987. [PMID: 29149948 DOI: 10.1016/j.transproceed.2017.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/22/2017] [Accepted: 09/02/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The number of organ donors in Italy is increasing, but with still disappointing living donation activity and relatively frequent objection by potential deceased donors' relatives to organ recovery. Few studies have assessed health care students' knowledge and attitude on donation. METHODS We administered a questionnaire to medical (MS) and nursing students (NS) at University of Modena and Reggio Emilia, Italy, and 749 students (406 MS and 343 NS) completed the questionnaire. RESULTS Although 95% of students were in favor of donation, only 21.9% of NS and 24.9% of MS were registered as donors. One quarter of students reported family disagreement. MS appeared more confident with personnel involved in donation. Overall, 60% of students knew the term donation after brain death but only 40% were aware of the criteria used to define it. Barely 27.1% of NS and 15.3% of MS believed they had received sufficient information in lessons. Backward logistic regression demonstrated that students whose families agree with them and who knew the definition of donation after brain death were more likely to express the disposition of registering, and those who showed distrust in the declaration of brain death were half as likely to register as donors. DISCUSSION Students expressed a lack of knowledge, controversial attitudes on donation, and strong need for education; increased awareness may help increase donation rates. The majority of educational institutions in Italy do not directly address training on organ donation and transplantation for health care students; an integrated curriculum favoring interpersonal discussion including practical aspects is urgently required.
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Affiliation(s)
- F Fontana
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy.
| | - M Massari
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - L Giovannini
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Alfano
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
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Abstract
Immunosuppressive therapy is arguably the most important component of medical care after lung transplantation. The goal of immunosuppression is to prevent acute and chronic rejection while maximizing patient survival and long-term allograft function. However, the benefits of immunosuppressive therapy must be balanced against the side effects and major toxicities of these medications. Immunosuppressive agents can be classified as induction agents, maintenance therapies, treatments for acute rejection and chronic rejection and antibody directed therapies. Although induction therapy remains an area of controversy in lung transplantation, it is still used in the majority of transplant centers. On the other hand, maintenance immunosuppression is less contentious; but, unfortunately, since the creation of three-drug combination therapy, including a glucocorticoid, calcineurin inhibitor and anti-metabolite, there have been relatively modest improvements in chronic maintenance immunosuppressive regimens. The presence of HLA antibodies in transplant candidates and development of de novo antibodies after transplantation remain a major therapeutic challenge before and after lung transplantation. In this chapter we review the medications used for induction and maintenance immunosuppression along with their efficacy and side effect profiles. We also review strategies and evidence for HLA desensitization prior to lung transplantation and management of de novo antibody formation after transplant. Finally, we review immune tolerance and the future of lung transplantation to limit the toxicities of conventional immunosuppressive therapy.
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Affiliation(s)
- Luke J Benvenuto
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, USA
| | - Michaela R Anderson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, USA
| | - Selim M Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, USA
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Hajar Z, Medawar W, Rizk N. Saprochaete capitata (Geotrichum capitatum), an emerging fungal infection in kidney transplant recipients. J Mycol Med 2018; 28:387-389. [PMID: 29709266 DOI: 10.1016/j.mycmed.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 11/30/2022]
Abstract
We are reporting the case of an 82-year-old Yemeni patient, renal transplant recipient who was admitted to our institution and who subsequently developed disseminated infection with Saprochaete capitata. This pathogenic fungus is rarely reported in patients with solid organ trans-plants. Saprochaete capitata is an emerging fungal pathogen, ubiquitously spread in the environment. This is the second case to our knowledge of infection with Saprochaete capitata in a renal transplant patient. Our patient was treated for multiple nosocomial infections with prolonged antibiotic courses. He succumbed to the infection with Saprochaete capitate after several weeks spent in the intensive care unit.
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Affiliation(s)
- Z Hajar
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - W Medawar
- Department of Internal Medicine, Division of Nephrology, American University of Beirut Medical Center, Beirut, Lebanon
| | - N Rizk
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.
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71
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Kiani M, Abbasi M, Ahmadi M, Salehi B. Organ Transplantation in Iran; Current State and Challenges with a View on Ethical Consideration. J Clin Med 2018; 7:E45. [PMID: 29510570 PMCID: PMC5867571 DOI: 10.3390/jcm7030045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 12/31/2022] Open
Abstract
Organ transplantation is a new issue in medical science. It is an important achievement and a sign of the progression and ability of medical centers around the world. Governments, populations, the medical community and people involved in culture, art, and media all have a decisive role in the culture of organ donation, which is the only way to guarantee that the healthy organs of a brain-dead person can continue to work and save the lives of people in need of organ transplantation. The brain death phenomenon and its possible application in organ transplantation, while offering new hope for the salvation of a number of patients, has led to many ethical, cultural, and legal issues. Ethical issues in organ transplantation are very complicated due to many social factors such as religion, culture, and traditions of the affected communities. The ethical and legal points of removing organs from the body of a living or cadaveric source, the definition of brain death, the moral and legal conditions of the donor and the recipient, and the financial relationship between them and many others, are all critical issues in organ transplantation. While there may be no available explicit solution to these issues, they should be rigorously considered by the experts. Efforts to systematically eliminate barriers and solve problems in organ transplantation, can not only reduce the costs of maintaining brain-dead patients and encourage patients that need organ transplantation but can also prevent immoral and illegal activities. In this paper, we have reviewed the most important and current challenges in organ transplantation with a view to the ethical considerations, and we have suggested some strategies to extend it in Iran.
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Affiliation(s)
- Mehrzad Kiani
- Department of Medical Ethics, Faculty of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran.
| | - Mahmoud Abbasi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran.
| | - Mehdi Ahmadi
- Razi Vaccine and Serum Research Institute (RVSRI), Agricultural Research, Education and Extension Organization (AREEO), Karaj 3197619751, Iran.
| | - Bahare Salehi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran.
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72
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Buchanan IA, Mehta VA. Thyroid hormone resuscitation after brain death in potential organ donors: A primer for neurocritical care providers and narrative review of the literature. Clin Neurol Neurosurg 2018; 165:96-102. [DOI: 10.1016/j.clineuro.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/03/2018] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
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Mellon L, Doyle F, Hickey A, Ward KD, de Freitas DG, McCormick PA, O'Connell O, Conlon P. Interventions for improving medication adherence in solid organ transplant recipients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Lisa Mellon
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephens Green Dublin 2 Ireland
| | - Frank Doyle
- Royal College of Surgeons in Ireland; Department of Psychology; 123 Ste Stephens Green Dublin Dublin Ireland D2
| | - Anne Hickey
- Royal College of Surgeons in Ireland; Department of Psychology; 123 Ste Stephens Green Dublin Dublin Ireland D2
| | - Kenneth D Ward
- University of Memphis; School of Public Health; Memphis Tennessee USA 38152
| | - Declan G de Freitas
- Beaumont Hospital; Department Nephrology and Kidney Transplantation; Beaumont Road Dublin Dublin Ireland Dublin 9
| | - P Aiden McCormick
- St Vincent's University Hospital; Irish Liver Transplant Unit; Elm Park, Merrion Road Dublin Dublin Ireland D4
| | - Oisin O'Connell
- Mater Misericordiae University; Irish National Lung and Heart Transplant Program; Eccles Street Dublin Dublin Ireland D7
| | - Peter Conlon
- Beaumont Hospital; Department Nephrology and Kidney Transplantation; Beaumont Road Dublin Dublin Ireland Dublin 9
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74
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Abstract
The field of pediatric solid-organ transplantation has significantly evolved since its beginnings in the early 20th century. As advancements have led to the development of innovative surgical techniques and novel medication regimens, transplantation has now become a routine practice leading to an increase in the rates of organ recipients worldwide. The care of pediatric solid-organ transplant recipients differs from adults in several areas not only due to technically challenging surgeries, but mostly due to the complexity of their immunosuppression management. Although there is large variation of pediatric immunosuppression regimens worldwide, the use of calcineurin inhibitors, either tacrolimus or cyclosporine, still forms the backbone of immunosuppression regimens after solid-organ transplantation. Both medications are relatively well tolerated but are known to have long-term side effects, especially nephrotoxicity and neurotoxicity. The goal of care in long-term pediatric survivors of solid-organ transplant now aims to safely minimize exposure to immunosuppression and to achieve long-term graft tolerance.
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Affiliation(s)
- Niviann M Blondet
- Department of Pediatrics, Division of Gastroenterology and Hepatology, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA.
| | - Patrick J Healey
- Department of Pediatric Surgery, Division of Transplantation, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA
| | - Evelyn Hsu
- Department of Pediatrics, Division of Gastroenterology and Hepatology, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA
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Abstract
Penile transplantation is a novel approach to management of penile loss in the developing field of composite tissue allotransplantation (CTA). Prior management for significant penile loss has been free flap phalloplasty with issues related to function, cosmesis, and functional loss from the location of flap harvest. Transplantation has been an evolving field with advancement in CTA over the past several decades leading to the option of penile transplant. Management of penile injury with replantation provided some preliminary groundwork on the technical aspects for penile transplantation. Additionally, penile transplantation raises many ethical, emotional, and psychological considerations with need for patience amidst ongoing advancement within the field.
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Affiliation(s)
- Alison M Rasper
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ryan P Terlecki
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
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Hatayama N, Inubushi M, Naito M, Hirai S, Jin YN, Tsuji AB, Seki K, Itoh M, Saga T, Li XK. Functional evaluation of rat hearts transplanted after preservation in a high-pressure gaseous mixture of carbon monoxide and oxygen. Sci Rep 2016; 6:32120. [PMID: 27562456 PMCID: PMC4999799 DOI: 10.1038/srep32120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/02/2016] [Indexed: 02/08/2023] Open
Abstract
We recently succeeded in resuscitating an extracted rat heart following 24–48 hours of preservation in a high-pressure gaseous mixture of carbon monoxide (CO) and oxygen (O2). This study aimed to examine the function of rat hearts transplanted after being preserved in the high-pressure CO and O2 gas mixture. The hearts of donor rats were preserved in a chamber filled with CO and O2 under high pressure for 24 h (CO24h) or 48 h at 4 °C. For the positive control (PC) group, hearts immediately extracted from donor rats were used for transplantation. The preserved hearts were transplanted into recipient rats by heterotopic cervical heart transplantation. CO toxicity does not affect the grafts or the recipients. Light microscopy and [18F]-fluorodeoxyglucose positron emission tomography revealed that there were no significant differences in the size of the myocardial infarction or apoptosis of myocardial cells in post-transplant hearts between the PC and CO24h groups. Furthermore, at 100 days after the transplantation, the heart rate, weight and histological staining of the post-transplanted hearts did not differ significantly between the PC and CO24h groups. These results indicate that the function of rat hearts is well preserved after 24 hours of high-pressure preservation in a CO and O2 gas mixture. Therefore, high-pressure preservation in a gas mixture can be a useful method for organ preservation.
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Affiliation(s)
- Naoyuki Hatayama
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan.,Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-city, Aichi Pref., 480-1195, Japan
| | - Masayuki Inubushi
- Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan.,Department of Nuclear Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Munekazu Naito
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan.,Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-city, Aichi Pref., 480-1195, Japan
| | - Shuichi Hirai
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Yong-Nan Jin
- Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan
| | - Atsushi B Tsuji
- Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan
| | | | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Tsuneo Saga
- Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan
| | - Xiao-Kang Li
- National Research Institute for Child Health and Development, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW Transplantation tolerance, successful acceptance of an organ without the perils of immunosuppression, has been a central goal of transplant research. Many strategies to achieve this tolerance have been examined over the past three decades, culminating in several human trials of transplant tolerance. This progression from the 'benchtop to the clinic' has depended on the successful implementation of these tolerance strategies in nonhuman primates. This review will examine the described methods of transplant tolerance induction in nonhuman primates. RECENT FINDINGS Although costimulatory blockade and mixed chimerism have an established record of achieving transplant tolerance in nonhuman primates, some of the most innovative recent techniques of tolerance induction have relied on cellular transfer. This review will fully examine the role of regulatory T-cell transfer and the use of mesenchymal stem/stromal cells to promote tolerance of organ allografts in nonhuman primates. SUMMARY Use of translational nonhuman primate transplant models is a vital intermediate step to advance new approaches of transplant tolerance induction from the lab to the clinic. This review will explore numerous techniques of tolerance induction that have been piloted in primates, including depletional techniques, induction of mixed hematopoietic chimerism, costimulation blockade, and adoptive transfer of tolerogenic cell populations.
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78
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Abstract
Immunosuppression use for prevention of allograft recognition/rejection has evolved to reflect an expanded understanding of the immune system, as well as a fine tuning of the goals of therapy. Immunosuppression in organ transplantation represents a balance between the desire to improve the health status of an individual affected by chronic conditions versus not imposing an unintended immunodeficiency leading to iatrogenic morbidity/mortality. This article discusses the selection and general dosing of immunosuppression in organ allograft recipients to allow providers to be comfortable in monitoring immunosuppressive therapy long term and the associated, expected posttransplant complications in allograft recipients.
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Affiliation(s)
- Gregory Malat
- Solid Organ Transplantation, Hahnemann University Hospital, Drexel University College of Medicine, 216 North Broad Street, MS 417, 5th Floor Feinstein Building, Philadelphia, PA 19102, USA.
| | - Christine Culkin
- Solid Organ Transplantation, Hahnemann University Hospital, Philadelphia, PA, USA
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Public's Knowledge and Attitudes Toward Vascularized Composite Allotransplantation and Donation. Aesthetic Plast Surg 2016; 40:301-8. [PMID: 26893283 DOI: 10.1007/s00266-016-0623-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/01/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The purpose of this survey was to assess the public's knowledge and attitudes toward vascularized composite allotransplantation and donation. METHODS Members of the public (n = 5942) were surveyed using a questionnaire that examined their knowledge and attitudes concerning solid organs (kidney, heart, liver, lung, and pancreas) and vascularized composite tissue (hand/upper extremity, lower extremity, abdominal wall, and face) transplantations and donations. RESULTS Respondents demonstrated greater (all P < 0.05) knowledge and willingness to donate and/or receive solid organs than vascularized composite tissues. Educational level, accurate knowledge, willingness to donate, and willingness to receive were significant (all P < 0.05) determinants of acceptance to donate and/or receive hand/upper extremity, lower extremity, face, and/or abdominal wall. CONCLUSION The public presented less knowledge and willingness to donate and/or receive hand/upper extremity, lower extremity, abdominal wall, and face. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Morgan M, Kenten C, Deedat S, Farsides B, Newton T, Randhawa G, Sims J, Sque M. Increasing the acceptability and rates of organ donation among minority ethnic groups: a programme of observational and evaluative research on Donation, Transplantation and Ethnicity (DonaTE). PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BackgroundBlack, Asian and minority ethnic (BAME) groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks.ObjectiveTo identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent.MethodsThree-phase programme comprising (1) community-based research involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; (2) hospital-based research examining staff practices and influences on family consent through ethics discussion groups (EDGs) with staff, a study on intensive care units (ICUs) and interviews with bereaved ethnic minority families; and (3) development and evaluation of a training package to enhance cultural competence among ICU staff.SettingCommunity focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts (three in London and two in Midlands).Participants(1) Community studies: 228 focus group participants; (2) hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and (3) evaluation: 66 health professionals.Data sourcesFocus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation.Review methodsSystematic review and narrative synthesis.Results(1) Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. (2) Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation (SNOD) reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory (or cardiac) death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. (3) Evaluation: professional development package – a digital versatile disc-based training package was developed to promote confidence and skills in cross-cultural communication (available at:www.youtube.com/watch?v=ueaR6XYkeVM&feature=youtu.be). Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation.LimitationsParticipants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families.ConclusionsThe research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS.Future workGreater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Myfanwy Morgan
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Charlotte Kenten
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Sarah Deedat
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Bobbie Farsides
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Tim Newton
- Dental Institute, King’s College London, London, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Jessica Sims
- Division of Health and Social Care Research, King’s College London, London, UK
| | - Magi Sque
- Faculty of Education, Health and Wellbeing, University of Wolverhampton and Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Chang CC, Chen SCA. Colliding Epidemics and the Rise of Cryptococcosis. J Fungi (Basel) 2015; 2:jof2010001. [PMID: 29376920 PMCID: PMC5753082 DOI: 10.3390/jof2010001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/18/2015] [Accepted: 12/09/2015] [Indexed: 12/15/2022] Open
Abstract
Discovered more than 100 years ago as a human pathogen, the Cryptococcus neoformans–Cryptococcus gattii (C. neoformans–C. gattii) complex has seen a large global resurgence in its association with clinical disease in the last 30 years. First isolated in fermenting peach juice, and identified as a human pathogen in 1894 in a patient with bone lesions, this environmental pathogen has now found niches in soil, trees, birds, and domestic pets. Cryptococcosis is well recognized as an opportunistic infection and was first noted to be associated with reticuloendothelial cancers in the 1950s. Since then, advances in transplant immunology, medical science and surgical techniques have led to increasing numbers of solid organ transplantations (SOT) and hematological stem cell transplantations being performed, and the use of biological immunotherapeutics in increasingly high-risk and older individuals, have contributed to the further rise in cryptococcosis. Globally, however, the major driver for revivification of cryptococcosis is undoubtedly the HIV epidemic, particularly in Sub-Saharan Africa where access to care and antiretroviral therapy remains limited and advanced immunodeficiency, poverty and malnutrition remains the norm. As a zoonotic disease, environmental outbreaks of both human and animal cryptococcosis have been reported, possibly driven by climate change. This is best exemplified by the resurgence of C. gattii infection in Vancouver Island, Canada, and the Pacific Northwest of the United States since 1999. Here we describe how the colliding epidemics of HIV, transplantation and immunologics, climate change and migration have contributed to the rise of cryptococcosis.
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Affiliation(s)
- Christina C Chang
- Department of Infectious Diseases, Alfred Hospital, Monash University, Melbourne 3181, Australia.
- HIV Pathogenesis Programme, University of KwaZulu Natal, Durban 4001, South Africa.
| | - Sharon C-A Chen
- Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, University of Sydney, Sydney 2145, Australia.
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, Sydney 2145, Australia.
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82
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Tolerogenic Dendritic Cells on Transplantation: Immunotherapy Based on Second Signal Blockage. J Immunol Res 2015; 2015:856707. [PMID: 26543876 PMCID: PMC4620289 DOI: 10.1155/2015/856707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/23/2015] [Accepted: 06/29/2015] [Indexed: 12/16/2022] Open
Abstract
Dendritic cells (DCs), the most important professional antigen-presenting cells (APC), play crucial role in both immunity and tolerance. It is well known that DCs are able to mount immune responses against foreign antigens and simultaneously tolerate self-antigens. Since DCs can be modulated depending on the surrounding microenvironment, they can act as a bridge between innate and adaptive immunity. However, the mechanisms that support this dual role are not entirely clear. Recent studies have shown that DCs can be manipulated ex vivo in order to trigger their tolerogenic profile, what can be a tool to be used in clinical trials aiming the treatment of various diseases and the prevention of transplant rejection. In this sense, the blockage of costimulatory molecules on DC, in the attempt of inhibiting the second signal in the immunological synapse, can be considered as one of the main strategies under development. This review brings an update on current therapies using tolerogenic dendritic cells modulated with costimulatory blockers with the aim of reducing transplant rejection. However, although there are current clinical trials using tolerogenic DC to treat allograft rejection, the actual challenge is to modulate these cells in order to maintain a permanent tolerogenic profile.
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83
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Organ Donation Among Health Care Providers: Is Giving and Receiving Similar? Transplant Proc 2015; 47:1567-71. [DOI: 10.1016/j.transproceed.2015.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/16/2015] [Indexed: 12/23/2022]
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84
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Mercado-Martínez FJ, Padilla-Altamira C, Díaz-Medina B, Sánchez-Pimienta C. Views of health care personnel on organ donation and transplantation: A literature review. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-07072015003842014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study was to review the empirical studies on health personnel's views towards organ donation and transplantation. A scoping review was carried out in English, Portuguese and Spanish. The search was conducted in eight databases, and two search engines. Four groups of descriptors were used. The period covered was 1985 to 2013. Frequency and content analysis was performed. Two hundred forty-eight articles were selected, out of 316 identified. The literature is temporally and geographically clustered. Quantitative studies predominate. The studies prioritized the perspective of medical and nursing personnel over other actors, such as directors and organ donation coordinators. Health personnel's attitudes toward deceased organ donation was the most examined topic. In conclusion, a growing quantitative literature analyzes the perspective of physicians and nurses with regard to deceased organ donation and transplantation.
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85
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Pirofski LA, Casadevall A. What is infectiveness and how is it involved in infection and immunity? BMC Immunol 2015; 16:13. [PMID: 25887484 PMCID: PMC4374184 DOI: 10.1186/s12865-015-0076-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/05/2015] [Indexed: 12/02/2022] Open
Abstract
Proof of the Germ theory of disease and acceptance of Koch’s postulates in the late 1890’s launched the fields of microbial pathogenesis and infectious diseases and provided the conceptual framework that has guided thought and research in these fields. A central tenet that emerged from studies with microbes that fulfilled Koch’s postulates was that microbes that caused disease had characteristics that allowed them to do so, with the corollary that microbes that did not cause disease lacked disease-causing determinants. This observation, which held true for many diseases that were known to cause disease in the late 19th century, such as toxin-producing and encapsulated bacteria, led to the view that the ability to cause disease rested with microbes and reflected the activity of specific determinants, or virulence factors. With the dawn of the 20th century, efforts to neutralize virulence factors were under development and ultimately translated into anti-microbial therapy in the form of antibodies targeted to toxins and polysaccharide capsules. However, the 20th century progressed, antibiotics were identified and developed as therapy for infectious diseases while other medical advances, such as specialized surgeries, intensive care units, intravenous catheters, and cytotoxic chemotherapy became commonplace in resourced nations. An unintended consequence of many of these advances was that they resulted in immune impairment. Similarly, HIV/AIDS, which emerged in the late 1970’s also produced profound immune impairment. Unexpectedly, the prevailing view that microbes were the sole perpetrators of virulence was untenable. Microbes that were rarely if ever associated with disease emerged as major causes of disease in people with impaired immunity. This phenomenon revealed that available explanations for microbial infectiveness and virulence were flawed. In this review, we discuss the question ‘what is infectiveness’ based on the tenets of the Damage-response framework.
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Affiliation(s)
- Liise-anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Room 610 Belfer Building, 1300 Morris Park Avenue, Bronx, NY, 10461, USA. .,Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Arturo Casadevall
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA.
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86
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Champigneulle B, Charpentier J. Conséquences cardiovasculaires de la mort cérébrale et prise en charge pour prélèvement d’organe(s). MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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87
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One million haemopoietic stem-cell transplants: a retrospective observational study. LANCET HAEMATOLOGY 2015; 2:e91-100. [PMID: 26687803 DOI: 10.1016/s2352-3026(15)00028-9] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 01/27/2015] [Accepted: 01/30/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND The transplantation of cells, tissues, and organs has been recognised by WHO as an important medical task for its member states; however, information about how to best organise transplantation is scarce. We aimed to document the activity worldwide from the beginning of transplantation and search for region adapted indications and associations between transplant rates and macroeconomics. METHODS Between Jan 1, 2006, and Dec 31, 2014, the Worldwide Network for Blood and Marrow Transplantation collected data for the evolution of haemopoietic stem-cell transplantation (HSCT) activity and volunteer donors in the 194 WHO member states. FINDINGS 953,651 HSCTs (553,350 [58%] autologous and 400,301 [42%] allogeneic) were reported by 1516 transplant centres from 75 countries. No transplants were done in countries with fewer than 300,000 inhabitants, a surface area less than 700 km(2), and a gross national income per person of US$1260 or lower. Use of HSCT increased from the first transplant in 1957 to almost 10,000 by 1985. We recorded a cumulative total of about 100,000 transplants by 1995, and an estimated 1 million by December, 2012. Unrelated donor registries contributed 22·3 million typed volunteer donors and 645,646 cord blood products by 2012. Numbers of allogeneic HSCTs increased in the past 35 years with no signs of saturation (R(2)=0·989). Transplant rates were higher in countries with more resources, more transplant teams, and an unrelated donor infrastructure. INTERPRETATION Our findings show achievements and high unmet needs and give guidance for decisions; to grant access for patients, to provide a donor infrastructure, and to limit overuse by defining risk and region adapted indications for HSCT as an efficient and cost-effective approach for life-threatening, potentially curable diseases. FUNDING Funding for this study was indirectly provided by support of the WBMT.
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88
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Moran EC, Dhal A, Vyas D, Lanas A, Soker S, Baptista PM. Whole-organ bioengineering: current tales of modern alchemy. Transl Res 2014; 163:259-67. [PMID: 24486135 DOI: 10.1016/j.trsl.2014.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/06/2014] [Indexed: 12/31/2022]
Abstract
End-stage organ disease affects millions of people around the world, to whom organ transplantation is the only definitive cure available. However, persistent organ shortage and the resulting widespread transplant backlog are part of a disturbing reality and a common burden felt by thousands of patients on waiting lists in almost every country where organ transplants are performed. Several alternatives and potential solutions to this problem have been sought in past decades, but one seems particularly promising now: whole-organ bioengineering. This review describes briefly the evolution of organ transplantation and the development of decellularized organ scaffolds and their application to organ bioengineering. This modern alchemy of generating whole-organ scaffolds and recellularizing them with multiple cell types in perfusion bioreactors is paving the way for a new revolution in transplantation medicine. Furthermore, although the first generation of bioengineered organs still lacks true clinical value, it has created a number of novel tissue and organ model platforms with direct application in other areas of science (eg, developmental biology and stem cell biology, drug discovery, physiology and metabolism). In this review, we describe the current status and numerous applications of whole-organ bioengineering, focusing also on the multiple challenges that researchers have to overcome to translate these novel technologies fully into transplantation medicine.
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Affiliation(s)
- Emma C Moran
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, NC
| | - Abritee Dhal
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, NC
| | - Dipen Vyas
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, NC
| | - Angel Lanas
- University of Zaragoza, Zaragoza, Spain; IIS Aragón, CIBERehd, Zaragoza, Spain
| | - Shay Soker
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, NC
| | - Pedro M Baptista
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, NC; Aragon Health Sciences Institute, Zaragoza, Spain.
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89
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Marino IR, Cirillo C. An Abridged Photographic History of Organ Transplantation. EXP CLIN TRANSPLANT 2014; 12 Suppl 1:11-6. [DOI: 10.6002/ect.25liver.l14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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90
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Abstract
Complex multiorgan failure may require simultaneous transplantation of several organs, including heart-lung, kidney-pancreas, or multivisceral transplantation. Solid organ transplantation can also be combined with hematopoietic stem cell transplantation to modulate immunologic response to a solid organ allograft. Combined multiorgan transplantation may offer a lower rate of allograft rejection and lower immunosuppression needs. In recent years, intestinal and multivisceral transplantations became viable as a rescue treatment for patients with irreversible intestinal failure who can no longer tolerate total parenteral nutrition with 70% survival after 5 years which is comparable to other types of solid organ allografts. Post-transplant neurologic complications were reported in up to 86% of allograft recipients and greatly overlap in intestinal and multivisceral allograft recipients, without a significant effect on the outcome of transplantation. Other common organ combinations in multiorgan transplantation include kidney-pancreas, which is mostly used for patients with renal failure and uncontrolled diabetes, and heart-lung for patients with congenital heart disease and idiopathic pulmonary arterial hypertension. Kidney-pancreas transplantation frequently results in an improvement of diabetic complications, including diabetic neuropathy. Heart-lung allograft recipients have very similar clinical course and spectrum of neurologic complications to lung transplant recipients. At this time there are no reports of an increased risk of graft-versus-host disease with combined transplantation of solid organ allograft and hematopoietic stem cells. Chronic immunosuppression and complex toxic-metabolic disturbances after multiorgan transplantation create a permissive environment for development of a wide spectrum of neurologic complications which largely resemble complications after transplantations of individual components of complex multiorgan allografts.
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Affiliation(s)
- Saša A Zivković
- Neurology Service, Department of Veterans Affairs and Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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91
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Quintin J. Organ transplantation and meaning of life: the quest for self fulfilment. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:565-574. [PMID: 23014955 PMCID: PMC3696169 DOI: 10.1007/s11019-012-9439-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Today, the frequency and the rate of success resulting from advances in medicine have made organ transplantations an everyday occurrence. Still, organ transplantations and donations modify the subjective experience of human beings as regards the image they have of themselves, of body, of life and of death. If the concern of the quality of life and the survival of the patients is a completely human phenomenon, the fact remains that the possibility of organ transplantation and its justification depend a great deal on the culture in which we live. The exploration of the philosophical tradition allows for a reconsideration of organ transplantation. If we listen to people who have experienced the decline of one of their organs and their own rebirth through the organ of someone else, we arrive at the conclusion that they went through an extreme experience in which nothing appeared as before. All those experiences intensify philosophical questionings on the meaning of life with respect to self fulfilment. The concept of nature as the experience of others can be an authentic source from which to nourish our thoughts about organ transplantation. However, and this is our hypothesis, we need something more if we are to decide something about our own life. We need a hermeneutical stance in relation to ourselves and to our world. Philosophical counselling, as a long established tradition originating with Pythagoras and later reframed by the German philosopher Achenbach could be useful in inspiring a reflection on the good life, chiefly as it takes the form of a Socratic dialogue.
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Affiliation(s)
- Jacques Quintin
- Université de Sherbrooke, 97 Heneker, Sherbrooke, QC J1J 3G2, Canada.
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92
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Marck CH, Neate SL, Weiland TJ, Hickey BB, Jelinek GA. Donation after cardiac death: are Australian emergency clinicians supportive? Intern Med J 2013; 43:816-9. [DOI: 10.1111/imj.12181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 11/21/2012] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - B. B. Hickey
- Intensive Care Unit; St Vincent's Hospital Melbourne
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93
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Widdicombe NJ, Van Der Poll A, Gould A, Isbel N. Donation after cardiac death in non-survivable burns. Anaesth Intensive Care 2013; 41:380-5. [PMID: 23659402 DOI: 10.1177/0310057x1304100317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Major burns have previously been considered a contraindication to solid organ donation. We present two cases of successful organ donation and transplantation, after Maastricht category III cardiac death in adult patients with non-survivable burns injury. The implications of the outcome of these cases are that major burns should not be considered a contraindication to organ donation, and that cardiac death provides opportunity for patients with non-survivable burns to contribute to the pool of potential organ donors.
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Affiliation(s)
- N J Widdicombe
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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94
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Piazza O, Romano R, Cotena S, Santaniello W, De Robertis E. Maximum tolerable warm ischaemia time in transplantation from non-heart-beating-donors. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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95
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Coulson TG, Pilcher DV, Graham SM, Snell GI, Levvey BJ, Philpot S, Teo A, Davies AR. Single‐centre experience of donation after cardiac death. Med J Aust 2012; 197:166-9. [DOI: 10.5694/mja11.11028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - David V Pilcher
- Alfred Hospital, Melbourne, VIC
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
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96
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Wong VW, Wan DC, Gurtner GC, Longaker MT. Regenerative Surgery: Tissue Engineering in General Surgical Practice. World J Surg 2012; 36:2288-99. [DOI: 10.1007/s00268-012-1710-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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97
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Kumar R, Shekar K, Widdicombe N, Fraser JF. Donation after cardiac death in Queensland: review of the pilot project. Anaesth Intensive Care 2012; 40:517-22. [PMID: 22577919 DOI: 10.1177/0310057x1204000319] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Organ transplantation is a viable therapeutic option for patients with endstage organ failure when other therapies have been exhausted. Donation after cardiac death (DCD) is re-emerging as a potential option to expand the donor pool to meet an increasing demand for organ transplantation. In this review, we evaluate the evolution of the Queensland DCD pilot project since its inception in August 2008. A retrospective analysis of registry data from Australia and New Zealand Organ Donation (ANZOD) and DonateLife Queensland was performed to collect information relating to donor characteristics, DCD process and outcomes. Data was compared with the ANZOD registry annual reports from 2008 to 2010. Twenty-three (82%) out of 28 potential DCD organ donors were successful in donating their organs. The median time from presentation to reaching consensus to withdraw cardiorespiratory support was four days (interquartile range three to eight days). The median time from withdrawal to death was 20 minutes (interquartile range 18 to 25 minutes), and the median warm ischaemia time was 17 minutes (interquartile range 14 to 19 minutes). DCD donors represented 16% (23) of the 144 deceased donors over the study period and provided approximately 10% (48) of the 505 deceased organs in Queensland. The DCD pilot project resulted in an increase in solid organ transplantation in Queensland. It allowed the development of policies to facilitate DCD, in accordance with state's legislation and DonateLife practices. If implemented state-wide, the program has the potential to be an effective way to improve organ donation rates in Queensland.
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Affiliation(s)
- R Kumar
- Department of Intensive Care Services, Prince Charles Hospital, Brisbane, Australia.
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98
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Howard RJ, Cornell DL, Cochran L. History of Deceased Organ Donation, Transplantation, and Organ Procurement Organizations. Prog Transplant 2012; 22:6-16; quiz 17. [DOI: 10.7182/pit2012157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The historical development of deceased organ donation, transplantation, and organ procurement organizations is reviewed. The concept of transplantation, taking parts from one animal or person and putting them into another animal or person, is ancient. The development of organ transplantation brought on the need for a source of organs. Although many early kidney transplants used kidneys from living donors, these donors could not satisfy the ever-growing need for organs, and extrarenal organs were recovered only from deceased donors. This need for organs to satisfy the great demand led to specialized organizations to identify deceased donors, manage them until recovery occurred, and to notify transplant centers that organs were available for their patients. The functions of these organ procurement organizations expanded to include other required functions such as education, accounting, and compliance with state and federal requirements. Because of the shortage of organs relative to the demand, lack of a unified organ allocation system, the perception that organs are a national resource and should be governed by national regulations, and to improve results of organ procurement organizations and transplant centers, the federal government has regulated virtually all phases of organ procurement and transplantation.
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Affiliation(s)
| | | | - Larry Cochran
- LifeQuest Organ Recovery Services, Gainesville, Florida
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99
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Shimodaira K, Okubo Y, Nakayama H, Wakayama M, Shinozaki M, Ishiwatari T, Sasai D, Nemoto T, Takahashi K, Ishii T, Saji T, Shibuya K. Trends in the prevalence of invasive fungal infections from an analysis of annual records of autopsy cases of Toho University. Mycoses 2012; 55:435-43. [PMID: 22320199 DOI: 10.1111/j.1439-0507.2012.02169.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Clinical diagnosis of invasive fungal infections (IFIs) is sometimes difficult, and obtaining an accurate assessment of trends concerning the prevalence of IFIs is a challenge. The aim of this study was to determine trends in the prevalence of IFIs from an autopsy survey. The retrospective review of autopsy records stored in Toho University was performed on all documented cases with fungal infection from 1955 to 2006. A total of 411 cases of IFIs were detected among 10 297 autopsies. The prevalence of candidiasis decreased from 3.6% (1981-93) to 2.0% (1994-2006), and that of aspergillosis increased throughout the 52-year period and reached 2.0% (1994-2006). The prevalence of IFIs in the patient group comprising haematological disorders was significantly higher (19.9%) than in other patient groups (2.9%), of which the odds ratio was 18.4 for mucormycosis and 10.0 for aspergillosis. The lung was the most common organ involved irrespective of major fungal species, and most cases with candidiasis showed multiple-organ infection. Results confirmed the increasing prevalence of aspergillosis and high risk of IFIs in the patient group with haematological disorders. IFIs were also detected in an immunocompromised state caused not only by primary disease but also by treatment with anti-tumour drugs and corticosteroids.
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Affiliation(s)
- Kayoko Shimodaira
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan
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100
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Schnitzbauer AA, Woeste G, Ulrich F, Bechstein WO. Indikationen und Komplikationen bei Multiorgantransplantationen. VISZERALMEDIZIN 2012. [DOI: 10.1159/000343766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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