August 2: Recent Transplant News
Monday, August 5, 2013
Post liver transplant metabolic syndrome linked to obesity, diabetes
Healio
Factors such as obesity and current and family history of diabetes increased the likelihood of developing metabolic syndrome following liver transplantation in a recent study. Researchers evaluated 84 patients (mean age, 53.9 years; 75 percent men) with cirrhosis before and after undergoing orthotopic liver transplantation (OLT). BMI, waist circumference, blood pressure and nutritional intake were assessed before and three, six and 12 months after transplantation, along with biochemical factors including glucose, triglycerides, cholesterol and ALT. Read more.
Impact of nutritional state on lung transplant outcomes: The weight of the evidence
The Journal of Heart and Lung Transplantation (login required)
Despite advances in perioperative and post-operative management, lung transplant recipients with select pre transplant risk factors have been shown to experience worse post-transplant outcomes in comparison to those without such risk factors. Among these variables, previous studies have shown that select markers of poor nutritional status prior to transplant, such as low body mass index (BMI) and hypoalbuminemia, have been associated with increased post-transplant mortality. In a past issue of the journal, Chamogeorgakis el al. examine a comprehensive battery markers previously associated with malnutrition to determine their impact on outcomes after lung transplantation. The authors find that hypoalbuminemia is associated with worse survival, but does not appear to affect the risk of post-transplant infections. This article reviews the study presented by Chamogeorgakis et al. to discuss how it furthers our understanding of the impact of nutritional status on transplant-related outcomes and consider areas for future investigation. Read more.
Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation
Transplantation (login required)
Cytomegalovirus (CMV) continues to be one of the most common infections after solid-organ transplantation, resulting in significant morbidity, graft loss and adverse outcomes. Management of CMV varies considerably among transplant centers but has been become more standardized by publication of consensus guidelines by the Infectious Diseases Section of The Transplantation Society. An international panel of experts was reconvened in October 2012 to revise and expand evidence and expert opinion-based consensus guidelines on CMV management, including diagnostics, immunology, prevention, treatment, drug resistance and pediatric issues. The following report summarizes the recommendations. Read more.
Parameters associated with short- and midterm survival in bridging to lung transplantation with extracorporeal membrane oxygenation
Clinical Transplantation (login required)
Patients with terminal lung failure may be bridged to lung transplantation (LTX) by extracorporeal membrane oxygenation (ECMO). With the present shortage of donor organs and the high level of invasiveness of ECMO treatment, appropriate selection criteria for bridge to transplant need to be defined. Read more.
Review: The use of lung donors older than 55 years
The Journal of Heart and Lung Transplantation (login required)
Current lung transplantation guidelines stipulate that the ideal donor is aged younger than 55 years, but several institutions have reported that outcomes using donors aged 55 years and older are comparable with those of younger donors. Read more.
Study: Different models of transition to adult care after pediatric kidney transplantation
Pediatric Transplantation (login required)
Transition from pediatric to adult care is a critical and difficult step for young people with transplants and for the multidisciplinary team involved. A retrospective study recently investigated the clinical course in a two year period of transition. Data from 66 teenagers were collected one year before and after their transfer to three different adult care settings: a specialized transition clinic, a general transplantation clinic and a nephrologist. Patient survival rate was 100 percent. Three patients developed graft loss. GFR development was comparable in the three settings. Read more.
Early use of renal-sparing agents in liver transplantation
Liver Transplantation (login required)
Renal dysfunction is a critical issue for liver transplant candidates and recipients. Acute nephrotoxicity and chronic nephrotoxicity, however, are the compromises for the potent immunosuppression provided by calcineurin inhibitors (CNIs). To maintain the graft and patient survival afforded by CNIs while minimizing renal dysfunction in liver transplant patients, the reduction, delay, or elimination of CNIs in immunosuppression regimens is being implemented more frequently by clinicians. The void left by standard-dose CNIs is being filled by nonnephrotoxic immunosuppressants such as mycophenolates and mammalian target of rapamycin inhibitors. The results of studies of renal-sparing regimens in liver transplant recipients have been inconsistent, and this may be explained upon a closer examination of several study-related factors, including the study design and the duration of follow-up. Read more.
Long-term medical management of the pediatric patient after liver transplantation
Liver Transplanation (login required)
These recommendations provide a data-supported approach to establishing guidelines. Intended for use by pediatricians and physicians, these recommendations suggest preferred approaches to the diagnostic, therapeutic and preventive aspects of care. Read more.