June 7: Recent Transplant News
Blood tests OK for fibrosis diagnosis in hepatitus C
Blood testing can accurately identify clinically significant fibrosis and cirrhosis in people with hepatitis C virus (HCV) infection and may be an alternative to liver biopsy in some patients, a new study found. The analysis of 172 studies comparing various blood tests to biopsy in HCV patients revealed that some of the simplest, cheapest blood tests performed as well as more expensive, complex tests, reported Dr. Roger Chou, and Ngoc Wasson, MPH, from the Evidence-Based Practice Center at Oregon Health and Science University in Portland. Read more.
Amnion-derived multipotent progenitor cells support allograft tolerance induction
American Journal of Transplantation (login required)
Donor-specific immunological tolerance using high doses of bone marrow cells (BMCs) has been demonstrated in mixed chimerism-based tolerance induction protocols; however, the development of graft versus host disease remains a risk. Here, researchers demonstrate that the co-infusion of limited numbers of donor unfractionated BMCs with human amnion-derived multipotent progenitor cells (AMPs) seven days post–allograft transplantation facilitates macrochimerism induction and graft tolerance in a mouse skin transplantation model. AMPs + BMCs co-infusion with minimal conditioning led to stable, mixed, multilineage lymphoid and myeloid macrochimerism, deletion of donor-reactive T cells, expansion of CD4+CD25+Foxp3+ regulatory T cells (Tregs) and long-term allograft survival (>300 days). It has been speculated that AMPs maybe a pro-tolerogenic cellular therapeutic that could have clinical efficacy for both solid organ and hematopoietic stem cell transplant applications. Read more.
Pulmonary hypertension in renal disease: Epidemiology, potential mechanisms and implications.
Pulmonary hypertension (PH) is highly prevalent in end-stage renal disease. Several observational studies, based on an echocardiographic diagnosis of PH, have suggested a prevalence of 30-60% and an association with increased mortality and poorer outcome following renal transplantation. The pathogenesis of PH in this population remains poorly understood. Reported associations include arteriovenous fistulae, cardiac dysfunction, fluid overload, bone mineral disorder and non-biocompatible dialysis membranes. Read more.
Infection, cardiovascular disease more prevalent among liver transplant recipients with metabolic syndrome
The presence of metabolic syndrome post-liver transplantation increased the risk for infection and cardiovascular disease, according to data presented at Digestive Disease Week. In a retrospective cohort study, researchers evaluated 158 patients who underwent liver transplantation between 2002 and 2007 at a single medical facility, with follow-up through September 2012. The presence of metabolic syndrome (MetS) before transplant and at six and 12 months post-transplant was determined in each case. Read more.
Cytomegalovirus infection post-pancreas-kidney transplantation — results of antiviral prophylaxis in high-risk patients
Clinical Transplantation (login required)
Cytomegalovirus (CMV) is a major pathogen affecting solid organ transplant (SOT) recipients. Prophylactic strategies have decreased the rate of CMV infection/disease among SOT. However, data on the effect of current prophylactic strategies for simultaneous pancreas–kidney (SPK) or pancreas after kidney (PAK) transplant remain limited. In a recent review, researchers report their experience of CMV prophylaxis in SPK/PAK recipients. Read more.
Change in immunosuppressive regimen, hemodynamic and inflammatory markers of cardiovascular disease after kidney transplantation
Although rejection rates and short-term graft survival have significantly improved in kidney transplantation with the introduction of calcineurin inhibitor (CNI), cardiovascular disease (CVD) and metabolic complications are being increasingly recognized as important causes of morbidity and mortality. We hypothesize that non-CNI proliferation signal inhibitor (PSI)-based immunosuppressive regimen is associated with improved arterial stiffness after kidney transplantation compared with CNI-based immunosuppressive regimens. Read more.
Kids with new hearts often skip meds
Among pediatric heart transplant recipients, failure to adhere to immunosuppressive medication is relatively common and is associated with a high mortality rate, researchers found. Over a seven-year period, 9 percent of heart transplant recipients younger than 18 were non-adherent at least once, which set back his or her recovery, according to Dr. Christopher Almond, MPH, of Boston Children's Hospital, and colleagues. Read more.
The effectiveness of the combination of rituximab and high-dose immunoglobulin in the immunomodulation of sensitized kidney transplant candidates
Clinical Transplantation (login required)
Kidney transplantation faces many challenges not the least of which is the presence of pre-formed HLA antibodies. At our institution, we have used a combination of methods to immunomodulate sensitized patients. Most recently, this has been attempted with a combination of immunoglobulin (IVIG) and rituximab. Read more.