Donation after circulatory death today: an updated overview of the European landscape.

Donation after circulatory death (DCD) has become an accepted practice in many countries and remains a focus of intense interest in the transplant community. The present study is aimed at providing a description of the current situation of DCD in European countries. Specific questionnaires were developed to compile information on DCD practices, activities and post-transplant outcomes. Thirty-five countries completed the survey. DCD is practiced in 18 countries: eight have both controlled DCD (cDCD) and uncontrolled DCD (uDCD) programs, 4 only cDCD and 6 only uDCD. All these countries have legally binding and/or nonbinding texts to regulate the practice of DCD. The no-touch period ranges from 5 to 30 min. There are variations in ante and post mortem interventions used for the practice of cDCD. During 2008-2016, the highest DCD activity was described in the United Kingdom, Spain, Russia, the Netherlands, Belgium and France. Data on post-transplant outcomes of patients who receive DCD donor kidneys show better results with grafts obtained from cDCD versus uDCD donors. In conclusion, DCD is becoming increasingly accepted and performed in Europe, importantly contributing to the number of organs available and providing acceptable post-transplantation outcomes.

Emerging technologies in organ preservation, tissue engineering and regenerative medicine: a blessing or curse for transplantation?

Since the beginning of transplant medicine in the 1950s, advances in surgical technique and immunosuppressive therapy have created the success story of modern organ transplantation. However, today more than ever, we are facing a huge discrepancy between organ supply and demand, limiting the potential for transplantation to save and improve the lives of millions. To address the current limitations and shortcomings, a variety of emerging new technologies focusing on either maximizing the availability of organs or on generating new organs and organ sources hold great potential to eventully overcoming these hurdles. These advances are mainly in the field of regenerative medicine and tissue engineering. This review gives an overview of this emerging field and its multiple sub-disciplines and highlights recent advances and existing limitations for widespread clinical application and potential impact on the future of transplantation.

The role of nanomaterials in cell delivery systems.

In more than one decade, cell transplantation has created an important strategy to treat a wide variety of diseases characterized by tissue and cell dysfunctions. In this course of action, cell delivery to target site has been always one of the most important constraints and complications, as only a small proportion of the cells are housed in the target sites. Nanotechnology and nanoscale biomaterials have been helpful for cell transplantation in various fields of regenerative medicine including diagnosis, delivery systems for the cell, drug or gene, and cells protection system. In this study, the basic concepts and recently studied aspects of cell delivery systems based on nanoscale biomaterials for transplantation and clinical applications are highlighted. Nanomaterials may be used in combination with cell therapy to control the release of drugs or special factors of engineered cells after transplantation.

What's new and hot in clinical organ transplantation: report from American Transplant Congress 2012.

Innovative and exciting advances in the clinical sciences in organ transplantation were presented at the American Transplant Congress 2012. The full spectrum of transplantation was covered with important advancements in many topics. Key areas covered by presentations included living donor outcomes, organ preservation, optimal allocation of deceased donors, new immunosuppression regimens, antibody mediated rejection and the regulatory environment. This review will highlight some of the most interesting and innovative clinical presentations from the meeting.

What's new and what's hot? Basic science at the American Transplant Congress 2012.

Application of advanced molecular techniques and novel animal models has provided new insights into basic mechanisms underlying clinical transplantation. Investigations in diverse areas, including graft rejection and tolerance, autoimmunity and infectious diseases, have revealed increasing complexity of the mechanisms controlling immune function, notably at the interface of the innate and adaptive immune systems and within secondary lymphoid organs. New roles have been identified for NK and dendritic cells, B-lymphocytes and for Th17 and regulatory T cells, notably in novel animal models of costimulatory blockade and tolerance. Confirmation of these observations will be needed in normal animals and in humans undergoing organ and cell transplantation. The impact of the microbiome, of vaccines, and of antimicrobial therapies on immune memory and reconstitution after lymphocyte depletion is beginning to be defined.

[Transplantation as a care about neighbour health and life]. / Transplantacja jako troska o zycie i zdrowie blizniego.

Taking into account current developments in medicine and the increasingly extended lifespan of our patients, the role of transplantation and the related issues have become increasingly more urgent and have demanded more attention in recent years. Transplantation is a branch of medical studies which has been developed as a result of the need to find answers to unsuccessful organ transplants. Transplants are the future of the contemporary medicine and provide better prospects for patients with defective organs. In spite of the rapid development and huge successes achieved in the field of transplantation, the major problem we are facing, both in terms of the legal and ethical aspects, is the lack of the organ donors. Developing social awareness and continuous education can bring about positive changes to the current shortage of donors. The role of the church and the media in promoting the importance of organ donation will also greatly contribute to the future success of transplantation thus saving human lives.

Metabonomics: a useful tool for the future surgeon.

BACKGROUND: In the past decade or so, a range of technologies have emerged that have shown promise in increasing our understanding of disease processes and progression. These advances are referred to as the "omics" technologies; genomics, transcriptomics, and proteomics. More recently, another "omics" approach has come to the fore: metabonomics, and this technology has the potential for significant clinical impact. Metabonomics refers to the analysis of the metabolome, that is, the metabolic profile of a system. The advantage of studying the metabolome is that the end points of biological events are elucidated. RESULTS: Although still in its infancy, the metabonomics approach has shown immense promise in areas as diverse as toxicology studies to the discovery of biomarkers of disease. It has also been applied to studies of both renal and hepatic transplants. Metabolome analysis may be conducted on a variety of biological fluids and tissue types and may utilize a number of different technology platforms, mass spectrometry (MS) and nuclear magnetic resonance (NMR) spectroscopy being the most popular. In this review, we cover the background to the evolution of metabonomics and its applications with particular emphasis on clinical applications. CONCLUSIONS: We conclude with the suggestion that metabonomics offers a platform for further biomarker development, drug development, and in the field of medicine.

UK Renal Registry 12th Annual Report (December 2009): chapter 5: demographic and biochemistry profile of kidney transplant recipients in the UK in 2008: national and centre-specific analyses.

INTRODUCTION: National renal transplant registries routinely report on centre-specific patient and graft survival following renal transplantation. However, other outcomes such as graft function (as measured by eGFR), haemoglobin and blood pressure are also important indicators of quality of care. METHODS: Transplant activity and incident graft survival data were obtained from NHS Blood and Trans-plant, laboratory and clinical variables and prevalent survival data were obtained from the UK Renal Registry. Data were analysed separately for prevalent and one year post-transplant patients. RESULTS: Increasing live and nonheartbeating donors were responsible for the increasing transplant activity. Graft failure occurred in 2.9% of prevalent transplant patients and death rates remained stable at 2.4/100 patient years. In transplant recipients with a specified cause of death, 21% died due to malignancy and 21% as a consequence of cardiac disease. There was centre variation in outcomes including eGFR and haemoglobin in prevalent and 1 year post-transplant recipients. Analysis of prevalent transplants by chronic kidney disease stage showed 14.7% with an eGFR <30 ml/min/1.73 m(2) and 2.1% <15 ml/min/1.73 m(2). Of those with CKD stage 5T, 40.4% had Hb concentrations <10.5 g/dl, 25.9% phosphate concentrations >or=1.8 mmol/L, 9.0% adjusted calcium concentrations >or=2.6 mmol/L and 40.8% PTH concentrations >or=32 pmol/L. With the exception of PTH, transplant recipients with CKD stage 5T were less likely to achieve the UK standards compared to prevalent dialysis patients. CONCLUSION: Wide variations in clinical and biochemical outcomes amongst transplant recipients continue to exist and may reflect differences in healthcare delivery across the UK.

Emerging approaches and technologies in transplantation: the potential game changers.

Newly emerging technologies are rapidly changing conventional approaches to organ transplantation. In the modern era, the key challenges to transplantation include (1) how to best individualize and possibly eliminate the need for life-long immunosuppression and (2) how to expand the donor pool suitable for human transplantation. This article aims to provide readers with an updated review of three new technologies that address these challenges. First, single-cell RNA sequencing technology is rapidly evolving and has recently been employed in settings related to transplantation. The new sequencing data indicate an unprecedented cellular heterogeneity within organ transplants, as well as exciting new molecular signatures involved in alloimmune responses. Second, sophisticated nanotechnology platforms provide a means of therapeutically delivering immune modulating reagents to promote transplant tolerance. Tolerogenic nanoparticles with regulatory molecules and donor antigens are capable of targeting host immune responses with tremendous precision, which, in some cases, results in donor-specific tolerance. Third, CRISPR/Cas9 gene editing technology has the potential to precisely remove immunogenic molecules while inserting desirable regulatory molecules. This technology is particularly useful in generating genetically modified pigs for xenotransplantation to solve the issue of the shortage of human organs. Collectively, these new technologies are positioning the transplant community for major breakthroughs that will significantly advance transplant medicine.

Pediatric transplantation in the United States, 1997-2006.

This article represents the sixth annual review of the current state of pediatric transplantation in the United States from the Scientific Registry of Transplant Recipients (SRTR). It presents updated trends, discussion of analyses presented during the year by the SRTR to the committees of the Organ Procurement and Transplantation Network (OPTN) and discussion of important issues currently facing pediatric organ transplantation. Unless otherwise stated, the statistics in this article are drawn from the reference tables of the 2007 OPTN/SRTR Annual Report. In this article, pediatric patients are defined as candidates, recipients or donors aged 17 years or less. Data for both graft and patient survival are reported as unadjusted survival, unless otherwise stated (adjusted patient and graft survival are available in the reference tables). Short-term survival (3 month and 1 year) reflects outcomes for transplants performed in 2004 and 2005; 3-year survival reflects transplants from 2002 to 2005; and 5-year survival reports on transplants performed from 2000 to 2005. Details on the methods of analysis employed may be found in the reference tables themselves or in the technical notes of the 2007 OTPN/SRTR Annual Report, both available online at http://www.ustransplant.org.

Transesophageal echocardiography utilization in high-volume liver transplantation centers in the United States.

OBJECTIVE: Transesophageal echocardiography (TEE) during liver transplantation (LT) has been shown to be helpful in managing fluid therapy, monitoring myocardial function, and identifying intraoperative LT complications. The present study sought to investigate the current utilization of TEE by anesthesiologists during LT as well as issues of training and credentialing in this monitoring modality. DESIGN: A survey distributed by electronic mail. SETTING: LT centers in the United States in which more than 50 liver transplantation procedures were performed annually. PARTICIPANTS: Survey respondents were contact persons in the LT divisions of the anesthesiology department of selected centers. INTERVENTIONS: Data collection only. MEASUREMENT AND MAIN RESULTS: A total of 40 high-volume LT centers were identified, and survey responses were received from 30 of those. Among 217 anesthesiologists, 86% performed TEE in some or all LT cases. Most users performed a limited-scope examination, although some performed a comprehensive TEE examination during LT. Most users acquired their TEE skills informally. Only 12% of users were board certified to perform TEE, and only 1 center reported having a policy related to credentialing requirements for TEE. CONCLUSIONS: There is high utilization of intraoperative TEE by anesthesiologists to perform limited-scope examinations during LT cases. Training to perform such examinations is mostly informal, and credentialing processes are lacking. An opportunity exists to establish guidelines, training programs, and standards for quality assurance in the use of this valuable monitoring modality.

Composite tissue transplantation: a rapidly advancing field.

Composite tissue allotransplantation (CTA) is emerging as a potential treatment for complex tissue defects. It is currently being performed with increasing frequency in the clinic. The feasibility of the procedure has been confirmed through 30 hand transplantation, 3 facial reconstructions, and vascularized knee, esophageal, and tracheal allografts. A major drawback for CTA is the requirement for lifelong immunosuppression. The toxicity of these agents has limited the widespread application of CTA. Methods to reduce or eliminate the requirement for immunosuppression and promote CTA acceptance would represent a significant step forward in the field. Multiple studies suggest that mixed chimerism established by bone marrow transplantation promotes tolerance resulting in allograft acceptance. This overview focuses on the history and the exponentially expanding applications of the new frontier in CTA transplantation: immunology associated with CTA; preclinical animal models of CTA; clinical experience with CTA; and advances in mixed chimerism-induced tolerance in CTA. Additionally, some important hurdles that must be overcome in using bone marrow chimerism to induce tolerance to CTA are also discussed.

[Advances in tracheal transplantation].

The length of tracheal defect or stenosis exceeded 5 cm could not be treated by simple resection and end-to-end anastomosis of the remaining trachea. Various ways of tracheal replacement had appeared sequentially, such as radial forearm free flap with cartilage grafts, tracheal tissue-engineering and tracheal allotransplantation. Among these methods, tracheal allotransplantation displayed a better long-term result. In this review, we are focused on recent advances in tracheal allotransplantation, particularly on revascularization and reepithelialization of graft, as well as on the application of immunosuppressive agents.