Transplantation Principles

2020 ◽  
Author(s):  
Maria Siemionow ◽  
Fatih Zor
Keyword(s):  
Transplant Rejection ◽  
Solid Organ Transplantation ◽  
Surgical Techniques ◽  
Immunosuppressive Drugs ◽  
Organ Shortage ◽  
Solid Organ ◽  
Major Advance ◽  
Vascularized Composite Allotransplantation ◽  
Comprehensive Overview ◽  
Keywords Transplantation

Transplantation is a truly multidisciplinary specialty where a surgical procedure requires inputs from both, the specialists of the specific organ e.g. nephrologist for kidney transplant or hepatologist for liver transplant, as well as from experts of other specialties such as immunology, infectious diseases etc. It is also a rapidly grooving field with the advances in surgical techniques, immunological knowledge and pharmacology. A recent, major advance in the field of transplantation is the emergence of new procedure of vascularized composite allotransplantation, which includes transplantation of non-lifesaving organs such as face, hands, abdominal wall or uterus. Additionally, organ shortage in transplantation yielded a new area of research such as xenotransplantation and regenerative medicine. The specialty of transplantation may be difficult to comprehend for those entering the field; thus, the goal of this chapter is to provide a comprehensive overview of the most important aspects of transplantation. This review contains 2 figures, 3 tables, and 67 references. Keywords: transplantation, solid organ transplantation (SOT), vascularized composite allotransplantation (VCA), transplant immunology, allorecognition, acute rejection, chronic transplant rejection, principles of transplantation, transplantation terminology, immunosuppressive drugs

Surgical Techniques for Revascularization in Abdominal Wall Transplantation

2020 ◽  
Vol 36 (07) ◽  
pp. 522-527
Author(s):  
Andrew Atia ◽  
Andrew Hollins ◽  
Ronnie Shammas ◽  
Brett T. Phillips ◽  
Kadiyala V. Ravindra ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Organ Transplantation ◽  
Abdominal Wall Reconstruction ◽  
Solid Organ Transplantation ◽  
Surgical Techniques ◽  
Solid Organ ◽  
Vascularized Composite Allotransplantation ◽  
Ischemia Time ◽  
Feasible Option ◽  
Surgical Field

Abstract Background Abdominal wall vascularized composite allotransplantation (AW-VCA) can be considered as a technically feasible option for abdominal wall reconstruction in patients whose abdomen cannot be closed using traditional methods. However, successful initial abdominal wall revascularization in the setting of visceral organ transplantation can pose a major challenge as graft ischemia time, operating in a limited surgical field, and variable recipient and donor anatomy must be considered. Several techniques have been reported to accomplish abdominal wall revascularization. Methods A literature review was performed using PubMed for articles related to “abdominal wall transplantation (AWT).” The authors of this study sorted through this search for relevant publications that describe abdominal wall transplant anatomy, technical descriptions, and outcomes of various techniques. Results A total of four distinct revascularization techniques were found in the literature. Each of these techniques was described by the respective authors and reported varying patient outcomes. Levi et al published a landmark article in 2003 that described technical feasibility of AWT with anastomosis between donor external iliac and inferior epigastric vessels with recipient common iliac vessels in end-to-side fashion. Cipriani et al described a microsurgical technique with anastomosis between donor and recipient inferior epigastric vessels in an end-to-end fashion. Giele et al subsequently proposed banking the abdominal wall allograft in the forearm to reduce graft ischemia time. Recently, Erdmann et al described the utilization of an arteriovenous loop for synchronous revascularization of abdominal wall and visceral transplants for reduction of ischemia time, operative time, while eliminating the need for further operations. Conclusion Vascularized composite allotransplantation continues to advance with improving immunotherapy and outcomes in solid organ transplantation. Optimizing surgical techniques remains paramount as the field continues to grow. Refinement of the presented methods will continue as additional evidence and outcomes become available in AW-VCA.

scholarly journals Neurological complications of solid organ transplantation

2017 ◽  
Vol 75 (10) ◽  
pp. 736-747 ◽  
Author(s):  
José Luiz Pedroso ◽  
Lívia Almeida Dutra ◽  
Pedro Braga-Neto ◽  
Agessandro Abrahao ◽  
João Brainer Clares de Andrade ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Prognostic Significance ◽  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Surgical Techniques ◽  
Neurological Complications ◽  
Immunosuppressive Drugs ◽  
Solid Organ ◽  
Neurological Manifestations ◽  
Diagnostic Challenge

ABSTRACT Solid organ transplantation is a significant development in the treatment of chronic kidney, liver, heart and lung diseases. This therapeutic approach has increased patient survival and improved quality of life. New surgical techniques and immunosuppressive drugs have been developed to achieve better outcomes. However, the variety of neurological complications following solid organ transplantation is broad and carries prognostic significance. Patients may have involvement of the central or peripheral nervous system due to multiple causes that can vary depending on time of onset after the surgical procedure, the transplanted organ, and the intensity and type of immunosuppressive therapy. Neurological manifestations following solid organ transplantation pose a diagnostic challenge to medical specialists despite extensive investigation. This review aimed to provide a practical approach to help neurologists and clinicians assess and manage solid organ transplant patients presenting with acute or chronic neurological manifestations.

scholarly journals Impact of Melatonin in Solid Organ Transplantation—Is It Time for Clinical Trials? A Comprehensive Review

2018 ◽  
Vol 19 (11) ◽  
pp. 3509 ◽  
Author(s):  
Philipp Stiegler ◽  
Augustinas Bausys ◽  
Bettina Leber ◽  
Kestutis Strupas ◽  
Peter Schemmer
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Experimental Studies ◽  
Organ Shortage ◽  
Solid Organ ◽  
Comprehensive Overview ◽  
Donor Pool ◽  
End Stage ◽  
New Strategies ◽  
Significant Mortality

Solid organ transplantation is the “gold standard” for patients with end-stage organ disease. However, the supply of donor organs is critical, with an increased organ shortage over the last few years resulting in a significant mortality of patients on waiting lists. New strategies to overcome the shortage of organs are urgently needed. Some experimental studies focus on melatonin to improve the donor pool and to protect the graft; however, current research has not reached the clinical level. Therefore, this review provides a comprehensive overview of the data available, indicating that clinical evaluation is warranted.

scholarly journals Advanced Genomics-Based Approaches for Defining Allograft Rejection With Single Cell Resolution

2021 ◽  
Vol 12 ◽  
Author(s):  
Tiffany Shi ◽  
Krishna Roskin ◽  
Brian M. Baker ◽  
E. Steve Woodle ◽  
David Hildeman
Keyword(s):  
Single Cell ◽  
Allograft Rejection ◽  
Immune Cell ◽  
Transplant Rejection ◽  
Solid Organ Transplantation ◽  
Genomic Analysis ◽  
Solid Organ ◽  
Single Cell Level ◽  
Cell Level ◽  
Network Analyses

Solid organ transplant recipients require long-term immunosuppression for prevention of rejection. Calcineurin inhibitor (CNI)-based immunosuppressive regimens have remained the primary means for immunosuppression for four decades now, yet little is known about their effects on graft resident and infiltrating immune cell populations. Similarly, the understanding of rejection biology under specific types of immunosuppression remains to be defined. Furthermore, development of innovative, rationally designed targeted therapeutics for mitigating or preventing rejection requires a fundamental understanding of the immunobiology that underlies the rejection process. The established use of microarray technologies in transplantation has provided great insight into gene transcripts associated with allograft rejection but does not characterize rejection on a single cell level. Therefore, the development of novel genomics tools, such as single cell sequencing techniques, combined with powerful bioinformatics approaches, has enabled characterization of immune processes at the single cell level. This can provide profound insights into the rejection process, including identification of resident and infiltrating cell transcriptomes, cell-cell interactions, and T cell receptor α/β repertoires. In this review, we discuss genomic analysis techniques, including microarray, bulk RNAseq (bulkSeq), single-cell RNAseq (scRNAseq), and spatial transcriptomic (ST) techniques, including considerations of their benefits and limitations. Further, other techniques, such as chromatin analysis via assay for transposase-accessible chromatin sequencing (ATACseq), bioinformatic regulatory network analyses, and protein-based approaches are also examined. Application of these tools will play a crucial role in redefining transplant rejection with single cell resolution and likely aid in the development of future immunomodulatory therapies in solid organ transplantation.

Barcelona Consensus on Biomarker-Based Immunosuppressive Drugs Management in Solid Organ Transplantation

2016 ◽  
Vol 38 ◽  
pp. S1-S20 ◽  
Author(s):  
Mercè Brunet ◽  
Maria Shipkova ◽  
Teun van Gelder ◽  
Eberhard Wieland ◽  
Claudia Sommerer ◽  
...  
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Immunosuppressive Drugs ◽  
Solid Organ

scholarly journals Regulatory T Cells and Kidney Transplantation

2018 ◽  
Vol 13 (11) ◽  
pp. 1760-1764 ◽  
Author(s):  
Paloma Leticia Martin-Moreno ◽  
Sudipta Tripathi ◽  
Anil Chandraker
Keyword(s):  
T Cells ◽  
Regulatory T Cells ◽  
Organ Transplantation ◽  
Tissue Repair ◽  
Solid Organ Transplantation ◽  
Immunosuppressive Drugs ◽  
Solid Organ ◽  
Effective Expansion ◽  
Conventional Immunosuppression

The ability of the immune system to differentiate self from nonself is critical in determining the immune response to antigens expressed on transplanted tissue. Even with conventional immunosuppression, acceptance of the allograft is an active process often determined by the presence of regulatory T cells (Tregs). Tregs classically are CD4+ cells that constitutively express high levels of the IL-2 receptor α chain CD25, along with the transcription factor Foxp3. The use of Tregs in the field of solid organ transplantation is related specifically to the objective of achieving tolerance, with the goal of reducing or eliminating immunosuppressive drugs as well as maintaining tissue repair and managing acute rejection. A key issue in clinical use of Tregs is how to effectively expand the number of Tregs, either through increasing numbers of endogenous Tregs or by the direct infusion of exogenously expanded Tregs. In order to realize the benefits of Treg therapy in solid organ transplantation, a number of outstanding challenges need to be overcome, including assuring an effective expansion of Tregs, improving long-term Treg stability and reduction of risk-related to off-target, nonspecific, immunosuppressive effects related specially to cancer.

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