The December 2020 issue of Transplantation Direct is ready for viewing and covers several topics in the field. In kidney transplantation, results are presented on the effects of Quercetin and sucrose on the efficacy of different organ preservation methods in a pig transplant model. New-onset gout as an indicator of poor transplant outcome is examined using USRDS data. Treatment of chronic-active T cell-mediated rejection is reported in an interesting case series. The economics of using hepatitis C+ viremic donors in kidney transplantation is investigated; regarding living-donation, an analysis of donor interviews is presented asking the question whether interdependent donor-recipient relationships shift the risk-benefit paradigm. In liver transplantation, influence of the microbiome on post-transplant redevelopment of NAFLD is studied. Using SRTR data, the role of donor-recipient sex is investigation in terms of survival outcomes. Considering pulmonary arterial pressure 35 mmHg, liver transplant outcomes are reported on in patients treated for portopulmonary hypertension. In canine bone marrow transplantation, the effects of in vitro CD94-selected NK cells on engraftment and GvHD are investigated. Regarding general organ donation, a study is presented on which types of “prosocial" behaviors are associated with likelihood of registering for organ donation. What about COVID-19? We also have an interesting article about how to manage COVID-19+ transplant recipients in the setting of community-local health care systems. For more details and free full article access, please visit our Transplantation Direct website.
Dr. Jeremy R. Chapman, Editor-in-Chief, Transplantation
Marinelli TM, Kumar D
Transplantation: October 8, 2020 - Volume Online First
SARS-CoV-2 is not the only virus out there, despite what one reads in the newspaper. This overview of Influenza infection identifies the significant risk for solid organ transplant recipients who suffer more severe infection and increased complications than the general community. Recommended strategies include: annual inactivated influenza vaccine with higher dose vaccine or multiple doses in the same season providing greater immunogenicity; neuraminidase inhibitors for both treatment and chemoprophylaxis but with a risk of resistance; and the recent licensure of baloxavir, yet to be evaluated in transplant recipients which is not yet in routine clinical use. The paper provides a useful guide to both individual clinicians and program and policy managers as to where the field is heading.
World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs — remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a — in patients hospitalized with coronavirus disease 2019 (Covid-19). At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan–Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P=0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P=0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P=0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P=0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration.
This article compared the cumulative incidence (CI) and the outcome of SARS-COV-2 infection in solid organ transplant recipients (SOTRs) to non-transplanted patients (Non-SOTRs) with follow-up through September 30, 2020 in Italy. The CI of SARS-CoV-2 infection in SOTRs was 1.02%, higher than in COVID+ Non-SOTRs (0.4%, p<0.05) with a greater risk in the Lombardy region (2.89%). The CI by kind of organ transplant was higher for heart [CI 1.57%, Incidence Rate Ratio (IRR) 1.36] and lower for liver [CI 0.63%, IRR 0.54]. The 60-day CI of mortality was 30.6%, twice as much that of COVID+ Non-SOTRs (15.4%) with a 60-day gender&age adjusted odds ratio (adjusted-OR) of 3.83 for COVID+ SOTRs [95%CI (3.03-4.85)]. The lowest 60day adjusted-OR was observed in liver SOTRs [OR 0.46, 95%CI (0.25-0.86)].
This is a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3-5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. A total of 1210 patients were included [median age, 61 (quartile 1-quartile 3 48-71) years, female 551 (45.5%)] composed of four groups: control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9-45.2; and 82/289 (28.4%); 95% CI 23.9-34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3-29.9; P < 0.001) and 63/390 (16.2%; 95% CI 13.0-20.4; P < 0.001); RT = 17/81 (21.0%; 95% CI 13.2-30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7-19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8-10.8; P < 0.001) and 18/450 (4%; 95% CI 2.5-6.2; P < 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52-5.44); P = 0.001; 2.44 (1.35-4.40); P = 0.003; HD: 2.32 (1.21-4.46); P = 0.011; 2.25 (1.23-4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76-4.72); P = 0.169; 1.87 (0.81-4.28); P = 0.138, respectively].
Every two years, the ISODP Congress brings together clinicians and scientists from all parts of the world in the fields of organ procurement and donation
The Allied Health Provider Committee of the Intestinal Rehabilitation and Transplantation Association (IRTA) is pleased to collaborate with the Allied Health Provider group of the biannual Pediatric Intestinal Failure and Rehabilitation Symposium (PIFRS) to present a virtual education event that focuses on pediatric and adult intestinal rehabilitation and transplant.
Current strategies in medical, surgical, nutritional, and psychosocial care of patients with intestinal failure and transplant will be discussed. Presentations also include practical interventions for routine care and information on long-term outcomes. Opportunities for questions and discussion are also scheduled.
Plan to attend this free virtual event! There is something of interest for everyone on the transplant and intestinal failure multidisciplinary teams.
The Transplantation Society (TTS) and our journal Transplantation have developed online resources to keep you informed on the Coronavirus (COVID-19) outbreak.
We are also requesting contributions and news from the transplant community to be sent to firstname.lastname@example.org for inclusion on our resources page.
In this dashboard, you will find links to TTS and other global and regional resources, as well as interactive maps, publications and webinars. We encourage you to explore this dashboard and share with your colleagues.
Editors and contributors to Transplantation have shared their thoughts on how they are dealing with the current crisis. While we understand that the information of today may be quite different tomorrow in this fast-moving pandemic, this report will open our forum of an international exchange on COVID for the transplant community.
Please send your own contributions and news to email@example.com for inclusion on our resources page.
Nov. 30 - Patients with kidney failure undergoing dialysis may develop cognitive impairment; the prevalence of cognitive impairment in this patient population ranges from 10% to 80%, depending on the specific population being studied and the test used to define it.
Dec. 1 - Health care organizations, like many other enterprises, face steep challenges in their attempt to maximize operational efficiency in the face of resource constraints. Whether it is a hospital’s attempt to optimize staffing or a government trying to fairly allocate and distribute limited doses of Covid-19 vaccines, these tasks can be formidable. A promising way to manage the complexity is to enlist data-driven analytics and artificial intelligence (AI).
Nov. 30 - Frailty was associated with worse outcomes in patients who underwent liver transplantation, according to research presented at The Liver Meeting Digital Experience. In her presentation, Jennifer Cindy Lai, MD, from the University of California, San Francisco, said frailty has been recognized as a predictor of mortality among patients on the transplant waitlist.
Dec. 1 - Occasionally, following a transplant procedure, the donor's immune cells recognize the recipient's tissues as foreign and trigger a multisystem disorder called graft-versus-host disease (GVHD). Occurring commonly after bone marrow or stem cell transplants performed to treat some blood cancers, GVHD may even follow solid organ transplants and is, in essence, the reverse of transplant rejection. Now, researchers have clarified the pathogenesis of the characteristic skin changes in chronic GVHD.
Dec. 3 - In a new paper, published in JAMA Surgery, researchers found the metrics used to rank organ procurement organizations don't create an even playing field for organizations, and lead to inaccuracies.