Current opinion in organ transplantation
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Curr Opin Organ Transplant · Feb 2013
ReviewMesenchymal stromal cells to promote solid organ transplantation tolerance.
Mesenchymal stromal cells (MSCs) possess unique immunomodulatory features. MSCs dampen effector T-cell response while promoting the emergence of regulatory T cells. By skewing this balance, MSC could represent the ideal strategy for tolerance induction in organ transplantation. Here we review recent evidence on the efficacy of MSC-based therapy in experimental models of solid organ transplantation as well as the early clinical experiences in kidney transplantation. ⋯ Immunoregulatory functions of MSC are not fixed but rather the result of microenvironment they encounter in vivo. Further studies are needed to establish how and wherein these cells have to be administered and how they may function to safely modulate host immune response in vivo in clinical transplant setting.
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Lung transplant continues to be hampered by the number of available donors. Ex-vivo lung perfusion (EVLP) has emerged as an essential tool for the reassessment, under a controlled scenario, of lungs that initially did not meet transplantation criteria. The purpose of the current study is to review the most recent clinical and research reports and summarize their findings. ⋯ EVLP has already proved its value as a tool to identify 'good' lungs from the previously rejected pool. But as new therapeutics arise , EVLP will also prove its value as a reproducible platform for their evaluation.
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Curr Opin Organ Transplant · Oct 2012
ReviewBridge to lung transplantation with extracorporeal membrane oxygenation support.
The significant growth in the use of extracorporeal life support (ECLS) devices has been driven by technological advances and new applications. Extracorporeal membrane oxygenation (ECMO) can provide pulmonary and, if needed, right heart support for patients with acute and chronic lung disease. Many patients on lung transplant lists die from acute exacerbations of their underlying chronic lung disease before they can receive a lung transplant. Transplant teams have taken advantage of these recent advances in ECLS to bridge such patients to lung transplantation (bridge to transplant, BTT). We review the recent body of literature in this area and suggest an algorithm for the management of BTT patients. ⋯ In carefully selected patients, ECMO is a safe and effective means of bridging patients with acute decompensations of their end-stage lung disease to lung transplantation.
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Curr Opin Organ Transplant · Dec 2011
ReviewTransplantation of the broadly sensitized patient: what are the options?
Recipient sensitization to a wide variety of human leukocyte antigens (HLA) represents a major barrier to transplantation. We discuss the options for the challenging group of broadly sensitized kidney transplant candidates. ⋯ A multifaceted repertoire of complementary strategies was shown to facilitate successful live and deceased donor kidney transplantation in high-risk patients. Recent promising developments can be expected to significantly improve outcomes.
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The number of patients listed for lung transplantation largely exceeds the number of available transplantable organs because of both a shortage of organ donors and a low utilization rate of lungs from those donors due to injuries acquired during the process of brain death and intensive care unit (ICU) care. A novel strategy for donor lung preservation - ex-vivo lung perfusion (EVLP) - that keeps the organ at physiological protective conditions has shown great promise to increase lung utilization by reassessing, treating, and repairing injured donor lungs prior to transplantation. ⋯ EVLP triggers a new era in lung transplantation. This method will allow for more and better organs to become available. Several experimental studies, clinical case reports, and a clinical trial have shown the safety of EVLP and the numerous potentials of EVLP.