Current opinion in organ transplantation
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Despite improvements in respiratory care and lung transplant organ allocation algorithms, waiting lists continue to grow worldwide. Attempts at improving organ donation rates have generally had little impact on the increase in the number of transplants performed. Improved use of the available pool of cadaveric organ donors, therefore, represents one of few immediately available strategies to alleviate organ shortages. ⋯ Although the available evidence for and against the commonly used lung donor selection criteria leaves many questions unanswered, it can help decrease the large number of uncertainties that be falls the practice of lung donor selection and recipient matching.
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Curr Opin Organ Transplant · Dec 2008
ReviewGranulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, and other immunomodulatory therapies for the treatment of infectious diseases in solid organ transplant recipients.
Infections continue to cause significant morbidity and mortality in SOT recipients despite major advances in immunosuppressive and antimicrobial regimens. Immunomodulatory cytokines provide a potential means to augment the host immune response to infection. This review will focus on cytokine therapy for the prophylaxis and treatment of infections in solid organ transplant recipients, and will speculate on the potential for further advances in the field. ⋯ Despite encouraging results in vitro and in preclinical models, immunomodulatory cytokines have not met expectations when administered to SOT recipients. Nonetheless, the principle of selective enhancement of innate immunity for the prevention and treatment of infections in this patient population has promise and warrants further study.
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Mechanical circulatory support is expanding the treatment of advanced heart failure. The number of heart transplantations performed worldwide remains fairly static, and medical therapy alone for end stage heart failure continues to have dismal results. This article presents the authors' opinion as to the current status, challenges, and future course of the field of mechanical circulatory support. ⋯ Mechanical circulatory support holds great promise in the treatment of advanced heart failure. It is critical to change the perception of both the clinician and the patient toward the prognosis of end stage heart failure. The prospect of achieving long-term myocardial recovery using mechanical support as a platform for other strategies is exciting and requires intensive future investigation.
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Curr Opin Organ Transplant · Oct 2008
ReviewEvidence for immunosuppression in lung transplantation.
Historically, most lung transplant recipients have received triple-drug maintenance immunosuppression consisting of a calcineurin inhibitor, azathioprine, and prednisolone. The introduction of mycophenolate mofetil, mammalian target of rapamycin (mTOR) inhibitors, and antibody-based induction therapy has broadened immunosuppressive options. The purpose of this review is to summarize the evidence for immunosuppressive regimens in the prevention and treatment of lung allograft rejection. ⋯ Combination therapy with a calcineurin inhibitor, antimetabolite, and a corticosteroid derivative remains the backbone of lung transplant immunosuppression. Induction therapy (in whatever form) may reduce acute rejection, but does not lower the incidence of chronic rejection or improve survival. New strategies utilizing mTOR inhibitors may herald a more promising era.