Current opinion in organ transplantation
-
Curr Opin Organ Transplant · Oct 2015
Pediatric mechanical circulatory support: available devices and outcomes as bridge-to-transplant therapy.
The use of mechanical circulatory support in children has increased dramatically over the current decade. A review of the pediatric ventricular assist device (VAD) literature is timely and relevant in order to improve outcomes and refine patient selection as new devices become available and current VADs are used in smaller patients. ⋯ There are many implications of improving and expanding durable device use in children. VAD therapy is evolving as a standard of care as a bridge to transplant in children. Continued surveillance of outcomes is critical to improving patient selection and decreasing adverse events in children with advanced heart failure.
-
Curr Opin Organ Transplant · Oct 2015
ReviewExpanding the lung donor pool: advancements and emerging pathways.
The number of patients listed for lung transplantation largely exceeds the number of available transplantable organs because of a shortage of organ donors and a low utilization rate of lungs from those donors who are available. In recent years, novel strategies have been developed to increase the donor lung pool: improved donor management, the use of lungs from donations after cardiac death (DCD), the use of lobar lung living-donors (LLLD) and the use of ex-vivo lung perfusion (EVLP) to assess and repair injured donor lungs. ⋯ A significant increase in the number of available lungs for transplantation is expected in the future because of the wider use of lungs from controlled or uncontrolled DCD and LLLD lungs, and with organ-specific EVLP treatment strategies.
-
Curr Opin Organ Transplant · Apr 2015
ReviewDonation after circulatory death: the current state and technical approaches to organ procurement.
In this review, we discuss the current state of donation after circulatory death (DCD). We define the DCD donor and describe the current protocols in management of the DCD patient. We then discuss current techniques in organ procurement of the lung and abdominal organs. ⋯ In light of the continually growing disparity between organ supply and demand, DCD has regained traction as a means to increase the donor pool.
-
Curr Opin Organ Transplant · Apr 2015
ReviewPsychiatric evaluation of the face transplant candidate.
There have now been a total of 32 face transplants done in the world since the first in Amien, France, in 2005. This procedure is moving from being considered experimental to being considered an accepted option for reconstruction in cases of severe facial disfigurement. ⋯ There have been three deaths in the first 32 cases of facial transplantation (9.4%), two cases of post-transplant lymphoproliferative disorder in the first 20 face transplant recipients (10%). This rate of post-transplant lymphoproliferative disorder is about 10 times the rate seen in solid-organ transplant recipients. Collaborative assessment protocols are needed to determine whether the improvement in quality of life with facial transplantation is justified in the face of the risk of lifelong immunosuppression.
-
Curr Opin Organ Transplant · Dec 2014
ReviewAcute rejection in vascularized composite allotransplantation.
Acute rejection is the most common complication after vascularized composite allotransplantation (VCA). This review provides a state-of-the-art analysis of prevention, diagnosis and treatment of acute rejection episodes and highlights recent findings with the potential to improve patient care and enhance understanding of the underlying biologic processes. ⋯ Acute rejection is higher in VCA than in any other organ in the field of transplantation, although most episodes are controlled by high-dose steroids and optimization of maintenance immunosuppression. Because of limitations in patient number and the duration of follow-up, the long-term safety and effectiveness of VCA remain unclear. Moreover, the tests currently used to diagnose acute rejection are of limited value. Better diagnostic tools and a better understanding of the immunologic events during acute rejection are therefore needed to improve diagnosis, treatment and outcomes of this life-changing restorative surgery.