Transplantation (all articles)
RCT: Hypothermic Oxygenated Perfusion Trends Toward Lower Primary Graft Dysfunction in Heart Transplantation – The Lancet
17 Aug, 2024 | 19:38h | UTCStudy Design and Population: This randomized, controlled, open-label, multicenter clinical trial evaluated the safety and efficacy of hypothermic oxygenated machine perfusion (HOPE) compared to static cold storage (SCS) in preserving donor hearts for transplantation. Conducted across 15 transplant centers in eight European countries, the study enrolled 229 adult heart transplant candidates between November 2020 and May 2023. The trial included 204 patients who received a transplant and met the study’s inclusion and exclusion criteria.
Main Findings: The primary composite endpoint, including cardiac-related death, graft dysfunction, and rejection within 30 days post-transplant, occurred in 19% of patients in the HOPE group compared to 30% in the SCS group, reflecting a 44% risk reduction (HR 0.56, 95% CI 0.32–0.99, p=0.059). Notably, primary graft dysfunction was significantly lower in the HOPE group (11% vs. 28%, RR 0.39, 95% CI 0.20–0.73). The incidence of major adverse cardiac transplant events was also reduced with HOPE (18% vs. 32%, RR 0.56, 95% CI 0.34–0.92).
Implications for Practice: HOPE showed a potential clinical benefit by reducing the incidence of primary graft dysfunction and major adverse cardiac events after heart transplantation. Although the primary endpoint was not statistically significant, the observed risk reductions suggest that HOPE could improve outcomes in heart transplantation. Further research is needed to confirm these findings and optimize donor heart preservation strategies.
RCT | Exploring the impact of total pancreatectomy with islet autotransplantation to reduce postoperative complications
8 Aug, 2023 | 13:25h | UTC
AAP Policy Statement | Pediatric organ donation and transplantation: across the care continuum
1 Aug, 2023 | 14:26h | UTCPediatric Organ Donation and Transplantation: Across the Care Continuum – Pediatrics
News Release: Policy underscores role of medical home in pediatric organ donation, transplantation – AAP News
Nonrandomized Controlled Trial | Long-term survival of 80% in selected colorectal cancer patients post liver transplant
1 Aug, 2023 | 14:20h | UTCLong-Term Survival, Prognostic Factors, and Selection of Patients With Colorectal Cancer for Liver Transplant: A Nonrandomized Controlled Trial – JAMA Surgery (link to abstract – $ for full-text)
Commentary on Twitter
Selected patients with liver-only CRLM and favorable pre-transplant prognostic scoring have long-term OS comparable to conventional indications for LT, providing a potential curative treatment option in patients otherwise offered only palliative treatments https://t.co/Xso5R7IDsX pic.twitter.com/uwEWijcrBp
— JAMA Surgery (@JAMASurgery) July 26, 2023
Study | Left ventricular dysfunction in brain-dead heart donors – incidence, reversibility, and implications
31 Jul, 2023 | 14:09h | UTCLeft Ventricular Dysfunction Associated With Brain Death: Results From the Donor Heart Study – Circulation (free for a limited period)
Cohort Study | Proton pump inhibitor use linked to increased fatigue in kidney transplant recipients
26 Jul, 2023 | 13:21h | UTC
Commentary on Twitter
Proton Pump Inhibitor Use, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients: Results From the TransplantLines Biobank and Cohort Study https://t.co/DkDTvs9zjo #OpenAccess#VisualAbstract @umcg pic.twitter.com/XooY16qFVT
— AJKD (@AJKDonline) July 25, 2023
AHA Statement | Indications, evaluation, and outcomes for dual heart-kidney and heart-liver transplantation
14 Jul, 2023 | 12:51h | UTC
Guideline | Acute liver failure
10 Jul, 2023 | 13:59h | UTCAcute Liver Failure Guidelines – The American Journal of Gastroenterology
Related:
EASL Clinical Practice Guidelines on acute-on-chronic liver failure – Journal of Hepatology
Guidelines for the management of adult acute and acute-on-chronic liver failure in the ICU
Acute-on-chronic liver failure: far to go—a review – Critical Care
Canadian Guidance | Deceased organ and tissue donation after medical assistance in dying
10 Jul, 2023 | 13:41h | UTCCommentary: What happens to the organs of people who choose medically assisted deaths? – CTV News
RCT | Substituting saline with balanced crystalloid solution reduces delayed graft function in kidney transplantation
30 Jun, 2023 | 14:56h | UTCSummary: The BEST-Fluids study was a pragmatic, multicentre, double-blind, randomized controlled trial carried out across 16 hospitals in Australia and New Zealand, aimed at comparing the use of balanced crystalloid solution (Plasma-Lyte 148) and saline in deceased donor kidney transplantation. The sample size comprised of 808 participants, who were either adults or children of any age, with the primary outcome defined as delayed graft function (DGF) occurring within 7 days post-transplantation.
Findings from the trial revealed that the balanced crystalloid group experienced less DGF than the saline group, with 121 out of 404 participants (30%) and 160 out of 403 participants (40%), respectively. This result yields an adjusted relative risk of 0.74 and an adjusted risk difference of 10.1%.
The study suggests that balanced crystalloid solution significantly reduces the incidence of DGF compared to saline. As no significant safety concerns were raised during the trial, the researchers recommend the use of balanced crystalloid solution as the standard-of-care intravenous fluid in deceased donor kidney transplantation. However, the study doesn’t indicate any significant differences in graft failure or mortality rates, which calls for further research.
Article: Balanced crystalloid solution versus saline in deceased donor kidney transplantation (BEST-Fluids): a pragmatic, double-blind, randomised, controlled trial – The Lancet (free registration required)
Liver Transplantation 2023 | Status report, current and future challenges
29 Jun, 2023 | 13:50h | UTC
RCT | Cyclophosphamide-based regimen enhances GVHD-free survival after hematopoietic stem-cell transplantation
27 Jun, 2023 | 13:54h | UTCSummary: The article details a phase 3 trial comparing the efficacy of two graft-versus-host disease (GVHD) prophylactic regimens in hematologic cancer patients undergoing allogeneic hematopoietic stem-cell transplantation (HSCT). The experimental group received cyclophosphamide–tacrolimus–mycophenolate mofetil, and the standard group received tacrolimus–methotrexate. The patients, a total of 431, underwent HSCT from an HLA-matched related donor or a matched or 7/8 mismatched unrelated donor.
The primary end point was GVHD-free, relapse-free survival at 1 year. Results indicated a significantly higher incidence of this outcome in the experimental group (hazard ratio, 0.64; 95% confidence interval [CI], 0.49 to 0.83; P=0.001). At 1 year, adjusted GVHD-free, relapse-free survival was 52.7% (95% CI, 45.8 to 59.2) in the experimental group, compared to 34.9% (95% CI, 28.6 to 41.3) in the standard group.
Notably, patients in the experimental-prophylaxis group appeared to have less severe acute or chronic GVHD and a higher incidence of immunosuppression-free survival at 1 year. Overall survival, disease-free survival, relapse, transplantation-related death, and engraftment did not show a substantial difference between the groups. These results suggest that cyclophosphamide–tacrolimus–mycophenolate mofetil may offer a more effective prophylaxis against GVHD in HSCT patients.
Article: Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: Study Sets New Standard for Graft-Versus-Host Disease Prevention After Stem Cell Transplant – Johns Hopkins Medicine
Commentary on Twitter
In this trial, 1-year GVHD-free, relapse-free survival after stem-cell transplantation was 52.7% in the cyclophosphamide–tacrolimus–mycophenolate mofetil group and 34.9% in the tacrolimus–methotrexate group. https://t.co/wCdvP1LChu
— NEJM (@NEJM) June 21, 2023
Consensus Paper | Primary prophylaxis of invasive fungal diseases in patients with hematological malignancies
23 Jun, 2023 | 13:23h | UTC
Review | Acute graft-versus-host disease
14 Jun, 2023 | 14:20h | UTCAcute graft-versus-host disease – Nature Reviews Disease Primers (if the link is paywalled, try this one)
Commentary on Twitter
Tissue damage resulting from allogenic hematopoietic cell transplantation conditioning regimens triggers cellular interactions and #inflammatory cascades that lead to acute #GraftVersusHost disease symptoms https://t.co/iHyUVoV75J pic.twitter.com/ob9X7zQWB8
— Nature Reviews Disease Primers (@DiseasePrimers) June 11, 2023
RCT | No change in delayed graft function with normothermic perfusion vs. cold storage in kidney transplants
13 Jun, 2023 | 14:00h | UTC
Commentary on Twitter
In an open-label, randomized controlled trial, normothermic machine perfusion of kidneys from donation after circulatory death was found to be feasible and safe but did not reduce the rate of delayed graft function compared to static cold storage. https://t.co/faaAzK3bpc pic.twitter.com/iL7Je7Z7jO
— Nature Medicine (@NatureMedicine) June 2, 2023
Review | Challenges and opportunities in antimicrobial stewardship among hematopoietic stem cell transplant and oncology patients
13 Jun, 2023 | 13:55h | UTC
RCT | Noninferior survival rates with hearts donated after circulatory death versus brain death
12 Jun, 2023 | 13:57h | UTCTransplantation Outcomes with Donor Hearts after Circulatory Death – New England Journal of Medicine (link to abstract – $ for full-text)
Video summary: Outcomes with Donor Hearts after Circulatory Death | NEJM
News Release: Multicenter Trial Finds Using Circulatory Death Donors is Safe and Effective for Heart Transplantation – Northwestern Medicine
Commentary: Transplantation Outcomes With Donor Hearts After Circulatory Death – American College of Cardiology
Commentary on Twitter
In a randomized trial, survival at 6 months after transplantation with hearts donated after circulatory death was noninferior to that with hearts donated after brain death. https://t.co/IymsknTqSE#cardiology pic.twitter.com/oYAS10fVJt
— NEJM (@NEJM) June 7, 2023
RCT | Letermovir demonstrates noninferiority to valganciclovir for CMV prophylaxis in kidney transplantation
12 Jun, 2023 | 13:38h | UTCLetermovir vs Valganciclovir for Prophylaxis of Cytomegalovirus in High-Risk Kidney Transplant Recipients: A Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: A New Antiviral Option for Cytomegalovirus Prevention After Kidney Transplant – JAMA (free for a limited period)
See also: Visual Abstract
Consensus Paper | Organ donation in the surgical ICU
1 Jun, 2023 | 12:12h | UTC
ISHLT Guideline | Mechanical circulatory support
29 May, 2023 | 10:40h | UTC
ISHLT Guidelines for the care of heart transplant recipients
3 May, 2023 | 15:09h | UTC
Extracorporeal CPR dissemination and integration with organ preservation in the USA: ethical and logistical considerations
28 Apr, 2023 | 12:47h | UTC
Perspective | Liver transplantation for patients with severe acute on chronic liver failure: it is time to change paradigms
25 Apr, 2023 | 14:37h | UTC
Commentary on Twitter
Liver #Tx in severe acute on chronic failure
➡️ #ICU care crucial in ACLF-3
➡️ improve referrals to LT centers & pre-LT workup
➡️ to decide to put pt on waitlist consider donor shortage/collective utility of LT
➡️ identifying transplantability window
?️ https://t.co/VZxDyZ1k74 pic.twitter.com/6YOcd5rzMu— Intensive Care Medicine (@yourICM) April 19, 2023
Cold static preservation at 10°C shows promising results for safely extending lung transplantation timeframes
24 Apr, 2023 | 13:38h | UTCExtension of Cold Static Donor Lung Preservation at 10°C – NEJM Evidence
Commentary on Twitter
Donor lungs for transplantation are stored on ice and transplanted as rapidly as possible. In an advance that may ease transplant logistics, Ali et al. now report that prolonged storage of donor lungs at 10°C may lead to equivalent outcomes.
Read the Original Article:
— NEJM Evidence (@NEJMEvidence) April 22, 2023
Guidelines for the management of adult acute and acute-on-chronic liver failure in the ICU
17 Apr, 2023 | 13:19h | UTCGuidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Neurology, Peri-Transplant Medicine, Infectious Disease, and Gastroenterology Considerations – Critical Care Medicine (free for a limited period)
Executive Summary: Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Neurology, Peri-Transplant Medicine, Infectious Disease, and Gastroenterology Considerations – Critical Care Medicine (free for a limited period)