Increase In Transplant Activity Research Articles

Early experience of a new national lung allocation scheme in the UK based on clinical urgency

IntroductionA new UK Lung Allocation Scheme (UKLAS) was introduced in 2017, replacing the previous geographic allocation system. Patients are prioritised according to predefined clinical criteria into a three-tier system: the...

Organization of the specialized medical care in conditions of limited resources (military status) (on the example of the provision of nephrology aid in Ukraine)

The paper considers the features of the provision of pediatric and adult nephrology medical care during martial law in Ukraine from February 2022 to May 2023. The influence of military stages on the nephrology care are presented, territorial zones during the conflict are highlighted, event tracks are shown. Separately, the activity of the Ukrainian Association of Nephrologists/Ukrainian Association of Pediatric Nephrologists, new opportunities for integrating nephrology into the system of medical knowledge are considered. Along with the negative trends, positive results were revealed that made it possible to move forward in the system of specialized medical care, namely an increase in transplant activity, a wider use of “long” treatment regimens with rituximab, and the use of digital kidney biopsy. Statistical data, SWOT analysis at the stages of the military conflict are given, an analysis is presented for refugees who left for the European Union to receive kidney replacement therapy. The enormous role of humanitarian programs for maintaining the structure of nephrological care in Ukraine is emphasized. The accumulated experience is unique and can serve as material for the analysis of similar situations in the world in the future.

Prévalence de l’IRCT et part des différentes modalités de traitement

On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of ESKD prevalence, the following key messages were retained. While chronic kidney disease affects all age groups, there always are more patients to treat in the older age groups, with a median age of 71.1 years (IIQ 60.3-80.0) under dialysis and 58.7 years (IIQ 47.4-68.3) under renal transplant. Despite an increase in transplant activity and improved survival of grafts, the gap between the number of dialysis patients and transplant patients at the end of each year is only moderately reduced. There has been a moderate decrease in the proportion of in-centre haemodialysis that is explained by a significant increase in medicalised dialysis units (out-centre haemodialysis) and a decrease in self-care haemodialysis. Finally, a stable home-based care has been observed despite the ministerial incentives and the recommendations of the French-speaking scientific society (SFNDT-white paper).

Early Single Center Experience of Heart Transplantation from Donation After Circulatory Death Donors in the United States

<h3>Purpose</h3> Heart transplantation (HT) from donation after circulatory death (DCD) donors has been proposed as a means of addressing the scarcity of available donor grafts. International experience has suggested that DCD HT is safe, with outcomes comparable to donation after brain death (DBD) HT. Herein we describe our center's early experience using 2 DCD heart procurement strategies: 1) A direct procurement and perfusion (DPP) protocol, and 2) A thoracoabdominal normothermic regional perfusion (TA-NRP) protocol. <h3>Methods</h3> In September 2020, we launched a DCD HT program as part of a randomized trial using DPP and the OCS Transmedics platform. We subsequently launched a TA-NRP program. The TA-NRP protocol uses mobile cardiopulmonary bypass (CPB) to assess hearts in situ following declaration of death. Functional warm ischemic time (FWIT) was defined as the time from onset of mean pressure <50mm Hg or oxygen saturation <70%, to cold flush (DPP) or initiation of CPB (TA-NRP). FWIT was ≤30 minutes for DPP, while there was no pre-defined limit for TA-NRP. Data was prospectively collected. Donor and recipient characteristics were analyzed. We report 30-day survival as the primary endpoint. Secondary endpoints include incidence of primary graft dysfunction requiring mechanical support, immediate cardiac performance, ventilator days, need for renal replacement therapy, and intensive care and hospital length of stay. <h3>Results</h3> From September 2020 to October 2021, our center attended 50 candidate DCD donors, and performed 33 DCD HTs (66.0%), comprised of 13 DPP and 20 TA-NRP protocol donors. Among candidate DPP donors, 13 of 23 (56.5%) hearts were transplanted, whereas among candidate TA-NRP donors, 20 of 27 (74.1%) were transplanted. Year-to-date, DCD as a proportion of all HTs at our center has been 43.1%. Comparing similar time periods before and after implementing our DCD heart transplant program revealed a 20.3% increase in transplant activity. Donor and recipient characteristics are described in tabular format. 30-day survival is 100% among all DCD heart recipients. The incidence of primary graft dysfunction and other secondary endpoints are comparable with standard DBD HT. <h3>Conclusion</h3> DCD HT using both the DPP and TA-NRP procurement protocols is feasible and safe. Outcomes in our early single center experience are comparable with standard DBD HT.

Implementation of allogeneic hematopoietic stem cell transplantation from unrelated donors from Russian and foreign registries

Introduction. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a standard treatment for many patients with hematological malignancies. Over the past 20 years, an increase in transplantation activity has been noted throughout the world. About 50 % of all allo-HSCT are transplanted from unrelated donors. Aim: to present the dynamics and stages of the development of unrelated donation using the example of one transplant center.Materials and methods. This study analyzed Allo-HSCT performed from 2009 to March 2019 at the National Research Center for Hematology (NRCH). The work of the unrelated donor recruiting group and the tissue typing laboratory was analyzed for this period. 107 patient requests for unrelated donor search were dissected to identify search failures. The parameters of 206 unrelated donors were estimated depending on the register (Russian Federation/foreign). Results. The number of allo-HSCTs did not exceed more than 20 per year, in 2009–2011. Since 2012, the number of alloHSCT signifi cantly increased when the possibility for searching for unrelated donors abroad as well as in the Russian Federation (RF) databases appeared. During this time an increase by more than 50 % was noted in the number of allo-HSCTs. Allo-HSCs from unrelated donors of the Russian Federation make up 30–40 % of all unrelated allo-HSCs. 16 % of potential donors of hematopoietic stem cells included in the NRCH registry are donors of the human blood components. Despite the increasing number of unrelated donors in international and RF databases, 12 % of patients did not fi nd a compatible donor in any of the registers, due to a rare combination of HLA genes. It was revealed that among donors from the RF from whom alloHSCT was performed, there was not a signifi cant prevalence of men, compared to the foreign registry, 50.7 % and 66.7 %, respectively, despite the preference of donor-male by doctors. The 5-year overall survival in patients with acute leukemia in the fi rst complete remission, depending on the performance of allo-HSCT from a donor from the RF or foreign registers, are comparable, 40 % and 39.5 %, respectively.Conclusion. The number of allo-HSCT has increased 5 times over the past 10 years largely due to the development of unrelated donation: 30–40 % of allo-HSC transplants received from unrelated donors were performed from donors from the United database of the Russian Federation. The 5-year overall survival of these patients is comparable with the results of the overall survival patients who received transplants from donors from foreign registers.

Progress and trends in pediatric hematopoietic cell transplantation in Central-East European countries

AbstractHematopoietic cell transplantation (HCT) is widely used as a treatment for acquired and congenital disorders. In recent years, a significant increase in transplant activity around the world has been observed, especially in Eastern European countries. This article aimed to assess progress and trends in pediatric HCT in Central-Eastern European countries between 2013 and 2018. Transplant activity survey in 2013 and 2018 in nine Central-Eastern European countries (Czech Republic, Croatia, Hungary, Lithuania, Poland, Romania, Slovakia, Slovenia, and Ukraine) was performed. The highest transplant rates in total were found in the Czech Republic and Hungary. When calculated per 10 million of the pediatric population, a 25.9% increase in the number of allo-HCT was observed with the highest in Croatia, Romania, Lithuania, and Poland; and a 12.2% increase in the number of auto-HCT was observed with the highest in Slovenia, Slovakia, Romania, Poland, Ukraine, and Croatia. We have shown, over the years 2013 and 2018, in some countries of Central-Eastern Europe that there was a significant increase in transplant activity, especially in those with the lower rates. This increase was observed mainly in centers already existing in 2013, especially in the allo-HCT setting. The rise of activity was significantly less influenced by the creation of new transplant centers or the increase in the number of pediatric transplant beds. In conclusion, our analysis indicates that in the Czech Republic, Hungary, Lithuania, and Slovenia, the actual infrastructure and the number of HCTs cover the needs, whereas in other countries, especially in Romania and Ukraine, the number of HCT needs to be increased.

Hematopoietic Stem Cell Transplant Recipients Surviving at Least 2 Years from Transplant Have Survival Rates Approaching Population Levels in the Modern Era of Transplantation.

The health and outcomes of long-term survivors after hematopoietic cell transplant (HCT) are areas of evolving interest as short-term transplant outcomes improve. Because recent changes in transplant practice have likely changed the survivor population, we sought to assess the survival of a contemporary cohort of patients who were alive and free of disease 2 years after HCT. Data were extracted from first transplants documented between 2002 and 2011 in the Australasian Bone Marrow Transplant Recipient Registry on patients who received an allogeneic HCT for acute myeloid leukemia (AML), acute lymphoblastic leukemia, chronic myeloid leukemia (CML), non-Hodgkin lymphoma, and myelodysplastic syndromes or an autologous HCT for myeloma or lymphoma. Patients were included if they had survived at least 2 years without disease relapse or progression. Mortality rates were compared with standard Australian and New Zealand populations using relative-survival analysis. A total of 1562 allogeneic and 3822 autologous HCT patients were included, with a median follow-up of 5.6 years. Compared with a matched group of patients from our previous study from 1992 to 2001, the contemporary cohort of allogeneic HCT recipients was older and more likely to receive peripheral blood stem cells and from unrelated donors. Allogeneic HCT for AML increased, wheresa transplants for CML fell from 32% to 8%. Increasing use of reduced-intensity conditioning and unrelated donors was also seen. Long-term survival after allogeneic and autologous HCT were very similar to the previous 1992 to 2001 cohort despite changes in practice over time. Recipients of autologous HCT for myeloma demonstrated substantially lower overall survival than HCT for other indications with no clear plateau. Annual relative survival for survivors of allogeneic HCT was 96% to 99% of the general population but only 89% to 96% of the general population for recipients of autologous HCT. Late deaths were primarily due to nonrelapse causes after allogeneic HCT, but relapse or disease progression remained prominent for recipients of autologous HCT, particularly for myeloma. The management of late HCT effects is important to improve long-term survival of transplant recipients but should be tailored to the risks specific to the primary disease and transplant type. Future planning should account for the impact of the expected increase in transplant activity and number of survivors on resource utilization.

Establishing a heart transplant programme using donation after circulatory-determined death donors: a United Kingdom based single-centre experience.

Demand for heart transplant donors worldwide continues to outstrip supply. Transplanting hearts following donation after circulatory-determined death (DCD) is increasingly recognized as a safe and effective alternative. As the fourth centre worldwide to have established such a programme, our goal was to present our initial experience. This was a single-centre retrospective observational study. All DCD hearts were retrieved using direct procurement and perfusion. Continuous normothermic perfusion of the procured heart was then established on the TransMedics® Organ Care System. The primary outcome of this study was the 30-day survival rate. Between May 2017 and December 2018, 8 DCD hearts were procured and 7 were subsequently implanted, including in 2 patients who had left ventricular assist devices explanted. During the same time period, 30 patients received donation after brainstem death heart transplants. Therefore, the DCD heart transplant programme led to a 23% increase in transplant activity. The median donation warm ischaemic time was 34 min [interquartile range (IQR) 31-39 min]. The median functional warm ischaemic time was 28 min (IQR 25-30 min). The median time spent by the organ on the Organ Care System was 263 min (IQR 242-296 min). The overall 30-day survival rate was 100% and the 90-day survival rate was 86%. Postoperative extracorporeal membrane oxygenation was required in 3/7 (43%). DCD heart transplants can lead to a 23% increase in heart transplant activity and should be adopted by more institutions across the world. Already established transplant programmes with good early outcomes can start such a programme safely.

The donor heart and organ perfusion technology

Recent advancement in organ perfusion technology has led to increase clinical transplantation of marginal donor organs and allow for distant procurement of cardiac allograft beyond the time limitation of cold static storage. Ex-situ heart perfusion also provides essential nutrients to maintain cell integrity, thereby reducing the risk of ischaemic injury for functional preservation and provides a platform to assess organ viability and feasibility, with the potential for pharmacotherapy to recover these hearts. Notably, the use of NMP has led to the first distant procurement cardiac transplantation from a donation after circulatory death (DCD) in 2014, which resulted in the adoption of DCD heart transplantation in 4 centres between the United Kingdom and Australia. To date, over 100 DCD heart transplants have been performed utilising cardiac perfusion system with an estimated 10-15% increase in transplant activity in the individual units. This review aims to provide an overview of current experience and outcomes using cardiac perfusion technology, including future technologies and recent advancement within the field.

Allograft Trauma in Transplant Recipients. A Case Series

Introduction We are witnessing an age of violence. There is a parallel increase in transplant activity as well. Kidney and pancrese allografts are placed in illiac fossa making them vulnerable to injury. There are only a handful of case reports describing the results of trauma in transplant recipients. We present our experience of managing traumatic allograft injuries in kidney and kidney pancreas allograft recipient. Materials and Methods We describe the outcome of two of our transplant recipients who were exposed to major trauma and managed in different ways. Case 1 A 46 year old male who had undergone a renal transplant 18 years ago, presented following a road traffic accident and was noted to have tenderness at the graft site. Computerised tomographic (CT) scan revealed an isolated grade III laceration of upper pole of transplant kidney with a perinephric haematoma. The patient remained heamodynamically stable and a repeat CT scan on day 3 did not show any increase in the perinephric collection.There was an initial increase in his serum creatinine but this subsequently improved and he was discharged on the 6th day. His subsequent clinical course remained uneventful with graft function returning to base line at 6 months follow up. Case 2 A 45 year old male with a simultaneous pancreas kidney transplant done 29 months ago presented following a fall from the second floor. Tenderness was noted over the renal allograft and an urgent CT scan revealed a haematoma with a grade III laceration of the renal graft.Rest of the abdomen and transplanted pancreas were unremarkable. Patient remained unstable heamodynamically despite adequate resuscitation. After optimization, a follow-up CT scan showed an increase in the size of perinephric haematoma and extravasation of contrast suggestive of an active bleed. It was decided to perform an angiogram and embolization of the bleeding vessel using micro coils. A follow-up doppler scan showed preservation of global perfusion apart from a small avascular area in the upper pole. The patient was discharged with stable graft function on day 10 and no complications identified at 6 months follow up. Conclusion Basic principle of resuscitation should be applied in managing traumatic injuries in transplant recipients. Life of the patient takes precedence over the allograft. These cases highlight the importance of close clinical monitoring, serial imaging and the role of interventional radiology in the management of trauma in transplant recipients.

Living donor liver transplantation in India.

Liver transplantation is currently in its golden period in India. The number of transplants being performed and the steady increase in the new programs that have emerged over the last decade is a testimony to it. The growth was not smooth, especially in the early years. But a multipronged approach in developing infrastructure and the involvement of multidisciplinary teams in the management of transplant patients has had a major positive impact on the outcome and as a result a positive impetus to the growth of this specialty in India. To date, the majority of transplants performed in India are live donor liver transplants. Deceased donation is more sporadic and concentrated in a couple of regions. With phenomenal increase in transplant activity in India, there is huge potential for streamlining data sharing among programs in India and with the rest of the world to ultimately benefit the transplant community.

The latest trends in clinical transplantation on the results of the World Congress of Transplantation (26-31.07.2014, San Francisco, USA)

The World Congress of Transplantation was held on 26.07-31.07.2014 in San Francisco (USA). There were presented 3090 reports, among them 2073 (70 %) were in clinical transplantation, including renal transplantation – 1,089 reports, liver transplantation – 495, heart transplantation – 71, lungs transplantation – 35, and pancreas transplantation – 11. An overall increase in transplant activity was observed, especially significant in a number of African countries (Tunisia, Sudan, and Nigeria), Thailand, Qatar, Iran, Brazil and a significant improvement in the results of transplantation, promoting longevity of transplant recipients with good quality of life. As one of many examples can be childbirth in women with a heart transplanted in early childhood.

Factors associated to depression in renal transplant recipients in Panama

Aim:High rates of affective disorders have been reported in kidney transplant recipients treated for end-stage renal disease. Latin America has experienced a significant increase in transplant activity in recent decades, but there is a dearth of data regarding psychosocial issues following kidney transplantation. The aim of this study was to measure the prevalence of depression and the demographic factors associated to depression among renal transplant recipients in Panama.Materials and Methods:This cross-sectional study was conducted between March to May 2010 in a hospital setting during routine outpatient evaluations. The study included 119 renal transplant recipients (58 males, 61 females). Depressive symptoms were measured using the self-report Hospital Anxiety and Depression Scale and diagnoses were established by a trained psychiatrist using the Mini-International Neuropsychiatric Interview. Regression models were used to explore the association between depression and sociodemographic variables.Results:The prevalence of depression was 11.8% among transplant recipients. Linear regression indicated that the presence of an anxiety disorder, increasing age, and lower education levels were significantly and independently associated with depressive symptoms. Logistic regression analysis confirmed that anxiety and a perception of negative social support significantly increased the likelihood of depression.Conclusions:These findings have important clinical implications. Depression after kidney transplantation has been shown to affect health outcomes adversely. Our results underscore the need to assess depressive symptoms as well as other affective disorders as part of the screening and treatment of renal transplant patients in Panama.

L’évolution de la transplantation rénale ces 20 dernières années

Kidney transplantation is an efficient treatment of end stage renal disease, decreasing patient mortality by comparison with mortality in dialysis and improving patient quality of life. The number of patients living in France with a functioning transplant is almost as high as the number of patients on dialysis (33,000 versus 37,500 in 2009). The constant progress in immunosuppressive treatments has made graft survival improve. According to the "Agence de biomédecine", the national institution in charge of transplantation regulation and management, overall graft survival is 68% at 10 years but 80% for living donor transplantation. Transplantation indications have been extended with time to more difficult patients: retransplanted patients and elderly patients, to the point that age per se is no more a contraindication to transplantation. Increase in transplant activity has followed increase in kidney harvesting in marginal donors, called "extended criteria donors": older, hypertensive, having atherosclerotic pathologies. Kidney from these donors are attributed to recipients of similar age. With organ shortage, new sources of donors are proposed, non heart beating donors and living donors. Living donor transplantation is the best transplantation with the best results but it is insufficiently developed in France (8-10% of the total annual number of renal transplantations versus 30-50% in the Scandinavian and Anglo-Saxon countries). Extension of the definition of the living donor through the successive revisions of the Law of Bioethics should hopefully improved this situation.