Transplant Facilities Research Articles

The Outcome of A Centralization Program in Biliary atresia: 20 years and beyond.

Biliary atresia (BA) is a rare disease and reported outcomes of surgical management, typically a Kasai portoenterostomy (KPE), vary considerably across the world. Centralization has been proposed to improve this. A national centralization programme was started in Jan. 1999, involving 3 English units with co-located liver transplant facilities. As the program has now reached the 20-year point, the main aim was to update outcome statistics and identify trends. Prospective registry and database. The main measures of outcome were (i) time to KPE, (ii) Clearance of Jaundice (CoJ), defined as reaching a bilirubin value of <20µmol/L (≈1.5 mg/dL), and (iii) actuarial native liver survival (NLS) and overall survival (OS). Data are quoted as median (IQR) and non-parametric statistical comparison used with P<0.05 regarded as significant. 867 infants were born with BA and managed between January 1999 and December 2019. Death occurred without intervention (n=10, 1.1%) or were subject to primary transplant (n=26, 3.0%); leaving 831 (95.9%) infants who underwent KPE at median age of 51 (IQR 39-64) days. Age at KPE reduced over the period (P=0.0001) becoming 48(35-57) days in the last 5-year era. CoJ was achieved in 505/831 (60.6%), also increasing over the period (P=0.002). 42 (5.0%) died post-KPE and 384 were transplanted, leaving 405 alive with their native livers at last follow-up. Of the 412 children transplanted, there were 23 (5.6%) deaths, leaving 387 alive. 5-year and 10-year native liver survival were 51.3% (95% CI 54.8-47.8) and 46.5% (95% CI 50.1 - 42.9) and overall survival were 91.5% (95% CI 93.2 - 89.4) and 90.5% (95% CI 92.3 - 88.2%) respectively. There have been continued improvements in efficiency over the period of centralization with a significant reduction in time to KPE and improved CoJ following KPE. Overall survival in this disease remains >90%.

Pediatric and adult liver transplantation in Bahrain: The experiences in a country with no available liver transplant facilities.

Liver transplantation (LT) is a life-saving procedure for patients with end-stage liver disease and has become the standard and most effective treatment method for these patients. There are many indications for LT that vary between countries and settings. The outcome of LT depends on the available facilities and surgical expertise, as well as the types of liver graft donors available. To assess the clinical characteristics of patients from Bahrain who underwent LT overseas, and analyze factors affecting their survival. In this retrospective cohort study, we reviewed the medical records and overseas committee registry information of all pediatric and adult patients who were sent overseas to undergo LT by the Pediatric and Medical Departments of Salmaniya Medical Complex and Bahrain Defence Force Hospital via the Overseas Treatment Office, Ministry of Health, Kingdom of Bahrain, between 1997 and 2023. Demo graphic data, LT indication, donor-recipient relationship, overseas LT center, graft type, post-LT medications, and LT complications, were collected. Outcomes measured included the overall and 5-year LT survival rate. Fisher's exact, Pearson χ2, and Mann-Whitney U tests were used to compare the pediatric and the adults' group in terms of clinical characteristics, donor-recipient relationship, medication, complications, and outcome. Survival analysis was estimated via the Kaplan-Meier's method. Univariate and multivariate analyses were used to detect predictors of survival. Of the 208 eligible patients, 170 (81.7%) were sent overseas to undergo LT while 38 (18.3%) remained on the waiting list. Of the 170 patients, 167 (80.3%) underwent LT and were included in the study. The majority of the patients were Bahraini (91.0%), and most were males (57.5%). One-hundred-and-twenty (71.8%) were adults and 47 (28.3%) were children. The median age at transplant was 50.0 [interquartile range (IQR): 14.9-58.4] years. The main indication for pediatric LT was biliary atresia (31.9%), while that of adult LT was hepatitis C-related cirrhosis (35.0%). Six (3.6%) patients required re-transplantation. Most patients received a living-related liver graft (82%). Pediatric patients received more living and related grafts than adults (P = 0.038 and P = 0.041, respectively), while adult patients received more cadaveric and unrelated grafts. Most patients required long-term immunosuppressive therapy after LT (94.7%), of which tacrolimus was the most prescribed (84.0%), followed by prednisolone (50.7%), which was prescribed more frequently for pediatric patients (P = 0.001). Most patients developed complications (62.4%) with infectious episodes being the most common (38.9%), followed by biliary stricture (19.5%). Tonsilitis and sepsis (n = 12, 8.1% for each) were the most frequent infections. Pediatric patients experienced higher rates of infection, rejection, and early poor graft function than adult patients (P < 0.001, P = 0.003, and P = 0.025, respectively). The median follow-up time was 6.5 (IQR: 2.6-10.6) years. The overall survival rate was 84.4%, the 5-year survival rate, 86.2%, and the mortality rate, 15.6%. Younger patients had significantly better odds of survival (P = 0.019) and patients who survived had significantly longer follow-up periods (P < 0.001). Patients with end-stage liver disease in Bahrain shared characteristics with those from other countries. Since LT facilities are not available, an overseas LT has offered them great hope.

Population Genomics Reveals an Emerging Lineage of Xanthomonas perforans on Pepper.

Xanthomonas perforans-the dominant causal agent of bacterial leaf spot of tomato-is an emerging pathogen of pepper, indicative of a potential host expansion across the southeastern United States. However, studies of the genetic diversity and evolution of X. perforans from pepper remain limited. In this study, the whole-genome sequences of 35 X. perforans strains isolated from pepper from four fields and two transplant facilities across southwest Florida between 2019 and 2021 were used to compare genomic divergence, evolution, and variation in type III secreted effectors. Phylogenetic analysis based on core genes revealed that all 35 X. perforans strains formed one genetic cluster with pepper and tomato strains from Alabama and Turkey and were closely related to strains isolated from tomato in Indiana, Mexico, and Louisiana. The in planta population growth of tomato strains isolated from Indiana, Mexico, Louisiana, and Turkey in pepper leaf mesophyll was on par with pepper X. perforans and X. euvesicatoria strains. Molecular clock analysis of the 35 Florida strains dated their emergence to approximately 2017. While strains varied in copper tolerance, all sequenced strains harbored the avrHah1 transcription activation-like effector located on a conjugative plasmid, not previously reported in Florida. Our findings suggest that there is a geographically distributed lineage of X. perforans strains on tomato that has the genetic background to cause disease on pepper. Moreover, this study clarifies potential adaptive variants of X. perforans on pepper that could help forecast the emergence of such strains and enable immediate or preemptive intervention.

Adherence to recommended vaccination policies for pre- and post-solid organ transplantation patients: A national questionnaire survey in Japan

BackgroundPre-transplant vaccination is recommended for patients undergoing solid organ transplantation (SOT). While appropriate vaccination protocols are implemented at some facilities, transplantation is sometimes performed with inadequate preoperative vaccine management. Vaccination rates vary across facilities, but those of SOT centers in Japan have never been investigated. This study aimed to conduct a nationwide questionnaire survey to assess pre- and post-transplant vaccination policies among SOT facilities in Japan. MethodsThe survey was conducted from September to November 2022. All registered (n = 221) solid organ (namely, the lungs, liver, kidneys, pancreas, heart, and small intestine) transplant facilities were asked to complete a web-based survey. ResultsThe survey response rate was 70.2 %. Live and inactivated vaccines were recommended at 64.9 % and 68.9 % of the responding facilities, respectively. The following vaccines were incorporated into the vaccination protocols of facilities: pneumococcal vaccine, 31.7 % (13-valent pneumococcal conjugate vaccine) and 65.4 % (23-valent pneumococcal polysaccharide vaccine); hepatitis B virus vaccine, 67.3 %; severe acute respiratory syndrome coronavirus 2 vaccine, 73.1 %; influenza vaccine, 73.1 %; and zoster vaccines, 23.1 %. The reasons for unresponsiveness to vaccinations included inadequate time before transplantation (60.3 %), cost burden (41.1 %), high number of vaccinations (21.9 %), no recognition of the need for vaccination (17.9 %), and the requirement to explain the need for vaccination (15.2 %). ConclusionsOur study revealed gaps in vaccination practices across nationwide facilities in Japan. The findings indicate the importance of promoting scheduled efficiency and encouraging the national health system to reduce vaccine costs with the support of public subsidies.

Transplant tourism - a missed opportunity.

To explore the resurgence of transplant tourism (TT) despite the recent reiteration of the Declaration of Istanbul (DoI) in 2018. As demand grows exponentially and supply remains static, novel approaches to bridging the gap should be explored. TT is estimated to comprise up to 10% of transplants worldwide. Prosecuting patients seeking organs through TT has been unsuccessful. Extra jurisdictional prosecution of brokers, vendors and institutions participating in illicit TT has been difficult. Resurgence of TT has occurred in both "traditional" and new countries. The public attitude towards TT and paid donation is largely positive. The Iranian experience with state regulated paid donors merits attention and perhaps emulation. Numerous philosophers, ethicists and transplant professionals find it acceptable to promote financial consideration for organ donors. Acknowledging the autonomy of persons, including poor and vulnerable ones, to receive financial consideration for their sacrifice should not be considered morally reprehensible. Strict international regulation, oversight and legislation should be implemented to assure adequate compensation, donor wellbeing, elimination of brokers and excellent medical care. Implementing such a system internationally may eliminate kidney waiting lists, provide great benefits to vendors, improve transplant facilities in developing countries and provide substantial savings to insurers.

Comorbid psychiatric disorders and long-term survival after liver transplantation in transplant facilities with a psychiatric consultation-liaison team: a multicenter retrospective study

ObjectiveComorbid psychiatric disorders negatively affect the survival rate of patients with some physical disorders. In liver transplant recipients, various psychiatric disorders have been identified as worsening prognosis. However, little is known about how the presence of any comorbid (overall) disorders affect the survival rate of transplant recipients. In this study, we examined the effect of overall comorbid psychiatric disorders on survival rate in liver transplant recipients.MethodsA total of 1006 recipients who underwent liver transplantation between September 1997 and July 2017 across eight transplant facilities with a psychiatric consultation-liaison team were identified consecutively. Recipients were categorized into those with comorbid psychiatric disorders and those without comorbid psychiatric disorders. In the comorbid psychiatric disorder group, psychiatric disorder diagnosis and time of diagnosis were investigated retrospectively.ResultsOf the 1006 recipients, 294 (29.2%) had comorbid psychiatric disorders. Comorbid psychiatric disorders in the 1006 recipients were insomnia (N = 107, 10.6%), delirium (N = 103, 10.2%), major depressive disorder (N = 41, 4.1%), adjustment disorder (N = 19, 1.9%), anxiety disorder (N = 17, 1.7%), intellectual disability (N = 11, 1.1%), autism spectrum disorder (N = 7, 0.7%), somatic symptom disorder (N = 4, 0.4%) schizophrenia (N = 4, 0.4%), substance use disorder (N = 24, 2.4%) and personality disorder (N = 2, 0.2%). The most common time of psychiatric disorder diagnosis was within the first 3 months after liver transplantation (51.6%). The final mortality in patients with comorbid psychiatric disorder diagnosis during the five periods (pretransplant, transplant to 3 months, months to 1 year, 1 to 3 years, and over 3 years posttransplant) was 16.2%, 18.8%, 39.1%, 28.6%, and 16.2% respectively, and there were no significant differences between the five periods (χ2 = 8.05, df = 4, p = 0.09). Overall comorbid psychiatric disorders were significantly associated with shorter survival time (log-rank test: p = 0.01, hazard ratio: 1.59 [95% confidence interval: 1.14–2.21], survival rate at the endpoint [%]: 62.0 vs. 83.3). However, after adjusting for confounding variables using Cox proportional hazards regression, there was no significant effect of overall comorbid psychiatric disorders on prognosis.ConclusionComorbid psychiatric disorders did not affect the survival rate of liver transplant recipients in this study.

Emerging, re‐emerging and/or atypically behaving infectious diseases

Emerging, re‐emerging and/or atypically behaving infectious diseases

Nurse-led clinical activity in kidney transplantation care in Spain: A cross-sectional observational study.

To explore the presence of specialist outpatient nursing activity in care for kidney transplant recipients in Spain and to determine the level of competence development of this activity according to the Advanced Practice Nurse model. Descriptive, cross-sectional study. All outpatient nurses specialising in renal transplantation in the 39 transplant hospitals in Spain were included. To fulfil the study objectives, an ad hoc questionnaire and the 'Advanced Practice Nurse Role Definition Instrument (IDREPA)'were administered to assess the nurses' level of competence development. Of the facilities included in the study, 25 (64.1%) had posttransplant nursing activity, 13 (33.3%) had pretransplant nursing activityand 11 (28.2%) had nursing activity involving kidney donor candidates. Twenty-seven specialist nurse's offices were identified. The results of the IDREPA reflect the presence of advanced practice in the domains of 'expert care planning' and 'comprehensive care'. Three (11.1%) nurses met all criteria for advanced nursing practice. The results on specialised outpatient nursing activity at the 39 transplantation facilities in Spain indicate a low presence of this type of activity, with an even lower presence of advanced practice nurses. Management teams should consider investing in the quality of care provided by advanced nurse practice to ensure that suitable treatment is provided and better clinical outcomes are obtained.

The unmet need of organ transplantation in Africa.

The unmet need of organ transplantation in Africa.

CFTR-beyond the airways: Recent findings on the role of the CFTR channel in the pancreas, the intestine and the kidneys

With increased longevity of patients suffering from cystic fibrosis, and widespread lung transplantation facilities, the sequelae of defective CFTR in other organs than the airways come to the fore. This minireview highlights recent scientific progress in the understanding of CFTR function in the pancreas, the intestine and the kidney, and explores potential therapeutic strategies to combat defective CFTR function in these organs.

Indian society of organ transplantation: New Era

Dear Esteemed colleagues, I am writing this column after taking over as ISOT president being supported by the proactive executive committee. Former president Prof. Sunil Shroff had provided new initiatives in 2021–2022, which have gone above and beyond in leading by example with regard to team working, cross-specialty collaboration, and raising awareness of how the social determinants of health such as organ donation drive affect and save many lives. I congratulate his leadership for these endless efforts. Prof. Manisha Sahay editor-in-chief of the Indian Journal of Transplantation has commendably published every edition suitably representing the broad spectrum of scientific literature. As she demits editorship, I say a big thank you, as she hands over the reins of the journal to Prof. Narayan Prasad. As we are all aware of the lacunae in transplantation immunology, transplant-related infections, and appropriate transplant-related multiple organ biopsy interpretation, I convened a zoom meeting of Prof. Dolly Daniel (Immunologist), Prof. Priscilla Rupoli (Infectious disease), and Prof. Seethalakshmi (Pathologist) with Prof. Vivek Kute last week to form subcommittees. These three will work 24 × 7 through the website to give timely support to all transplant facilities across India. I express my thanks for their commitment. Having been the organizing chairman for ISOT 1997 and 2015 in Chennai, I understand how pressurized is our transplantation landscape. I request our trainee nephrologists, urologists, Pathologists, infectious disease people, other multi-organ transplant physicians, and surgeons to join the society to strengthen our society and be beneficiaries. The collaborative efforts undertaken by ISOT, the British Transplant Society, and the European Society of Transplantation on a mutually respectable platform will accelerate our efforts in terms of the exchange of knowledge. Short-term and long-term fellowship programs and other exchanges should be utilized to the best of our efforts. Our young members in the executive and membership are exemplary value to the society. They are an absolutely vital part of our commitment to encourage upcoming youngsters to develop an active role in future issues that matter to them in our influencing work. The pandemic greatly disrupted our work. Nevertheless, Prof. Vivek Kute and other colleagues put in extraordinary efforts to show the transplant community across the world of our challenges and solutions through publications. They deserve special appreciation. Although we lost some patients during the first and second waves, we gained much-desired experience in the management of our patients. As the misinformation and paucity of information and unnecessary hype created by some media demoralized our eminent doctors and uncalled punishment action by certain government authorities falling prey to misinformed advice, we have to stand together as a responsible body to take and deal with these challenges effectively. The discussion highlighting legal issues by Prof. Sanjay Agarwal along with ISN and facing the media in a previous incident was highly educative. We require a strong legal cell to protect our doctors. I also look forward to bidding for a future WCT in India. I take this opportunity to congratulate the three Indians Prof. Manikkam Suthanthiran, Dr. Gomathy Narasimhan, and Prof. Vivek Kute for receiving prestigious awards by TTS at the WCT in Buenos Aires, Argentina. They are the face of India. I wish you all a Happy New Year. Figure 1 is the picture of Prof. Krishna Menon, President BTS; Gabriel Oniscu, President ESOT; and myself.Figure 1: Gabriel Oniscu, Georgi Abraham, Krishnan Menon

International pediatric transplant association (IPTA) guidance on developing and/or expanding pediatric solid organ transplantation programs in low- and middle-income countries.

Pediatric solid organ transplantation (SOT) is a preferred treatment for medically suitable children with end-stage organ failure. Still, many of them have no access to transplantation owing to socioeconomic constraints or lack of transplant facilities in low- and middle-income countries (LMIC). Establishing pediatric SOT programs in LMIC offers children the opportunities to receive transplant care in more familiar home environments as well as help curtail transplant tourism and improve transplant outcomes as pediatric transplantation would be performed ethically and legally. The International Pediatric Transplant Association (IPTA) is a professional organization aiming to promote safe, ethical, and high-quality pediatric transplantation worldwide. This society paper describes major obstacles to pediatric SOT in LMIC and provides guidance on developing and/or expanding pediatric SOT programs in such countries. We also summarize available resources from the IPTA Outreach Program to help establish and support pediatric SOT programs in LMIC.

Fludarabine/Cyclophosphamide Conditioning Regimen in Aplastic Anemia Patients Receiving Matched-Sibling Donor Transplant Is Non-inferior to ATG/Cyclophosphamide: A Single-Center Experience from Pakistan.

The successful outcome of allogeneic hematopoietic stem cell transplant (HSCT) in aplastic anemia patients is driven by suitable donor selection, appropriate conditioning regimen, early intervention, and optimal supportive care after transplant. Pakistan, being a developing country, faces grave economic challenges due to meager health care budget; therefore, cost constraints remain the foremost impediment in optimizing transplant facilities for socioeconomically deprived patients. We conducted a single-center retrospective analysis of aplastic anemia patients (N = 130), who received matched sibling donor transplants from 2011 to 2019, treated with either fludarabine/cyclophosphamide (Flu/Cy) or antithymocyte globulin/cyclophosphamide (ATG/CY) conditioning regimen. Median age was 16 years (IQR, 11-20), and it ranged from 3 to 48 years. The median time from diagnosis to transplant was 3 months (IQR, 2 to 4), and it ranged from 1 to 8 months. The estimated overall survival (OS), relapse-free survival (RFS), and GvHD-free survival (GFS) were found to be 69.0%, 66.7%, and 64.3% in the ATG/Cy group while 76.1%, 72.7%, and 62.5% in the Flu/Cy group, respectively, after a median follow-up of 30 months (IQR, 8 to 55), and it ranged from 0 to 98 months for the study groups. The Flu/Cy regimen was well tolerated and was not associated with increased risk of GvHD. Hence, it may be an appropriate alternative conditioning regimen for developing countries with limited health care resources.

P6.09: Extended Criteria Donor, Cold Ischemia Time and Delayed Graft Functions; Common Ingredients for an Expensive Recipe

Introduction and objectives: Delayed Graft Functions (DGF) has a relevant impact in Kidney Transplantation (KTx) being associated with suboptimal outcomes and increased healthcare costs. The necessary and increased use of Extended Criteria Donors (ECD) is inevitably linked with more DGF. Cold Ischemia Time (CIT) remains a crucial determinant of DGF. In the UK specific standards of CIT have been established for KTx from Donors after Brain Death (DBD), <18 hours and Donors after Circulatory Death (DCD) <12 hours. In this study we evaluate the incidence and impact of Beyond Standard (BS) CIT in ECD and estimate the cost of DGF in this group of recipients of KTx. Material and methods: We retrospectively reviewed our database with 218 consecutive KTx and analyzed type of donors, donor characteristics, incidence of DGF and Primary Non Functions (PNF). We also analyzed the CIT and its component defined as Extraction Time (ET) Transport Time (TT) and time from Delivery of the Kidney to Perfusion with Blood called Unit Time (UT). The cost estimate of the impact of DGF was based on the tariff for KTx currently paid by Healthcare Commissioners (HC) in the UK equivalent to £17,000. The cost estimate of DGF was based on available published evidence identifying an increased 10% for hospitalization and further 10% for dialysis sessions >1. Results: There were 103 (47.2%) KTx from ECD, of whom with a BS CIT were 37/103 (35.9%). Overall, in the ECD group DGF/PNF was observed in 47/103 (45.6%) patients. The incidence of DGF/PNF in ECD KTx with a BS CIT was 22/37 (59.5%) compared with 25/66 (37.9%) in those ECD transplanted Within Standard (WS); CIT (P=0.03). The major component of CIT was UT, representing 70%±15% of the CIT. There were 115 (52.8%) KTx from SCD, of whom with a BS CIT were 40/115 (34.8%). Overall in the SCD group DGF/PNF was observed in 33/115 (28.7%) patients. The incidence of DGF/PNF is SCD KTx with a BS CIT was 16/40 (40%) compared with 17/75 (22.7%) in those SCD transplanted Within Standard (WS) CIT (P=0.04). The major component of CIT was UT representing 65%±18% of the CIT. Univariate and multivariate analysis of risk factors of DGF is illustrated in table 1. Cost estimate: In the ECD group, we calculated £151.300 increase of the total cost. The Individual KTx had a mean ±SD cost in BS CIT and WS CIT of £19543.2 ±2173.9 and £18503± 2034 (p=0.01). Similarly, in the SCD group, we calculated £110.500 increase of the total cost. The Individual KTx had a mean ±SD cost in BS CIT and WS CIT of £18692.5 ±2140.6 and £17997.3± 1854.4 (p=0.07). Overall, the total increase of the cost was £261800 and the mean ±SD cost in BS CIT and WS CIT was £19543.2± 2173.9 and £18503 ±2034 (p=0.01). Conclusion: Our series shows that a substantial proportion of KTx have been performed with a BS CIT which certainly influences the incidence of DGF and PNF in KTx especially from ECD and consequently increases the estimate cost. Adequate infrastructure and readiness of all transplant facilities in order to reduce CIT are mandatory for accepting ECD.

Pediatric Kidney Transplantation in the Middle East: Challenges and Solutions.

Pediatric kidney transplant is the best option for treating children with end-stage renal disease. Poor economics and paucity of renal replacement therapy and transplant facilities are the most important challenges of pediatric kidney transplantation in the Middle East. The aim of the study was to collect data on the rates of pediatric kidney transplant during a recent year from the Middle East countries. All well-known kidney transplant centers from the Middle East were contacted to answer specified questions related to adult and pediatric kidney transplant volume from both living and deceased donors that was performed in each country during a recent year (preferably 2021, or, if not available, 2020 or 2019). In the single recent year, 8772 kidney transplants were performed for adult and pediatric patients in Middle East countries, making a total kidney transplant rate per million populations per year of 10.9 (ranging from 1.2 in Yemen and Pakistan to 39.7 in Turkey). Of these, 1399 transplants were from deceased donors (rate of deceased donor kidney transplants of 15.9%, ranging from 0% in 10 countries to 64.2% in Iran). Of 8772 total kidney transplants, 746 were pediatric recipients (<18 years old), with 166 pediatric kidney transplants from deceased donors (percent of deceased donor pediatric kidney transplant of 22.2%, ranging from 0% in 11 countries to 100% in Tunisia). Average pediatric kidney transplant rate per million populations per year was 0.93 (ranging from <0.1 in Pakistan to 3.2 in Syria). Average pediatric kidney transplant share was about 8.5% of total kidney transplants (ranging from 3.2 in Iraq to 20% in Algeria). The deceased kidney transplant program is currently available in only 8 of the 18 Middle Eastern countries included in this study. However, a deceased program is active in some Middle East countries (ie, Iran, Turkey, Kingdom of Saudi Arabia, Kuwait, and United Arab Emirates). Of note, Turkey had the highest kidney transplant rate per million populations per year (39.7), Syria had the highest pediatric kidney transplant rate per million populations per year (3.2), and Iran had the highest deceased donor kidney transplant percent of the total kidney transplants (64.2%). In the Middle East, Iran alone performed 63.5% (888/1399) of all deceased donor kidney transplants and 63.9% (106/166) of all deceased donor pediatric kidney transplants. Algeria had the highest pediatric kidney transplant share of the total transplants (20%). Low health spending, poorly developed infrastructures, delayed referral of children with chronic kidney disease, comorbidities, lack of technical expertise, inadequate pediatric dialysis programs, extended dialysis time, organ shortage, commercial transplantation, and posttransplant infections are the main pre- and posttransplant challenges. The community-government partnership model from the Sindh Institute of Urology and Transplantation in Karachi Pakistan showed that pediatric renal replacement therapy and transplant can be successfully established in a developing country. Although pediatric kidney transplant is active in many parts of the Middle East, it is still inactive in others, mostly relying on living donors. The lack of deceased donor programs in most Middle Eastern countries is a main issue to be addressed to adequately responding to the increasing demand for organs.

The safety and efficacy of hematopoietic stem cell mobilization using biosimilar filgrastim in related donors.

In April 2014, the Japan Society for Hematopoietic Cell Transplantation started a prospective observational study entitled "A short-term follow-up investigation of related hematopoietic stem cell donors receiving biosimilar G-CSF to mobilize peripheral blood stem cells." A total of 106 donors were registered from 25 transplant facilities through the end of March 2017. The study cohort consisted of 47 men and 58 women, and their median age was 38.5years (range 15-65years). The mean total count of collected CD34-positive cells/recipient body weight for all 106 donors was 4.40 ± 2.38 × 10 6/kg. The yield of CD34-positive cells was weakly correlated with donor age was observed. However, gender, WBC count on day 4, G-CSF dose reduction, type of apheresis device, collection speed, and treated blood volume had no significant impact on the collection efficacy of CD34-positive cells. The safety profile of biosimilar G-CSF was also acceptable: 126 adverse events in 73 donors were reported, but none was serious. The most common adverse events were low back pain, headache, and bone pain. This prospective study confirmed that biosimilar G-CSF had comparable efficacy and safety to reference G-CSF for CD34-positive cell mobilization in healthy related donors.

Outcomes of COVID-19 in Heart Transplant Recipients

PurposeData on outcomes after Covid-19 in heart transplant recipients are scarce and inconsistent. We sought to evaluate the early and late post-discharge outcomes in this patient population.MethodsThis case series includes 19 consecutive adult heart transplant recipients hospitalized for Covid-19 at our tertiary center between March 1, 2020 and April 30, 2021. After discharge, all patients were followed per standard post-transplant protocol for 6 months. Significant allograft dysfunction was defined as a decrease in LVEF ≥ 10% and myocardial damage was defined as at least 30% increase in troponin or NT-proBNP serum levels. CMV reactivation was defined as any positive PCR CMV requiring virostatic therapy.ResultsOf 19 recipients 15 (79%) were male with a mean age of 62±8 years and a mean time from transplantation of 4.5±3.4 years. 14 (73%) and 5 (26%) recipients had hypertension and diabetes, respectively. Immunosupressive (IS) regimen at the time of infection consisted of tacrolimus (TAC; mean C0 level 7.5±2.1 μg/mL), mycophenolate mofetil (MMF; mean dose 2052±359 mg) and steroids (mean dose 4.6±4.7 mg). During hospital management IS was reduced in 6 (31%) patients with a maintenence of TAC serum levels (mean C0 7.7±1.9 μg/mL pre-infection vs. 7.5±2.2 μg/mL during infection, P=0.75) and a decrease of MMF dose (2052±359 mg vs. 1906±657 mg, P= 0.01). In 11 (58%) patients we applied oxygen supplementation; however none required non-invasive or invasive forms of ventilation. During hospitalisation 12 (63%) recipients received hyperimmune plasma, 13 (68%) were treated with remdesivir (cumulative dose 600 mg), and 11 (58%) received steroid therapy (mean methylprednisolone dose 29±21 mg). All recipients survived to discharge (mean hospitalization time of 17.4±12.6 days) and to 6-month follow-up. We found no evidence of allograft dysfunction (LVEF 67±6% at baseline vs 68±7% at follow-up; P=0.88) or persistent myocardial damage (troponin: 22±28 pg/mL vs. 14±21 pg/mL; P=0.41 and NT-proBNP: 829±823 pg/mL vs. 817±940 pg/mL; P=0.96). CMV reactivation occured in 3 (16%) recipients and in 1 (5%) recipient a thrombotic event was noted.ConclusionCovid-19 outcomes in heart transplant recipients appear to be acceptable when managed in a tertiary center with dedicated heart transplant and Covid-19 facilities. Further data is needed to establish optimal Covid-19 management algorithms for this patient population.

Employment management and compensation related to organ donation at transplant facilities

Employment management and compensation related to organ donation at transplant facilities

Overtime pay and other incentives for transplant doctors involved in organ procurement and organ transplant at Japanese transplant facilities

Overtime pay and other incentives for transplant doctors involved in organ procurement and organ transplant at Japanese transplant facilities

Assessing the Roadblocks to Organ Donation

There has been a significant propulsion in the growth rate of organ failure across the globe in the recent times and major contributor for the same is rising graph of non-communicable diseases, especially diabetes and hypertension in developing countries like India. For patients with end- stage organ disease, organ transplantation is the most desired therapeutic option but according to the current estimates, there is a substantial discrepancy between the organ supply and demand ratio as organ transplantation serves only to less than 10% of the global need of organ donations. These figures thereby necessitates the action towards the promotion of organ donation at various levels. Despite massive advancements in the intricate procedure that occurs between organ donor identification and transplantation and overcoming challenges such as a lack of knowledge, financial restraints, and insufficient transplant facilities, there is still a perennial inability to meet the needs of donors across the country. Varying beliefs and cultures reflect different regulations and donation practices among different groups, posing a challenge to the standardized processes. The purpose of this article is to set out the close link between shortage of organ supply, its relation to the various factors contributing to it along with the certain suggestions in which we can counter these challenges. This article also provides a brief overview of the origin and evolution of India's Transplantation of Human Organ Act, in the hope that our experience in drafting legislation governing organ transplantation may be useful to ones who are considering or overseeing this life-saving procedure.