Transplantation Process Research Articles

CARD15: Parent Perceptions of Ex-Situ Heart Perfusion

Introduction: Pediatric heart transplant (HTx) candidates continue to have high waitlist mortality due to donor availability. Ex-situ heart perfusion (ESHP) has the potential to increase the donor pool, yet has been used sparingly in pediatrics due to size restrictions of the current technology. Previous work has shown that for ESHP to be accepted by pediatric healthcare providers (HCP), the risks to the donor heart and the costs need to be better understood and that rigorous research and implementation oversight is essential. Perspectives from caregivers about ESHP has not been assessed and forms the basis of this qualitative study. Methods: Virtual, semi-structured interviews were conducted with caregivers of children who are awaiting or received HTx. Data were analyzed using qualitative content analysis. Results: Twelve participants from 2 countries participated in this study. Awareness about and understanding of ESHP varied among participants from complete unawareness to understanding specifics. Independent of their awareness, all purported that it was an excellent and innovative technology, and supported ESHP implementation in pediatrics. No ethical issues or concerns about the use were identified that differed from other medical technologies, although participants did state that understanding the length of time the heart can be mounted and risks to donor and recipient were important. Participants expressed various views on how to approach parents regarding ESHP. Overall, most participants stated that the consent processes should be like other medical procedure and some commented that deferred or waived consent would be acceptable, especially if ESHP became part of routine clinical practice. Even if consent was waived, participants agreed that the use of ESHP should be disclosed just like other information is disclosed about the donor heart and that introduction of ESHP should come early in the HTx journey. Conclusion: Families are supportive of the use of ESHP. Like HCPs, they endorse the need to understand the potential risks and that information should be presented early in the transplant process.

Experience of a stem cell transplant in multiple myeloma: The patient and care partner perspective.

e18790 Background: Understanding patient experiences of their multiple myeloma (MM) disease journey, particularly related to the burden of autologous stem cell transplant (ASCT) and treatment recovery process, helps characterize unmet needs and quality of life of patients and their caregivers. A qualitative study of the experience of patients with MM who received ASCT and perspectives of caregivers was conducted. Methods: Recruited participants with MM were ≥18 years of age and received ASCT within the past 5 years or caregivers of patients who met these criteria. Two virtual focus group interviews were conducted, in which patients and caregivers were asked separately to narrate their disease journey starting with first symptoms and diagnosis, then focusing on the ASCT and recovery period. Results: A total of 16 participants, including 12 MM patients and 4 caregivers, were included. Nine participants (56.25%) were less than 60 years old, and eleven (68.75%) participants were female. Study participants were diverse in race/ethnicity; one-third of participants were Black and one-third comprised other minorities (Hispanic, Native Hawaiian, Asian, and Multiracial). Pain, weakness, and fractured bones (femur, hip, or spinal fractures) were common first symptoms. Other common patient-reported symptoms included high blood pressure, blurred vision, more frequent illnesses, unsteady gait, and anemia. The patients in the study were first diagnosed with MM in a variety of ways, mostly by a primary care physician and some in urgent care settings. The diagnosis process could take up to six months for some patients and commonly a community oncologist referred patients to a bone marrow transplant specialist, who was the primary driver in making ASCT decisions. Eight patients received their ASCT in an inpatient setting and four patients in an outpatient setting, with three eventually being hospitalized due to complications. Only one patient stayed in an outpatient setting the entire time. Initial recovery time after ASCT ranged from 2 weeks to 4 months; complete recovery took from 30 days to “never.” The most patient-reported difficulties during recovery time included nausea, loss of appetite, weakness, fatigue, and pain. Caregivers played an important role in the recovery process and often with negative financial impact related to missing work and travel expenses. Conclusions: Patients with MM who received ASCT and their caregivers perceived various unmet needs throughout their transplant journey. Post–stem cell transplant symptoms had a substantial impact on patients’ quality of life, especially with lengthy and challenging recovery. Innovative therapies are needed for newly diagnosed MM to reduce the burden of disease and enhance the quality of life for both patients and their caregivers.

The right to transplantation as a personal non-property right

The article examines the concept of personal non-property benefits and their place in civil law, emphasizing the importance of personal non-property rights as absolute rights. In particular, the author analyzes the right to transplantation in the context of the exercise of personal non-property rights, examines its legal, medical and ethical aspects, and highlights the problems associated with its implementation.
 Attention is drawn to the relationship between the right to transplantation and other human rights, such as the right to life, the right to medical care, and the right to health care. The article also examines the criteria that organs and anatomical materials must meet in terms of suitability for transplantation. The author analyzes the legal regime of organs and anatomical materials that can be separated from the human body and thus act as independent transplantation objects. The author emphasizes the importance of determining the list of objects that can be used as donor organs for transplantation in order to ensure the proper realization of the personal non-property right to life and health care.
 The author examines the concept of informed consent of the donor and the recipient and the importance of this legal category in transplantation relations. The author outlines the key elements of informed consent, including completeness, comprehensiveness and accessibility of information, as well as voluntariness of consent. The author points out the role of healthcare professionals and their ethical and legal responsibility in ensuring that informed consent is obtained and that complete and accurate information is provided to the participants of these relationships throughout the transplantation process. The article highlights the potential negative consequences of breach of the duty to obtain informed consent, concealment or failure to provide medical information, ranging from invalidation of a contract for the provision of medical services to criminal liability.
 The author analyzes the legislative acts regulating the right to transplantation, in particular, the provisions of the Civil Code of Ukraine and the Law of Ukraine «On the Application of Transplantation of Anatomical Materials a Human Being».

IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch promotes angiogenesis in transplanted flap and inhibits inflammatory response

Skin flap transplantation is one of the most common tissue transplantation methods for wound repair and organ reconstruction in plastic surgery. During the transplantation process, the inflammatory response of transplanted flap and angiogenesis are critical to the successful rate of skin flap transplantation. In recent years, to improve the biocompatibility and cell affinity of biomedical materials, the modified biomaterials have gradually become a popular subject in scientific researches. In our study, the IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch IL4-e-PTFE was prepared, and the rat skin flap transplantation model was constructed. The results of cell experiment prove that IL-4 has potentiation in the angiogenesis of human umbilical vein endothelial cell (HUVEC) induced by monocyte, and IL-4 can also promote angiogenesis by inducing the M2 macrophages. According to the results of in vivo experiment, the apoptosis level of transplanted flap cells of rats in the IL4-e-PTFE group was lower than that in the e-PTFE group, and in the IL4-e-PTFE group, the expression levels of pro-inflammatory cytokines IL-1β, IL-6 and TNF-α showed significantly decline compared to the e-PTFE group, while the expression levels of anti-inflammatory cytokines IL-1Ra, IL-10 and TGF-β presented significant increase compared to the e-PTFE group; the immunofluorescence staining results show that the number of M2 macrophages in transplanted flap area of rats in the IL4-e-PTFE group was significantly higher than that in the e-PTFE group, and the angiogenesis level was remarkably improved. In this study, by preparing IL4-e-PTFE and carrying out the cell and in vivo experiments, a reference method is proposed, which can reduce the inflammatory response during skin transplantation process using e-PTFE and optimize the long-term effects of flap blood vessels, hoping to provide a broader space for the applications of e-PTFE in medicine.

Serologic Profile of Donors In Argentina

Constructing serologic profiles of donors is the first step in establishing traceability in the donation and transplant process. These data allow us to implement various strategies to enhance the recipients' quality of care. We present the serologic profiles of donors in Argentina between 2017 and 2021. Donation processes initiated in 2017 to 2021 and registered in the National Information System of Procurement and Transplantation of the Argentine Republic were selected. The presence of complete serologic studies was considered an inclusion criterion. The serologic variables for viruses included HIV, human T-cell lymphotropic virus (HTLV), cytomegalovirus (CMV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Those for bacteria included Treponema pallidum and the genus Brucella, and those for parasites included Trypanosoma cruzi and Toxoplasma gondii. A total of 18,242 processes were initiated in the period 2017 to 2021. A total of 6015 processes had documented complete serologic studies. Most donors came from 2 jurisdictions: Buenos Aires (27.72%) and CABA (15.13%). Cytomegalovirus (84.70%) and T. gondii (40.94%) were the most prevalent serologies. We identified 0.25% reactive serologies for HIV, 0.24% for HTLV, 0.79% for HCV, and 2.49% for T. pallidum. In reference to HBV markers, 0.19% of donors presented Ag HBs, and the Ac HBc+Ac HBs association was observed in 2.31% of donors. Reactive serology for brucellosis was demonstrated in 1.11% of donors. Reactive serology for Chagas disease was found in 0.9% of donors. Given the wide variation in seroprevalence in the different jurisdictions of the country, the jurisdictional and national levels of government should be responsible for monitoring changes in behavior that require modification of selection and prevention strategies.

Pancreatic Islet Transplantation in Patients suffering from Type 1 diabetes - Indications, methods, possible risks and future directions: A literature review


 Introduction: Type 1 diabetes is a common and debilitating disease that requires regular glycemic control to prevent potentially fatal hypoglycemia.
 
 
 Objective: The aim of this study is to demonstrate the purpose, process, and consequences of pancreatic islet transplantation in patients with type 1 diabetes. Additionally, the results of the procedure after several years are described based on the available publications.
 
 
 Materials and Methods: The authors created a summary of available publications on pancreatic islet transplantation, based on databases such as PubMed and Google Scholar. Using the terms listed in the "key words" section, the authors searched for relevant information in other scientific papers to create the following review. 
 
 
 Conclusions: Reducing the number of donors and developing alternative sources of pancreatic islet cells for transplantation is an active area of research, that promises to expand access and indications for pancreatic islet transplantation in future diabetes treatment.

Undergraduate Education in Transplantation

Training in the transplants of organs, tissues, and cells as a therapeutic modality of multiple pathologies is essential in undergraduate education. The medical aspects typical of the theme are associated with ethical, legal, religious, and philosophical concerns, giving a holistic view of the process. We present a teaching model of the donation-transplant process with 15 years of experience. The subject of Organ, Tissue, and Cell Transplants began its activities in 2008. It is an elective, annual subject included in the last year of the medical career. Since its inception, it has established a continuous teaching methodology with a global approach to the donation and transplantation process. During the last 15 years and until the moment of the presentation, 1057 students have registered for the subject, 80.6% (852) completed the requirements of approval of the course, 79.9% of the students presented for the final evaluation (681), and 96.4% (654) of the students passed the final assessment. The average final grade calculated was equal to 6.53 ± 2.9 points out of 10; 205 students (19.4%) still need to comply with the final evaluative instance. The available literature has different training modalities, but none resembles the model presented. It is concluded that, during these 15 years, the pedagogic expectations in the training of human resources have been exceeded.

Deceased Donor Kidney Transplantation for Older Transplant Candidates: A New Microsimulation Model for Determining Risks and Benefits.

Under the current US kidney allocation system, older candidates receive a disproportionately small share of deceased donor kidneys despite a reserve of potentially usable kidneys that could shorten their wait times. To consider potential health gains from increasing access to kidneys for these candidates, we developed and calibrated a microsimulation model of the transplantation process and long-term outcomes for older deceased donor kidney transplant candidates. We estimated risk equations for transplant outcomes using the Scientific Registry of Transplant Recipients (SRTR), which contains data on all US transplants (2010-2019). A microsimulation model combined these equations to account for competing events. We calibrated the model to key transplant outcomes and used acceptance sampling, retaining the best-fitting 100 parameter sets. We then examined life expectancy gains from allocating kidneys even of lower quality across patient subgroups defined by age and designated race/ethnicity. The best-fitting 100 parameter sets (among 4,000,000 sampled) enabled our model to closely match key transplant outcomes. The model demonstrated clear survival benefits for those who receive a deceased donor kidney, even a lower quality one, compared with remaining on the waitlist where there is a risk of removal. The expected gain in survival from receiving a lower quality donor kidney was consistent gains across age and race/ethnic subgroups. Limited available data on socioeconomic factors. Our microsimulation model accurately replicates a range of key kidney transplant outcomes among older candidates and demonstrates that older candidates may derive substantial benefits from transplantation with lower quality kidneys. This model can be used to evaluate policies that have been proposed to address concerns that the current system disincentivizes deceased donor transplants for older patients. The microsimulation model was consistent with the data after calibration and accurately simulated the transplantation process for older deceased donor kidney transplant candidates.There are clear survival benefits for older transplant candidates who receive deceased donor kidneys, even lower quality ones, compared with remaining on the waitlist.This model can be used to evaluate policies aimed at increasing transplantation among older candidates.

Opinion of surveyed nurses on transplantation and reasons for negative public attitudes toward organ donation.

Organ transplantation saves thousands of lives every year. Despite growing awareness of transplantation, the issue of obtaining organs for transplantation has been controversial for years. Hundreds of people are waiting in lines all the time for transplantation, for whom it is the only hope for a cure. One extremely important factor contributing to the low number of transplants is the low number of organ donations from deceased donors. Nurses are considered key facilitators of the organ procurement and transplantation process. Their knowledge of and attitudes toward organ donation can influence public opinion, as well as the decisions of their families to donate the organs of the deceased. The purpose of our study was to determine the opinions of surveyed nurses about transplantation and the reasons for negative public attitudes toward organ donation. The survey included 793 nurses employed in surgical wards across Poland with varying levels of job seniority. The survey was conducted between September and October 2022. The research tool was a survey questionnaire, consisting of three parts: socio-demographic data, questions assessing the respondents' knowledge of behavior about transplantation, and a non-standardized tool to measure respondents' emotional and motivational attitudes toward transplantation. Participation in the survey was anonymous and voluntary. The statistical analysis for independence of variables used the χ 2 test. On the other hand, coefficients based on the Phi and Cramer's V test, as well as Kruskal Wallis non-parametric tests for assessing differences (for more than 2 samples) were used to determine the strength of the relationship. During these analyses, in addition to standard statistical significance, the corresponding "p" values were calculated using the Monte Carlo method. According to the nurses surveyed, transplantation is a life-saving procedure. A significant proportion of the nurses (85.6%) believe that there are too few donors in Poland. According to 41.8% of the respondents, this is due to the fear of misdiagnosis of death, for 23.4% it is incompatible with their worldview or religion and 31.8% believe it is due to the belief in the inviolability of the human body after death. The survey showed that, in the nurses' opinion, the reason for objections to organ transplantation is the deficit in public's knowledge of cell, tissue and organ donation from both living and dead donors. Therefore it is extremely important to conduct educational campaigns in this regard.

Mitigating Health Disparities in Transplantation Requires Equity, Not Equality.

Despite decades of research and evidence-based mitigation strategies, disparities in access to transplantation persist for all organ types and in all stages of the transplant process. Although some strategies have shown promise for alleviating disparities, others have fallen short of the equity goal by providing the same tools and resources to all rather than tailoring the tools and resources to one's circumstances. Innovative solutions that engage all stakeholders are needed to achieve equity regardless of race, sex, age, socioeconomic status, or geography. Mitigation of disparities is paramount to ensure fair and equitable access for those with end-stage disease and to preserve the trust of the public, upon whom we rely for their willingness to donate organs. In this overview, we present a summary of recent literature demonstrating persistent disparities by stage in the transplant process, along with policies and interventions that have been implemented to combat these disparities and hypotheses for why some strategies have been more effective than others. We conclude with future directions that have been proposed by experts in the field and how these suggested strategies may help us finally arrive at equity in transplantation.

Organ Donation Organization Architecture: Recommendations From an International Consensus Forum.

The Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This domain group included administrative, clinical, and academic experts in OTDT systems and 3 patient, family, and donor partners. We identified topic areas and recommendations through consensus, using the nominal group technique. Selected topics were informed by narrative literature reviews and vetted by the Forum's scientific committee. We presented these recommendations publicly, with delegate feedback being incorporated into the final report. This report has 33 recommendations grouped into 10 topic areas. Topic areas include the need for public and professional education, processes to assure timely referral of patients who are potential donors, and processes to ensure that standards are properly enforced. The recommendations encompass the multiple roles organ donation organizations play in the donation and transplantation process. We recognize the diversity of local conditions but believe that they could be adapted and applied by organ donation organizations across the world to accomplish their fundamental objectives of assuring that everyone who desires to become an organ donor is given that opportunity in a safe, equitable, and transparent manner.

Assessing the impact of COVID-19 on the performance of organ transplant services using data envelopment analysis

Organ transplant is one of the best options for many medical conditions, and in many cases, it may be the only treatment option. Recent evidence suggests, however, that the COVID-19 pandemic might have detrimentally affected the provision of this type of healthcare services. The main purpose of this article is to use Data Envelopment Analysis and the Malmquist Index to assess the impact that the pandemic caused by the novel coronavirus SARS-CoV-2 had on the provision of solid organ transplant services. To this purpose, we use three complementary models, each focusing on specific aspects of the organ donation and transplantation process, and data from Brazil, which has one of the most extensive public organ transplant programs in the world. Using data from 17 States plus the Federal District, the results of our analysis show a significant drop in the performance of the services in terms of the organ donation and transplantation process from 2018 to 2020, but the results also indicate that not all aspects of the process and States were equally affected. Furthermore, by using different models, this research also allows us to gain a more comprehensive and informative assessment of the performance of the States in delivering this type of service and identify opportunities for reciprocal learning, expanding our knowledge on this important issue and offering opportunities for further research.

Prediction of survival after lung transplantation at one year (SALTO cohort) using information available at different key time-points.

Lung transplantation is the final treatment option for end-stage lung disease. In this study, we evaluated the individual risk of 1-year mortality at each stage of the lung transplantation process. This was a retrospective analysis of patients undergoing bilateral lung transplantation between January 2014 and December 2019 in three French academic centers. Patients were randomly divided into development and validation cohorts. Three multivariable logistic regression models of 1-year mortality were applied (A) at recipient registration, (B) the graft allocation, and (C) after surgery. The 1-year mortality was predicted for individual patients assigned to three risk groups at time points A-C. The study population consisted of 478 patients with a mean (SD) age of 49.0 (14.3) years. The 1-year mortality rate was 23.0%. There were no significant differences in patient characteristics between the development (n = 319) and validation (n = 159) cohorts. The models analyzed recipient, donor, and intraoperative variables. The discriminatory power (area under the receiver operating characteristic curve) was 0.67 (0.62-0.73), 0.70 (0.63-0.77), and 0.82 (0.77-0.88), respectively, in the development cohort, 0.74 (0.64-0.85), 0.76 (0.66-0.86) and 0.87 (0.79 - 0.95), respectively, in the validation cohort. Survival rates were significantly different among the low- (< 15%), intermediate- (15%-45%), and high-risk (> 45%) groups in both cohorts. Risk prediction models allow estimation of the 1-year mortality risk of individual patients during the lung transplantation process. These models may help caregivers identify high-risk patients at times A-C, and reduce the risk at subsequent time-points.

Standardizing Corneal Transplantation Records Using openEHR: Case Study.

Corneal transplantation, also known as keratoplasty, is a widely performed surgical procedure that aims to restore vision in patients with corneal damage. The success of corneal transplantation relies on the accurate and timely management of patient information, which can be enhanced using electronic health records (EHRs). However, conventional EHRs are often fragmented and lack standardization, leading to difficulties in information access and sharing, increased medical errors, and decreased patient safety. In the wake of these problems, there is a growing demand for standardized EHRs that can ensure the accuracy and consistency of patient data across health care organizations. This paper proposes the use of openEHR structures for standardizing corneal transplantation records. The main objective of this research was to improve the quality and interoperability of EHRs in corneal transplantation, making it easier for health care providers to capture, share, and analyze clinical information. A series of sequential steps were carried out in this study to implement standardized clinical records using openEHR specifications. These specifications furnish a methodical approach that ascertains the development of high-quality clinical records. In broad terms, the methodology followed encompasses the conduction of meetings with health care professionals and the modeling of archetypes, templates, forms, decision rules, and work plans. This research resulted in a tailored solution that streamlines health care delivery and meets the needs of medical professionals involved in the corneal transplantation process while seamlessly aligning with contemporary clinical practices. The proposed solution culminated in the successful integration within a Portuguese hospital of 3 key components of openEHR specifications: forms, Decision Logic Modules, and Work Plans. A statistical analysis of data collected from May 1, 2022, to March 31, 2023, allowed for the perception of the use of the new technologies within the corneal transplantation workflow. Despite the completion rate being only 63.9% (530/830), which can be explained by external factors such as patient health and availability of donor organs, there was an overall improvement in terms of task control and follow-up of the patients' clinical process. This study shows that the adoption of openEHR structures represents a significant step forward in the standardization and optimization of corneal transplantation records. It offers a detailed demonstration of how to implement openEHR specifications and highlights the different advantages of standardizing EHRs in the field of corneal transplantation. Furthermore, it serves as a valuable reference for researchers and practitioners who are interested in advancing and improving the exploitation of EHRs in health care.

Viable Bifidobacterium tablets for the prevention of chemotherapy-/radiation-induced mucositis in patients undergoing haematopoietic stem cell transplantation

Mucositis is a frequent and severe complication in haematopoietic stem cell transplantation (HSCT). The effectiveness of probiotics in mucositis has been indicated by several clinical trials, but the results are still controversial. To date, studies on the influence of probiotics in HSCT are limited. Therefore, we conducted this retrospective study to evaluate the impact of viableBifidobacteriumtablets on the incidence and duration of chemotherapy-/radiation-induced mucositis in patients undergoing HSCT. Clinical data of 278 patients who underwent HSCT between May 2020 and November 2021 were retrospectively analysed. They were divided into a control group (138) and a probiotic group (140) according to whether they took viable Bifidobacterium tablets. First, we analysed the baseline data of the two groups. Then, we compared the incidence, severity and duration of mucositis between the two groups by using Mann-Whitney U test, chi-square test and Fisher's exact test according to the type of data. In order to exclude the influence of confounding factors, we further evaluated the efficacy of oral probiotics in preventing oral mucositis by Binary logistic regression analysis. The use of viable Bifidobacterium tablets markedly reduced the incidence of oral mucositis (OM) (62.9% vs. 81.2%, p = 0.001) and mainly reduced the incidence of grades 1-2 OM (74.6% vs. 58.6%,p = 0.005). There was no significant difference in the incidence of severe (grades 3-4) OM between the two groups (6.5% vs. 4.3%,p = 0.409). The median duration of OM was shorter in the probiotic group (10 vs. 12days,p = 0.037). The incidence and duration of diarrhoea did not differ between the two groups. Moreover, the use of viableBifidobacteriumtablets had no influence on engraftment. Our results suggested that viable Bifidobacterium tablets could effectively reduce the incidence of grades 1-2 OM and duration of OM during the transplant process without affecting the outcome of HSCT.

Preparation of Cell-Loaded Microbeads as Stable and Injectable Delivery Platforms for Tissue Engineering

Cell transplants in therapeutic studies do not preserve their long-term function inside the donor body. In mesenchymal stem cell (MSC) transplants, transplanted cells disperse through the body and are prone to degradation by immune cells after the transplant process. Various strategies, such as usage of the immunosuppressive drugs to eliminate allograft rejection, are designed to increase the efficiency of cell therapy. Another strategy is the construction of biomimetic encapsulates using polymeric materials, which isolate stem cells and protect them from environmental effects. In this study, fibroblasts (L929) and MSCs were investigated for their improved viability and functionality once encapsulated inside the alginate microbeads under in vitro conditions for up to 12 days of incubation. Thus, uniform and injectable (<200 µm) cell-loaded microbeads were constructed by the electrostatically assisted spraying technique. Results showed that both L929 and MSCs cells continue their metabolic activity inside the microbeads during the incubation periods. Glucose consumption and lactic acid production levels of both cell lines were consistently observed. The released cell number on day 12 was found to be increased compared to day 0. Protein expression levels of both groups increased every day with the expected doubling rate. Hence, this strategy with a simple yet clever design to encapsulate either MSCs or L929 cells might outstand as a potential cell delivery platform for cell therapy-based tissue engineering.

The story of melanocyte: a long way from bench to bedside.

Skin is composed of major layers, namely a superficial epidermis and a deeper dermis. The color of skin is influenced by a number of pigments, including melanin, which is produced by cells called melanocytes. Most skin disorders are relatively benign, but a few, including melanomas, can be fatal. A number of more noticeable disorders, namely albinism and vitiligo, affect the appearance of the skin and its accessory organs. Vitiligo is associated with significant psycho-social morbidity and a major effect on quality of life. Topical steroids, calcineurin inhibitors, phototherapy and surgery are the most common treatments for melanoma. However, there are many patients who do not respond to any of these modalities. The transplantation of cultured or non-cultured melanocyte is the most important treatment for hypopigmentory disorders. This study aims at reviewing the history of melanocyte cultivation, and evaluating the effectiveness of transplantation of cultured cells. For this purpose, the authors examined the initial process of isolation, characterization, and transplantation of epidermal cells. This review, thus, summarizes the current understanding of the cutaneous pigmentary system from the start of synthesis in the pigment cells, along with the response of repigmentation. During the production of melanin, melanosomes are transferred to neighboring keratinocyte in order to form perinuclear melanin caps. The objective of this review is to analyze the melanocytes transplantation in the last century to date, and explore the methods epidermal cells can increase pigmentation in hypo-pigmented areas in skin disorders. Moreover, the focus is on the story of the melanocyte back to 1950s. In addition, prior systemic therapy was associated with a significant increase, based on combined additional therapy, achieving desired results and improved outcomes. Despite the short study of a long way of melanocyte assessment and following up patient treatment, results of the all reports confirmed the efficacy of the method used in the treatment of stable vitiligo patients, who did not respond to the common algorithms of non-invasive treatments.

World Marrow Donor Association guidelines for the reporting of novel HLA alleles.

The guidelines for the implementation and reporting of HLA nomenclature for the World Marrow Donor Association have served as a reliable standard for communication of HLA data in the hematopoietic cell transplantation process. Wider use of next-generation sequencing made a special provision of the guidelines increasingly pertinent: how to communicate novel HLA alleles. Novel alleles need to be recognized by the WHO Nomenclature Committee for Factors of the HLA system to obtain official allele designations. Until then they have to be handled according to the specific rules. Leaving the actual rules basically unchanged we give some advice on how to communicate novel alleles to best facilitate the search process for cases where novel alleles are identified on donor or patient side.

DA ABORDAGEM MULTIDISCIPLINAR À ATUAÇÃO DO PSICÓLOGO NO PROCESSO DE TRANSPLANTE E DOAÇÃO DE ÓRGÃOS: UM OLHAR SOBRE OS ASPECTOS PSICOEMOCIONAIS

Transplantation is a treatment modality, which may be the only alternative for some patients. There is a careful assessment, by a multidisciplinary team, so that the patient gets in line to receive an organ donation from a living or dead donor. This article aims to discuss the possibilities of interventions and contributions in the multiprofessional approach, weaving a look at the psychological aspects, to patients and donors, inserted in the transplantation and organ donation process, using a literature review. We sought to present the specifics of psychic issues according to the organ to betransplanted by the patient, such as the confrontation of the donor and recipient of a living donor, fantasies, anxieties and fears permeating the decision and reception. The importance of the performance of the entire multidisciplinary team was highlighted, with the psychologist as an essential part in the approach during the entire process and in the post-transplantation process, being a facilitator, organizer and evaluator, effectively contributing to the understanding, elaboration, adherence and support against the lived moment, both for the patient and the donor, favoring adherence and minimizing negative repercussions throughout the organ transplant process.

Lived Experiences and Expectations of Postkidney Transplant Patients: A Phenomenological Study

Background: Kidney transplantation is the treatment of choice for most of the patients with end-stage renal disease. Transplantation brings many responsibilities related to medication adherence, immunosuppression, prevention of infection, regular follow-ups, etc. To meet the challenges faced by postkidney transplant patients, there is a need for deeper understanding of how people with kidney transplant learn to adapt to life posttransplant. Aim: The present study aims to explore the lived experiences of postkidney transplant patients. Materials and Methods: A phenomenological research design was adopted. By using purposive sampling technique, 18 postkidney transplant patients were enrolled. Data were collected through unstructured interviews and analyzed by using descriptive statistics for quantitative and Colaizzi’s method for qualitative data. Results: Based on participants’ responses, total 9 themes and 26 subthemes were extracted after data analysis. The main themes emerged were as follows: relief from dialysis-associated problems, perceived social neglect before and after transplant, burden of posttransplant regimen, impact on occupation, attitude toward donor, posttransplant lifestyle modifications, concerns about future quality of life, effect on family and children, and facilitating agents in transplant process. Conclusion: The present study concluded that the quality of life of participants after transplantation had improved in terms of relief from the dialysis-associated suffering. Worries about duration of graft function, future health, and cost were prevalent. There is a need to provide additional information, multidimensional support, and interventions following transplantation that target these concerns. This may support kidney recipients, better prepare for adaptation to life after transplant, and lead to improvements in the patient experience.