Current Issue

Volume 10 Issue 2 (February 2010)

The AJT Report

The AJT Report: News and issues that affect organ and tissue transplantation (p 196-198)
SUE PONDROM
Published Online: Jan 24 2010 9:40AM
DOI: 10.1111/j.1600-6143.2009.02948.x

This month, "The AJT Report" examines a new generation of drugs to treat hepatitis C that could change the landscape of liver transplantation. We also take a look at the National Living Donor Assistance Center, and review the CDC's quest for a national transplant safety network.

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Editorials

Donor Screening for Human T-Cell Lymphotrophic Virus 1/2: The future Is Uncertain (p 199-200)
A. Humar
Published Online: Jan 24 2010 9:40AM
DOI: 10.1111/j.1600-6143.2009.02970.x

Screening of organ donors for HTLV-1/2 infection has advantages and disadvantages that must be weighed, and rational decisions will require new evidence.
See minireview by Kaul et al on page 207.

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Allograft Fibrosis—Unmasking the Players at the Dance (p 201-202)
R. B. Mannon, R. Fairchild
Published Online: Jan 24 2010 9:40AM
DOI: 10.1111/j.1600-6143.2009.02926.x

New data suggest that the pleiotropic cytokine interleukin-6 may be a key contributor to allograft fibrosis through a complex interaction with connective tissue growth factor (CTGF), a downstream effector of TGF-beta.
See article by Booth et al on page 220.

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Pushing the Boundaries in Hepatopulmonary Syndrome (p 203-204)
J. G. O'Grady, J. Wendon
Published Online: Jan 24 2010 9:40AM
DOI: 10.1111/j.1600-6143.2009.02933.x

Hepatopulmonary syndrome is potentially no longer a contraindication to liver transplantation when the required clinical support is delivered.
See article by Gupta et al on page 354.

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Immunosuppression and Heart Transplantation: How Do We Define Success? (p 205-206)
D. A. Baran, D. O. Taylor, J. A. Kobashigawa
Published Online: Jan 24 2010 9:40AM
DOI: 10.1111/j.1600-6143.2009.02885.x

How do we balance the trade-offs between reduced rates of allograft rejection and other morbidities such as renal dysfunction, myelosuppression and non-specific graft failure?
See article by Teuteberg et al on page 382.

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Minireviews

Donor Screening for Human T-cell Lymphotrophic Virus 1/2: Changing Paradigms for Changing Testing Capacity (p 207-213)
D. R. Kaul, S. Taranto, C. Alexander, S. Covington, M. Marvin, M. Nowicki, J. Orlowski, C. Pancoska, T. L. Pruett, M. G. Ison
Published Online: Oct 15 2009 12:52PM
DOI: 10.1111/j.1600-6143.2009.02867.x

HTLV-1/2 screening in the solid organ donor population is increasingly challenging: donors that are HTLV1/2 positive are infrequently used despite most results being either false positive or due to HTLV-2, which has not been associated with disease.
See editorial by Humar on page 199.

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Tolerogenic Dendritic Cells: All Present and Correct? (p 214-219)
A. W. Thomson
Published Online: Jan 5 2010 3:07PM
DOI: 10.1111/j.1600-6143.2009.02955.x

Recent findings that enhance mechanistic insight into the functions of tolerogenic dendritic cells are summarized and the therapeutic potential of these antigen-presenting cells, with special reference to hematopoietic stem cell and organ transplantation, is discussed.

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Laboratory Science

Original Articles

Connective Tissue Growth Factor Promotes Fibrosis Downstream of TGF and IL-6 in Chronic Cardiac Allograft Rejection (p 220-230)
A. J. Booth, K. Csencsits-Smith, S. C. Wood, G. Lu, K. E. Lipson, D. K. Bishop
Published Online: Sep 25 2009 10:25AM
DOI: 10.1111/j.1600-6143.2009.02826.x

TGFβ and IL-6 serve as upstream contributors to connective tissue growth factor production, which in turn serves as an effector molecule of fibrosis in chronic cardiac allograft rejection.
See editorial by Mannon and Fairchild on page 201.

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RGS4 Controls Renal Blood Flow and Inhibits Cyclosporine-Mediated Nephrotoxicity (p 231-241)
A. Siedlecki, J. R. Anderson, X. Jin, J. R. Garbow, T. S. Lupu, A. J. Muslin
Published Online: Dec 2 2009 6:05PM
DOI: 10.1111/j.1600-6143.2009.02930.x

RGS4 deficient mice were treated with cyclosporine and found to be highly susceptible to ischemic kidney injury using a novel in vivo high resolution regional perfusion technique.

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Antiinflammatory and Anticoagulant Effects of Transgenic Expression of Human Thrombomodulin in Mice (p 242-250)
S. Crikis, X. M. Zhang, S. Dezfouli, K. M. Dwyer, L. M. Murray-Segal, E. Salvaris, C. Selan, S. C. Robson, H. H. Nandurkar, P. J. Cowan, A. J. F. d'Apice
Published Online: Jan 6 2010 4:48PM
DOI: 10.1111/j.1600-6143.2009.02939.x

Transgenic expression in mice of hTBM results in an antocoagulant and anti-inflammatory phenotype that confers survival advantages in models of transplantation, thrombosis and pulmonary embolism.

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Composite Tissue Vasculopathy and Degeneration Following Multiple Episodes of Acute Rejection in Reconstructive Transplantation (p 251-261)
J. V. Unadkat, S. Schneeberger, E. H. Horibe, C. Goldbach, M. G. Solari, K. M. Washington, V. S. Gorantla, G. M. Cooper, A. W. Thomson, W. P. Andrew Lee
Published Online: Dec 23 2009 2:06PM
DOI: 10.1111/j.1600-6143.2009.02941.x

In reconstructive transplantation, multiple acute rejections induce transplant vasculopathy preceded by increasing macrophages and fibrosis in deeper tissues, while skin changes are a late occurrence.

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The Changed Balance of Regulatory and Naive T Cells Promotes Tolerance after TLI and Anti-T-Cell Antibody Conditioning (p 262-272)
R. G. Nador, D. Hongo, Z. Yao, S. Strober
Published Online: Dec 23 2009 2:06PM
DOI: 10.1111/j.1600-6143.2009.02942.x

Mixed chimerism and tolerance to heart grafts was induced in mice conditioned with total lymphoid irradiation and anti-T cell antibodies, and tolerance was dependent upon the newly predominant host T cell subsets, Tregs and NKT cells.

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Impact of Thrombocytopenia on Survival of Baboons with Genetically Modified Pig Liver Transplants: Clinical Relevance (p 273-285)
B. Ekser, C. Long, G. J. Echeverri, H. Hara, M. Ezzelarab, C. C. Lin, M. E. de Vera, R. Wagner, E. Klein, R. F. Wolf, D. Ayares, D. K.C. Cooper, B. Gridelli
Published Online: Dec 23 2009 2:08PM
DOI: 10.1111/j.1600-6143.2009.02945.x

To investigate the feasibility of bridging to liver allotransplantation by orthotopic xenotransplantation, genetically-engineered pig livers were transplanted into baboons; the major limiting factor was the development of a profound thrombocytopenia.

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Clinical Science

Original Articles

Meta-Analyses Qualify Metzincins and Related Genes as Acute Rejection Markers in Renal Transplant Patients (p 286-297)
S. Rödder, A. Scherer, M. Körner, U. Eisenberger, A. Hertig, F. Raulf, E. Rondeau, H.-P. Marti
Published Online: Dec 2 2009 6:04PM
DOI: 10.1111/j.1600-6143.2009.02928.x

Microarray data using four studies of renal allograft biopsies qualified the extracellular matrix remodeling proteases metzincins and related genes as molecular classifiers of acute rejection, revealed uniform enrichment of 13 genes, further analyzed on protein and mRNA level, and correlated to Banff histological lesion scores

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Diabetes Mellitus: A Risk Factor for Delayed Graft Function after Deceased Donor Kidney Transplantation (p 298-303)
J. Parekh, A. Bostrom, S. Feng
Published Online: Jan 6 2010 12:02PM
DOI: 10.1111/j.1600-6143.2009.02936.x

Recipient diabetes mellitus is a highly significant risk factor for delayed graft function after deceased donor kidney transplantation, according to United Network for Organ Sharing data.

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Efficient Utilization of the Expanded Criteria Donor (ECD) Deceased Donor Kidney Pool: An Analysis of the Effect of Labeling (p 304-309)
R. A. Hirth, Q. Pan, D. E. Schaubel, R. M. Merion
Published Online: Jan 6 2010 12:03PM
DOI: 10.1111/j.1600-6143.2009.02937.x

The creation of a specific definition of an Expanded Criteria Donor for kidney transplantation corresponded to changes in number of such donors acquired and likelihood of use of such organs.

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Clinical Predictors of Proteinuria after Conversion to Sirolimus in Kidney Transplant Recipients (p 310-314)
A. Padiyar, K. A. Bodziak, D. E. Hricik, J. J. Augustine
Published Online: Jan 6 2010 12:04PM
DOI: 10.1111/j.1600-6143.2009.02940.x

This study analyzing outcomes after early conversion from tacrolimus to sirolimus therapy in stable kidney transplant patients showed that African Americans had a high rate of increased proteinuria after conversion.

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Histopathologic Clusters Differentiate Subgroups Within the Nonspecific Diagnoses of CAN or CR: Preliminary Data from the DeKAF Study (p 315-323)
A. J. Matas, R. Leduc, D. Rush, J. M. Cecka, J. Connett, A. Fieberg, P. Halloran, L. Hunsicker, F. Cosio, J. Grande, R. Mannon, S. Gourishankar, R. Gaston, B. Kasiske
Published Online: Dec 23 2009 2:07PM
DOI: 10.1111/j.1600-6143.2009.02943.x

Cluster analysis based on Banff score components distinguishes meaningful subgroups with differing outcomes.

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Pathological and Clinical Characterization of the 'Troubled Transplant': Data from the DeKAF Study (p 324-330)
S. Gourishankar, R. Leduc, J. Connett, J. M. Cecka, F. Cosio, A. Fieberg, R. Gaston, P. Halloran, L. Hunsicker, B. Kasiske, D. Rush, J. Grande, R. Mannon, A. Matas
Published Online: Jan 5 2010 3:07PM
DOI: 10.1111/j.1600-6143.2009.02954.x

In kidney allograft biopsy for new onset late dysfunction, local diagnosis of CAN is of no prognostic significance.

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Diabetes after Kidney Donation (p 331-337)
H. N. Ibrahim, A. Kukla, G. Cordner, R. Bailey, K. Gillingham, A. J. Matas
Published Online: Dec 23 2009 2:07PM
DOI: 10.1111/j.1600-6143.2009.02944.x

Kidney donors who develop diabetes are more likely to have hypertension and proteinuria than non-diabetic donors but the rate of eGFR change is not accelerated.

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Predicting Coronary Heart Disease after Kidney Transplantation: Patient Outcomes in Renal Transplantation (PORT) Study (p 338-353)
A. K. Israni, J. J. Snyder, M. A. Skeans, Y. Peng, J. R. Maclean, E. D. Weinhandl, B. L. Kasiske
Published Online: Jan 24 2010 9:40AM
DOI: 10.1111/j.1600-6143.2009.02949.x

Data from an international, multicenter consortium were collected to develop equations that predict coronary heart disease risk after kidney transplantation.

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Improved Survival After Liver Transplantation in Patients with Hepatopulmonary Syndrome (p 354-363)
S. Gupta, H. Castel, R. V. Rao, M. Picard, L. Lilly, M. E. Faughnan, G. Pomier-Layrargues
Published Online: Sep 22 2009 11:24AM
DOI: 10.1111/j.1600-6143.2009.02822.x

This series shows a higher survival post-liver transplant in patients with hepatopulmonary syndrome (HPS), and severe HPS in particular, compared to prior reports.
See editorial by O'Grady and Wendon on page 203.

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Adult Living Liver Donors have Excellent Long-Term Medical Outcomes: The University of Toronto Liver Transplant Experience (p 364-371)
L. Adcock, C. Macleod, D. Dubay, P. D. Greig, M. S. Cattral, I. McGilvray, L. Lilly, N. Girgrah, E. L. Renner, M. Selzner, N. Selzner, A. Kashfi, R. Smith, S. Holtzman, S. Abbey, D. R. Grant, G. A. Levy, G. Therapondos
Published Online: Jan 24 2010 9:40AM
DOI: 10.1111/j.1600-6143.2009.02950.x

Living liver right lobe donors have excellent long term medical outcomes with few complications after one year.

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Hypothermic Machine Preservation in Human Liver Transplantation: The First Clinical Series (p 372-381)
J. V. Guarrera, S. D. Henry, B. Samstein, R. Odeh-Ramadan, M. Kinkhabwala, M. J. Goldstein, L. E. Ratner, J. F. Renz, H. T. Lee, R. S. Brown, Jr., J. C. Emond
Published Online: Dec 2 2009 6:07PM
DOI: 10.1111/j.1600-6143.2009.02932.x

This report is the first clinical experience with human liver machine preservation for transplantation.

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Alemtuzumab Induction Prior to Cardiac Transplantation with Lower Intensity Maintenance Immunosuppression: One-Year Outcomes (p 382-388)
J. J. Teuteberg, M. A. Shullo, R. Zomak, Y. Toyoda, D. M. McNamara, C. Bermudez, R. L. Kormos, K. R. McCurry
Published Online: Nov 4 2009 11:33AM
DOI: 10.1111/j.1600-6143.2009.02856.x

Induction therapy after cardiac transplantation with alemtuzumab in combination with lower dose maintenance immunosuppression without steroids results in similar survival but greater freedom from rejection at one year compared to historical controls.
See editorial by Baran et al on page 205.

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Equivalent Outcomes for Pediatric Heart Transplantation Recipients: ABO-Blood Group Incompatible versus ABO-Compatible (p 389-397)
A. I. Dipchand, S. M. Pollock BarZiv, C. Manlhiot, L. J. West, M. VanderVliet, B. W. McCrindle
Published Online: Dec 23 2009 2:06PM
DOI: 10.1111/j.1600-6143.2009.02934.x

Comparison of two contemporary pediatric populations who received either ABO-compatible or ABO-incompatible heart transplants found that medium-term outcomes were indistinguishable, and the use of ABO-incompatible listing improved waitlist survival.

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Incidence of and Risk Factors for Posttransplant Diabetes Mellitus after Pancreas Transplantation (p 398-406)
N. Neidlinger, N. Singh, C. Klein, J. Odorico, A. Munoz del Rio, Y. Becker, H. Sollinger, J. Pirsch
Published Online: Jan 6 2010 12:02PM
DOI: 10.1111/j.1600-6143.2009.02935.x

In this single-center study of nearly 700 pancreas transplant (PTX) recipients with long-term follow up, the incidence of post transplant diabetes mellitus (PTDM) was 25% at 10-years after PTX.

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BK-Virus and the Impact of Pre-Emptive Immunosuppression Reduction: 5-Year Results (p 407-415)
K. L. Hardinger, M. J. Koch, D. J. Bohl, G. A. Storch, D. C. Brennan
Published Online: Jan 5 2010 3:06PM
DOI: 10.1111/j.1600-6143.2009.02952.x

Five year follow-up of preemptive withdrawal of immunosuppression upon detection of BK-viremia was associated with excellent graft survival, low rejection rates, excellent renal function, and freedom from clinically evident BK-virus nephropathy.

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Brief Communications

Centers for Disease Control 'High-Risk' Donors and Kidney Utilization (p 416-420)
K. I. Duan, M. J. Englesbe, M. L. Volk
Published Online: Dec 2 2009 6:06PM
DOI: 10.1111/j.1600-6143.2009.02931.x

Kidneys from CDC High Risk donors were less likely to be used for transplantation than kidneys from non-CDC High Risk donors, despite being associated with similar patient survival.

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Cluster Analysis of Lesions in Nonselected Kidney Transplant Biopsies: Microcirculation Changes, Tubulointerstitial Inflammation and Scarring (p 421-430)
B. Sis, G. Einecke, J. Chang, L. G. Hidalgo, M. Mengel, B. Kaplan, P. F. Halloran
Published Online: Jan 6 2010 12:04PM
DOI: 10.1111/j.1600-6143.2009.02938.x

Class discovery approach identifies robust lesion groups in non-selected kidney transplant biopsies and confirms most assumptions on which diagnoses are assigned by the Banff classification, but suggests new interpretations of some lesions.

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Case Report

A Case of Human Intramuscular Adrenal Gland Transplantation as a Cure for Chronic Adrenal Insufficiency (p 431-433)
E. Grodstein, M. A. Hardy, M. J. Goldstein
Published Online: Dec 2 2009 6:04PM
DOI: 10.1111/j.1600-6143.2009.02929.x

A case of human intramuscular adrenal gland transplantation as a cure for chronic adrenal insufficiency.

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Letters to the Editor

Activation of Coagulation by Living Donor Kidney Transplants Early After Reperfusion (p 434-434)
T. Lisman
Published Online: Nov 24 2009 10:56AM
DOI: 10.1111/j.1600-6143.2009.02879.x

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Azathioprine (AZA) or Mycophenolate in Renal Transplant Recipients? (p 435-435)
Claudio Ponticelli
Published Online: Jan 24 2010 9:40AM
DOI: 10.1111/j.1600-6143.2009.02884.x

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