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Transplantology, Volume 1, Issue 2 (December 2020) – 7 articles

Cover Story (view full-size image): In the first wave of the Coronavirus pandemic, it was unclear to what extent solid organ transplant (SOT) recipients are at risk for severe complications due to coronavirus disease (COVID-19). The analysis of the first reported cases resulted in the hypothesis that calcineurin inhibitors (CNI) are protective for these patients, modifying morbidity and mortality and possibly also the incidence. COVID-19 in SOT recipients may present with atypical symptoms or even be oligosymptomatic. Maintenance immunosuppression including a CNI appears to prevent the excessive immune response observed in some patients leading to severe stage III COVID-19 (hyperinflammation) with associated increased mortality. View this paper
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12 pages, 253 KiB  
Article
Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data
by Yuri Battaglia, Luigi Zerbinati, Elena Martino, Giulia Piazza, Sara Massarenti, Alda Storari and Luigi Grassi
Transplantology 2020, 1(2), 123-134; https://doi.org/10.3390/transplantology1020012 - 15 Dec 2020
Cited by 4 | Viewed by 2795
Abstract
Although the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for [...] Read more.
Although the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for a kidney transplant with consequent relevant psychological distress or even full-fledged psychiatric disorders, as diagnosed with traditional psychiatric nosological systems. Recent studies report, however, a higher prevalence of other psychosocial syndromes, as diagnosed by using the Diagnostic Criteria for Psychosomatic Research (DCPR) in medically ill and kidney transplant patients. Nevertheless, no data regarding DCPR prevalence are available in patients waitlisted for a renal transplant (WKTs). Thus, the primary aim of this study was to identify sub-threshold or undetected syndromes by using the DCPR and, secondly, to analyze its relationship with physical and psychological symptoms and daily-life problems in WKTs. A total of 30 consecutive WKTs were assessed using the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0. The Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist were used to assess physical and psychological distress symptoms and daily-life problems. A total of 60% of patients met the criteria for at least one DCPR diagnosis; of them, 20% received one DCPR diagnosis (DCPR = 1), and 40% more than one (DCPR > 1), especially the irritability cluster (46.7%), Abnormal Illness Behavior (AIB) cluster (23.3%) and somatization cluster (23.3%). Fifteen patients met the criteria for an ICD diagnosis. Among patients without an ICD-10 diagnosis, 77.8% had at least one DCPR syndrome (p < 0.05). Higher scores on ESAS symptoms (i.e., tiredness, nausea, depression, anxiety, feeling of a lack of well-being and distress), ESAS-Physical, ESAS-Psychological, and ESAS-Total were found among DCPR cases than DCPR non-cases. In conclusion, a high prevalence of DCPR diagnoses was found in WKTs, including those who resulted to be ICD-10 non-cases. The joint use of DCPR and other screening tools (e.g., ESAS) should be evaluated in future research as part of a correct psychosocial assessment of WKTs. Full article
(This article belongs to the Special Issue Mental Health and Transplantation: Challenges and Solutions)
12 pages, 232 KiB  
Review
The Revolution in Indication for Liver Transplantation: Will Liver Metastatic Disease Overcome the End-Stage Liver Disease in the Next Future?
by Tommaso Maria Manzia, Alessandro Parente, Roberta Angelico, Carlo Gazia and Giuseppe Tisone
Transplantology 2020, 1(2), 111-122; https://doi.org/10.3390/transplantology1020011 - 2 Dec 2020
Cited by 2 | Viewed by 3599
Abstract
Indications for liver transplantation (LT) have constantly been evolving during the last few decades due to a better understanding of liver diseases and innovative therapies. Likewise, also the underlying causes of liver disease have changed. In the setting of transplant oncology, recent developments [...] Read more.
Indications for liver transplantation (LT) have constantly been evolving during the last few decades due to a better understanding of liver diseases and innovative therapies. Likewise, also the underlying causes of liver disease have changed. In the setting of transplant oncology, recent developments have pushed the boundaries of oncological indications for LT outside hepatocellular carcinoma (HCC), especially for secondary liver tumors, such as neuroendocrine and colorectal cancer. In the next years, as more evidence emerges, LT could become the standard treatment for well-selected metastatic liver tumors. In this manuscript, we review and summarize the available evidence for LT in liver tumors beyond HCC with a focus on metastatic liver malignancies, highlighting the importance of these new concepts for future implications. Full article
(This article belongs to the Special Issue Infections, Complications, and Management of Liver Transplantation)
9 pages, 2887 KiB  
Case Report
Surgical Treatment of Severe Bowel Obstruction as a Rare Complication Following Allogenic Hematopoietic Stem Cell Transplantation
by Håkon Reikvam, Tor Henrik Anderson Tvedt, Silje Johansen, Hege Aase Setran and Roald Flesland Havre
Transplantology 2020, 1(2), 102-110; https://doi.org/10.3390/transplantology1020010 - 17 Nov 2020
Viewed by 2651
Abstract
Gastrointestinal graft-versus-host disease (GVHD) and cytomegalovirus (CMV) disease are common complications occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and contribute to a high degree of morbidity and mortality associated with allo-HSCT. Herein, we present a patient with severe intestinal GVHD complicated by [...] Read more.
Gastrointestinal graft-versus-host disease (GVHD) and cytomegalovirus (CMV) disease are common complications occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and contribute to a high degree of morbidity and mortality associated with allo-HSCT. Herein, we present a patient with severe intestinal GVHD complicated by recurring CMV enteritis, which overall resulted in severe terminal ileum stenosis. The patient underwent laparoscopic ileocecal resection that significantly reduced symptoms and possibly prevented the development of fulminant ileus. Surgical treatment is rarely used in the treatment of gastrointestinal GVHD; however, the current patient history illustrates that patients with inadequate symptom control and severe inflammatory bowel stenosis can be successfully managed with surgery. We also review published case reports on surgical treatment for severe gastrointestinal GVHD. Full article
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5 pages, 197 KiB  
Editorial
Dietary Assessment and Self-Management Using Information Technology in Order to Improve Outcomes in Kidney Transplant Recipients
by Fernanda G. Rodrigues, Martin H. de Borst and Ita P. Heilberg
Transplantology 2020, 1(2), 97-101; https://doi.org/10.3390/transplantology1020009 - 1 Nov 2020
Viewed by 2155
Abstract
Big data and artificial intelligence (AI) will transform the way research in nephrology is carried out and consequently improve the performance of clinical practice in nephrology and transplantation. Managing long-term health outcomes in kidney transplant recipients (KTR) includes the improvement of modifiable factors, [...] Read more.
Big data and artificial intelligence (AI) will transform the way research in nephrology is carried out and consequently improve the performance of clinical practice in nephrology and transplantation. Managing long-term health outcomes in kidney transplant recipients (KTR) includes the improvement of modifiable factors, such as diet. Self-management using information technology (IT) aims to facilitate lifestyle changes, manage symptoms and treatment in the course of chronic kidney disease (CKD) or any chronic condition. The advantages of health mobile applications further include the capacity of data compilation and yielding responses to numerous research questions in nephrology and transplantation. However, studies investigating the employment of such applications in KTR and its impact in kidney transplant outcomes are still lacking. The specific advantages of dietary assessment and self-management using IT in order to improve outcomes in KTR are presently discussed. This Special Issue features a great set of articles regarding IT approaches to improve kidney allograft survival and posttransplant outcomes in all areas. Full article
12 pages, 1669 KiB  
Review
Dental Implant Failure Rate and Marginal Bone Loss in Transplanted Patients: A Systematic Review and Meta-Analysis
by Marcela Paraizo, João Botelho, Vanessa Machado, José João Mendes, Ricardo Alves, Paulo Mascarenhas and José Maria Cardoso
Transplantology 2020, 1(2), 85-96; https://doi.org/10.3390/transplantology1020008 - 10 Oct 2020
Viewed by 3626
Abstract
This systematic review investigates the failure rate and marginal bone loss (MBL) of dental implants placed in patients undergoing solid-organ transplant (SOT) compared to healthy controls. Three databases (PubMed, Web of Sciences, and the Cochrane Library) were searched up to June 2020 (PROSPERO [...] Read more.
This systematic review investigates the failure rate and marginal bone loss (MBL) of dental implants placed in patients undergoing solid-organ transplant (SOT) compared to healthy controls. Three databases (PubMed, Web of Sciences, and the Cochrane Library) were searched up to June 2020 (PROSPERO CRD42019124896). Case-control and cohort studies reporting data failure rate and marginal bone loss (MBL) of dental implants placed in SOT patients were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Four case-control studies fulfilled the inclusion criteria; all had low risk of bias. Meta-analyses revealed consistently lower implant failure rate than control populations at patient and implant levels. SOT patients had a significant difference of −18% (p-value < 0.001) MBL compared to healthy patients. SOT status poses no serious threat to implant survival. Overall, this group of patients presented lower levels of dental implant failure rate and marginal bone loss compared to otherwise healthy patients. Further intervention trials with larger sample size and longer follow-ups are necessary to confirm these summarized results. Full article
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14 pages, 559 KiB  
Review
Transplant Drugs against SARS, MERS and COVID-19
by René Hage, Carolin Steinack, Fiorenza Gautschi and Macé M. Schuurmans
Transplantology 2020, 1(2), 71-84; https://doi.org/10.3390/transplantology1020007 - 3 Oct 2020
Cited by 4 | Viewed by 3427
Abstract
There is an urgent need to develop drugs and vaccines to counteract the effects of the new coronavirus SARS-CoV-2 and adequately treat the corona virus disease (COVID-19). As these drugs are still under investigation, research also focuses on existing medication with proven effectiveness [...] Read more.
There is an urgent need to develop drugs and vaccines to counteract the effects of the new coronavirus SARS-CoV-2 and adequately treat the corona virus disease (COVID-19). As these drugs are still under investigation, research also focuses on existing medication with proven effectiveness in other coronaviral diseases. The advantages of existing therapeutic drugs that are currently approved (for other indications) are the known safety profile, general availability and relatively lower costs involved in extending the purpose to a new disease. Calcineurin inhibitors (CNI) are drugs that have shown effectiveness in several coronaviral diseases, and are well-known and widely used drugs in transplant medicine. The aim of this narrative review is to present the current evidence of CNI in coronaviral diseases, the biophysiology of CNI and to suggest possible ways to study CNI as a new treatment option for COVID-19. We searched original papers, observational studies, case reports, and meta-analyses published between 2000 and 2020 in English in the PubMed database and Google Scholar using the keywords: (coronavirus), (treatment), (MERS), (SARS), (COVID-19), (tacrolimus), (ciclosporin), (cyclosporin) AND (calcineurin inhibitor). We excluded studies in patients with clear indications for immunosuppressive therapy. Additionally, we searched in the preprint servers and the World Health Organization bulletin. Ten studies were identified and included. Calcineurin inhibitor therapy has been suggested to be effective for coronaviral diseases in different settings. The results are summarized in a table. CNI should be investigated as a first treatment option based on evidence of direct antiviral effects and its properties preventing severe systemic hyperinflammation, as has been observed in COVID-19 with predominantly pulmonary immunopathological changes. Full article
(This article belongs to the Special Issue Solid Organ Transplantation in the Era of COVID-19)
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16 pages, 905 KiB  
Review
White Adipose Tissue as a Site for Islet Transplantation
by Naoaki Sakata, Gumpei Yoshimatsu and Shohta Kodama
Transplantology 2020, 1(2), 55-70; https://doi.org/10.3390/transplantology1020006 - 1 Sep 2020
Cited by 5 | Viewed by 3301
Abstract
Although islet transplantation is recognized as a useful cellular replacement therapy for severe diabetes, surgeons face difficulties in islet engraftment. The transplant site is a pivotal factor that influences the engraftment. Although the liver is the current representative site for clinical islet transplantation, [...] Read more.
Although islet transplantation is recognized as a useful cellular replacement therapy for severe diabetes, surgeons face difficulties in islet engraftment. The transplant site is a pivotal factor that influences the engraftment. Although the liver is the current representative site for clinical islet transplantation, it is not the best site because of limitations in immunity, inflammation, and hypoxia. White adipose tissue, including omentum, is recognized as a useful candidate site for islet transplantation. Its effectiveness has been evaluated in not only various basic and translational studies using small and large animals but also in some recent clinical trials. In this review, we attempt to shed light on the characteristics and usefulness of white adipose tissue as a transplant site for islets. Full article
(This article belongs to the Special Issue 2021 Profile Papers by Transplantology’s Editorial Board Members)
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