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Transplantology, Volume 5, Issue 2 (June 2024) – 4 articles

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13 pages, 1227 KiB  
Review
Histocompatibility Testing: A Fundamental Aspect of Renal Transplant Workup
by Vikash Chandra Mishra, Dinesh Chandra and Vimarsh Raina
Transplantology 2024, 5(2), 85-97; https://doi.org/10.3390/transplantology5020009 - 15 May 2024
Viewed by 315
Abstract
Histocompatibility testing is pivotal in any renal transplantation workup, aimed at enhancing prospective donor recipient compatibility and improving transplant outcomes. The evolution and advancement of histocompatibility testing, particularly HLA typing, have significantly improved its precision. This study outlines the historical progression from serologic [...] Read more.
Histocompatibility testing is pivotal in any renal transplantation workup, aimed at enhancing prospective donor recipient compatibility and improving transplant outcomes. The evolution and advancement of histocompatibility testing, particularly HLA typing, have significantly improved its precision. This study outlines the historical progression from serologic to DNA-based HLA typing, emphasizing the role of HLA proteins in immune response. Anti-HLA antibodies, targeting HLA proteins, pose challenges in renal transplantation. Monitoring and managing these antibodies are critical for renal transplant success. Complement-dependent cytotoxicity crossmatch and flow cytometry crossmatch are essential techniques for assessing donor–recipient compatibility. Panel-reactive antibody assesses antibodies against a panel of donor antigens, often HLA. Higher PRA levels (percentage) complicate donor matching, requiring specialized protocols. Virtual crossmatch evaluates recipient anti-HLA antibodies against potential donors through synthetic beads. This approach predicts crossmatch outcomes by comparing antibody profiles, offering a valuable tool for the risk assessment of renal transplantation. Despite advancements, a comprehensive understanding of alloreactive immune responses requires a combination of assays, emphasizing the importance of a multifaceted approach in histocompatibility testing. This is an attempt to compile the relevant information, providing a basis for comparison in a clear and foundational format for histocompatibility testing laboratories. Full article
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13 pages, 248 KiB  
Review
Robotic Surgical Techniques in Transplantation: A Comprehensive Review
by Marco Di Pangrazio, Federico Pinto, Alessandro Martinino, Francesco Toti, Gioia Pozza and Francesco Giovinazzo
Transplantology 2024, 5(2), 72-84; https://doi.org/10.3390/transplantology5020008 - 25 Apr 2024
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Abstract
In the field of surgery, the idea of performing organ transplants in a minimally invasive fashion has always been a significant technical challenge. The advent of the robotic approach facilitated the overcoming of difficulties in highly complex surgical procedures that demand high technical [...] Read more.
In the field of surgery, the idea of performing organ transplants in a minimally invasive fashion has always been a significant technical challenge. The advent of the robotic approach facilitated the overcoming of difficulties in highly complex surgical procedures that demand high technical skill. Furthermore, robotic transplants are showing significant benefits in patient outcomes, particularly in the obese population. The purpose of this review is to provide an overview of the current state of robotics applications for transplant surgery. Kidney transplants were the first to be performed using a fully robotic approach. Since then, robotic surgery has gradually been applied to other organ transplants, with very recent reports of fully robotic lung and liver transplants. Further experiences and studies will be needed to verify their effectiveness and to satisfy some concerns regarding the longer warm ischemia time related to the robotic approach in comparison with open surgery. Full article
7 pages, 199 KiB  
Case Report
From Normal Renal Function to Renal Replacement Therapy after Liver Transplantation: A Case Report
by Samuel Mangold, Gergely Albu, Julien Maillard, Florence Aldenkortt and Eduardo Schiffer
Transplantology 2024, 5(2), 65-71; https://doi.org/10.3390/transplantology5020007 - 11 Apr 2024
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Abstract
Postoperative renal failure significantly impacts long-term renal function and the overall survival of patients receiving liver transplantation (LT), being a crucial factor in their morbidity and mortality. It is difficult to define whether the causes of renal failure are solely related to surgery [...] Read more.
Postoperative renal failure significantly impacts long-term renal function and the overall survival of patients receiving liver transplantation (LT), being a crucial factor in their morbidity and mortality. It is difficult to define whether the causes of renal failure are solely related to surgery or anaesthesia during liver transplantation (LT). Indeed, liver disease requiring liver transplantation is often the cause of preoperative renal failure. We report a case of a 62-year-old patient undergoing LT for cholangiocarcinoma that led to acute kidney injury postoperatively while his preoperative renal function was normal. This report highlights the major influence that the surgical and anaesthetic procedure can have on renal function and identifies the factors that may have led to renal replacement therapy being required for this patient. Full article
(This article belongs to the Collection Progress and Recent Advances in Solid Organ Transplantation)
14 pages, 1227 KiB  
Article
Wasted Potential: Decoding the Trifecta of Donor Kidney Shortage, Underutilization, and Rising Discard Rates
by Ceilidh McKenney, Julia Torabi, Rachel Todd, M. Zeeshan Akhtar, Fasika M. Tedla, Ron Shapiro, Sander S. Florman, Matthew L. Holzner and L. Leonie van Leeuwen
Transplantology 2024, 5(2), 51-64; https://doi.org/10.3390/transplantology5020006 - 28 Mar 2024
Viewed by 688
Abstract
Kidney transplantation is a life-saving intervention for end-stage renal disease; yet, the persistent gap between organ demand and supply remains a significant challenge. This paper explores the escalating discard rates of deceased donor kidneys in the United States to assess trends, discard reasons, [...] Read more.
Kidney transplantation is a life-saving intervention for end-stage renal disease; yet, the persistent gap between organ demand and supply remains a significant challenge. This paper explores the escalating discard rates of deceased donor kidneys in the United States to assess trends, discard reasons, demographical differences, and preservation techniques. Data from the Scientific Registry of Transplant Recipients from 2010 to 2021 was analyzed using chi-squared tests for trend significance and logistic regression to estimate odds ratios for kidney discard. Over the last decade, discard rates have risen to 25% in 2021. Most discarded kidneys came from extended criteria donor (ECD) donors and elevated kidney donor profile index (KDPI) scores. Kidney biopsy status was a significant factor and predictor of discard. Discard rates varied greatly between Organ Procurement and Transplantation Network regions. Of reasons for discard, “no recipient located” reached a high of 60%. Additionally, there has been a twofold increase in hypothermic machine perfusion (HMP) since 2010, with transportation difficulties being the main reason for the discard of perfused kidneys. Our findings suggest a need to recalibrate organ utilization strategies, optimize the use of lower-quality kidneys through advanced preservation methods, and address the evolving landscape of organ allocation policies to reduce kidney discard rates. Full article
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