China
Africa
Explore chapters and articles related to this topic
Introduction: HLA Matching in Transplantation
Published in M. Kam, Jeffrey L. Bidwell, Handbook of HLA TYPING TECHNIQUES, 2020
The relationship between availability of donors and proportion of patients who could achieve a beneficially matched organ transplant was investigated in a simulation model.19 The model assumed a constant flow of donors, all typed for HLA-A, -B, and -DR by serological methods and transplanted to ABO identical recipients. Furthermore, all kidneys were assumed offered to a single national pool for transplantation for the best-matched recipient. The results showed that with waiting lists of 100 patients, beneficial matching could be achieved for 12%, but with waiting lists of 5000 patients, beneficial matching could be achieved for 80%o (Table 1). This is the rationale for multicenter organ sharing schemes based on HLA matching.20
Transplants: Experiment or Therapy?
Published in David Lamb, Organ Transplants and Ethics, 2020
In recent years there have also been developments in multi-organ transplants, such as heart-lung and liver-pancreas. Heart-lung transplants are usually performed for patients with terminal pulmonary hypertension. The first was at Stanford University in 1981. It is still regarded as an experimental procedure, with only a 50 per cent one-year survival rate (New York Task Force, 1988:17). Apart from medical complications there are other problems: it is hard to find suitable donors; and following brain death there is a quick deterioration of the lungs, so rapid transplantation is essential.
Ethics and Brain Death
Published in David Lamb, Death, Brain Death and Ethics, 2020
However, objections to the second reason given in the Harvard Report have been raised by Hans Jonas who argues (1974, p. 133) that freedom for organ use is not covered by the primary rationale, that is, the interests of the patient. Jonas’s point is that the theoretical requirement to define death is one thing, and it is essential if the patient’s interests are uppermost. But the requirement for organ transplants – even to save lives – is another interest, one which must not be allowed to intrude upon the former. Commenting on the Harvard interest in organ transplants, Jonas (p. 133) says: I contend that, pure as this interest, viz, to save other lives, is in itself, its intrusion into the theoretical attempt to define death makes the attempt impure; the Harvard Committee should never have allowed itself to adulterate the purity of its scientific case by baiting it with the prospect of this extraneous – though extremely appealing gain.
The effect of the third dose of the BNT162b2 vaccine on anti-SARS-CoV-2 spike antibody levels in healthcare workers with and without COVID-19 infection
Published in Annals of Medicine, 2023
Blanka Wolszczak-Biedrzycka, Anna Bieńkowska, Beata Cieślikiewicz, Elwira Smolińska-Fijołek, Grzegorz Biedrzycki, Justyna Dorf
Before the third dose was introduced, attempts had been made to determine which population group would benefit most from the booster dose and should receive priority. Special attention was paid to immunocompromised subjects who may not have developed sufficient immunity after the first two doses of the vaccine. Kamar et al. [34] studied immunocompromised patients (recipients of solid organ transplants) and detected anti-SARS-CoV-2 antibodies in only 40% of the subjects (40 out of 99) four weeks after the administration of the second dose. However, antibodies were detected in 68% of the examined patients (67 out of 99) four weeks after the third dose. Similar observations were made by Werbel et al. [35] in a study of 30 recipients of solid organ transplants. Antibody levels increased after the third dose (24–101 days after the second dose) in one-third of the patients (n = 6) who had not developed anti-SARS-CoV-2 antibodies after the first two doses (n = 24) and in all patients with low antibody levels (n = 6). Peled et al. [33] examined immune responses to a booster dose in heart transplant patients. A humoral immune response was noted in only 23% of the subjects after two vaccines, and anti-SARS-CoV-2 antibodies were detected in 67% of the subjects after the third dose. In other studies, antibody levels also increased in dialysis patients after a third dose of the Pfizer/BioNTech vaccine, and the highest increase was noted in patients who had responded weakly to the first two doses of the vaccine [36].
Bictegravir/emtricitabine/tenofovir alafenamide combination in the management of kidney transplant patients with HIV receiving immunosuppressants
Published in Journal of Chemotherapy, 2022
Jennifer Lagoutte-Renosi, Mylène Flammang, Didier Ducloux, Jamal Bamoulid, Pierre-Yves Royer, Quentin Lepiller, Anne-Laure Clairet, Siamak Davani, Patrice Muret
Thanks to the advent of combined Antiretroviral Therapy (cART), persons living with HIV/AIDS (PLWHA) are living longer [1]. As a result, in the coming years, older PLWHA will increasingly develop chronic end-stage renal disease. Many of these patients will be eligible for organ transplant according to the American Society of Transplantation criteria [2]. However, the combination of immunosuppressant therapy initiated at the time of transplant with pre-existing cART can be challenging. Indeed, it is well-established that some antiretroviral agents are substrates, inhibitors or inducers of hepatic enzymes and transporters involved in the metabolism and transport of immunosuppressants. Here, we describe the case of a PLWHA treated by cART who presented an interaction with tacrolimus, despite initial adaptation of the tacrolimus dose and therapeutic drug monitoring (TDM). A switch from cART to a single-tablet regimen associating bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) was successfully performed in this patient. However, after one year of treatment by BIC/FTC/TAF, TDM shows that tenofovir concentration is higher than usually for a TAF form. It seems necessary to maintain the monitoring of tenofovir level in kidney transplant patient who are at higher risk of tenofovir accumulation.
The history of organ transplantation
Published in Baylor University Medical Center Proceedings, 2022
Kristen D. Nordham, Scott Ninokawa
By the 1950s, skin grafts had been the only successful transplants performed, but basic science had been researching the viability of transplanting organs. Much of early organ transplant research focused on kidneys, since live donors, the only kind at the time, could survive with just one of their own. In 1953, 22-year-old Richard Herrick was discharged from the Coast Guard with chronic nephritis, a then life-threatening diagnosis with no cure. At this time, there had been other renal transplants in humans that had proven unsuccessful: the first renal human allograft was performed on April 3, 1933, by Dr. Yurii Voronoy in Ukraine.10 In this case, the patient survived for 2 days, and the failure of the case is largely attributed to ABO incompatibility and prolonged warm ischemia time of the kidney. Other surgeries had also been performed in Boston, Chicago, and Paris.