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Transfusion support in transplantation
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
Darrell J Triulzi, Ileana López-Plaza
Solid-organ transplantation continues to grow as a treatment modality in the USA. There are currently more than 74 000 patients waiting for an organ transplant. However in 1999 only 21 990 transplants were performed, limited primarily by the availability of organs. The total number of organ transplants performed was up 3.5% in 1999, with liver, lung, and kidney accounting for the majority of the increase (Table 4.3).
Lung transplantation
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Increased participation in daily physical activity and exercise after transplantation might be beneficial to improve exercise capacity and reduce the risk of developing some highly prevalent morbidities after solid organ transplantation, such as osteoporosis or muscle dysfunction as well as metabolic and cardiovascular abnormalities (2). Weight gain after transplantation is a common problem, and metabolic as well as cardiovascular morbidities such as hypertension, diabetes and dyslipidemia and hyperglycaemia rank among the five most common morbidities after lung transplantation (2,34). These metabolic syndrome components are often exacerbated by transplant-specific factors such as a sedentary lifestyle and immunosuppression (35,36). The presence of a higher number of metabolic syndrome components has also been shown to be associated with worse graft function in liver and kidney transplant recipients (37,38). There is some preliminary evidence from small single-centre studies available showing that exercise training or participation in regular physical activity may be a promising intervention for markers of metabolic syndrome in transplant recipients (39). Increased participation in physical activity and associated health effects can either be achieved by supervised exercise training interventions in the early post-transplant period or by lifestyle physical activity programmes, such as pedometer-based walking interventions, in the later post-transplant period.
Infections in Solid Organ Transplant Recipients Admitted to the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Almudena Burillo, Patricia Muñoz, Emilio Bouza
To improve the success of solid organ transplantation, infections in transplant patients need to be effectively diagnosed and treated. This still remains a challenge today. Diagnostic tests for infection are frequently initiated when clinical symptoms arise, which in immunocompromised patients are often late in the disease course. Thus, clinicians must be extra vigilant of the possibility of severe infection through a comprehensive diagnostic approach, including the assessment of infection mimics.
Click Here to Complete This Survey: Online Research, Adolescents, and Parental Consent
Published in The American Journal of Bioethics, 2020
Liza-Marie Johnson, Devan M. Duenas, Benjamin S. Wilfond
Young adults who undergo solid organ transplantation are at risk of non-adherence with their anti-rejection medications, increasing their risk of rejection and graft failure after transplant (Dobbels et al. 2005). Based on a 2005 meta-analysis (Dobbels et al. 2005) which found that up to one-third of adolescent patients were non-adherent, an investigator wants to develop and test a digital tool to support adherence among teens and young adults. As a first step, the investigator would like to survey teenage and young adult transplant recipients to identify the barriers and facilitators of adherence. The investigator would like to enroll teenagers age 13 and above in addition to those 18–30. The survey does not include any sensitive questions and will have no direct benefit for respondents but may benefit future young transplant recipients. The investigator would like to post the survey on-line and advertise the availability of the survey on websites frequented by recent recipient donors and their parents. A consult is requested around how to consent participants for this survey study.
Laparoscopic-Assisted Resection for Advanced Colorectal Cancer in Solid Organ Transplant Recipients
Published in Journal of Investigative Surgery, 2018
Ze-Nan Xia, Rui Hou, Wei Zhu, Ru Yao, Zhao Lu, Hui-Zhong Qiu, Guo-Le Lin
Recipients of solid organ transplantation represent a group of high-risk patients, for the reason that they have associated problems of chronic immunosuppression, potential hazard of allograft dysfunction, and numerous comorbidities, as well as the primary etiology of their organ failure [5–7]. Given that conventional open surgery may pose a great risk to these patients, they seem to benefit more from minimally invasive surgery like laparoscopic procedures. Rivas et al. [8] have documented favorable outcomes of laparoscopic-assisted colectomies for colon cancer in three kidney transplant recipients. However, studies focusing on laparoscopic colorectal surgery in transplant patients are much few and there are only a limited number of case reports in the literature. Particularly, due to concerns regarding the oncological outcomes of laparoscopic approach, its use in transplant recipients with advanced cancer is very limited. There is currently a lack of systemic evaluation of the short- and long-term outcomes of laparoscopic surgery for advanced CRC in recipients of solid organ transplantation.
Graft rejection after immune checkpoint inhibitor therapy in solid organ transplant recipients
Published in Acta Oncologica, 2018
Tor Magnus Smedman, Pål-Dag Line, Tormod K. Guren, Svein Dueland
Long-term survival after solid organ transplantation has increased during the last decades. Organ-transplanted patients require lifelong immunosuppression to control the balance between risk of allograft rejection and adverse side effects such as infection. The required level of immunosuppression vary between different organ transplant types with the liver being the organ transplant needing the lowest level [5]. The specific protocols also vary between organ types and centers, but the general principle is to combine 2–3 drugs, thereby minimizing dose-related side effects of any particular agent. Most patients receive corticosteroids. Due to the side effect profile of chronic steroid use, they are either tapered gradually off in the first months or maintained at a low maintenance dose. Calcineurin inhibitors (CNI) like cyclosporine and tacrolimus block the signal-2 of T-cell activation, and these agents are the mainstay of immunosuppression in almost all protocols. Agents that interact with the cell cycle, like mycophenolate mofetil are often added. Due to the nephrotoxicity associated with CNI, agents interacting with the mTOR pathway like sirolimus and everolimus are increasingly used. Chronic immunosuppressive treatment in organ transplant recipients is associated with an increased incidence of de novo malignancies, including non-melanoma skin cancer, malignant melanoma, lymphoma, kidney, head and neck cancer, colorectal cancer and lung cancer [6–9].