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Clinical Transplantation 

About: Clinical Transplantation is an academic journal. The journal publishes majorly in the area(s): Transplantation & Kidney transplantation. Over the lifetime, 6284 publication(s) have been published receiving 107185 citation(s).

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TL;DR: The most influential factor for patient survival in SPK and PAK in the multivariate and the univariate models was the status of the transplanted organ.
Abstract: As of December 31, 2004, more than 23,000 pancreas transplant had been reported to the IPTR, >17,000 in the US and almost 6000 from outside the US. An analysis of US pancreas transplants performed between 1988 and 2003 showed a progressive improvement in outcome, with pancreas transplant graft survival rates (GSRs) going from 75% at 1 yr for 1988/1989 to 85% for 2002/2003 simultaneous pancreas-kidney (SPK) cases, from 55 to 78% for pancreas after kidney (PAK) cases, and from 45 to 77% for pancreas transplants alone (PTA) cases. The improvements were due both to decreases in technical failure (TF) rates (from 12 to 6% in SPK, 13-8% in PAK, and 24-7% in PTA) and immunological failure rates (going from 7 to 2% for SPK, from 28 to 7% for PAK, and from 38 to 8% for PTA cases). These results are even more impressive under the aspect that during the same time the rate of potential risk factors increased and the duct management techniques changed from bladder to enteric drainage. The improvement in outcome allowed also an increase in the number of solitary pancreas transplants from initially 12% to now 35%. Contemporary primary deceased donor pancreas transplant outcomes were calculated separately for 2000-2004 US and non-US cases. The US patient survival rates at 1 yr were >95% in each recipient category, with 1 yr primary pancreas GSRs of 85% for SPK, 78% for PAK, and 76% for PTA (p or =80% in all three recipient categories. The results were comparable (> or =83% 1-year GSR) for patients (approximately 10%) treated with Sirolimus (SIR) under various protocols. In regard to non-US pancreas transplants, even for 2000-2004 the overwhelming majority continued to be in the SPK category (91%), with 1-year patient, kidney and pancreas survival rates of 94, 92, and 87%. Solitary transplants are still very rarely done outside the US. Non-US PAK GSR at 1 yr was 85%, non-US PTA GSR at 1 yr was 76%. In summary, with the new advancements in immunosuppression and changes in surgical techniques the outcomes in patient survival and pancreas transplant graft function continue to improve even with an increasing proportion of high risk patients in all three categories.

582 citations

Journal Article
TL;DR: Key benefits of the NTPR are the personal contact between registry staff and participants, the wide range of pregnancy-related variables that are analyzed, and the opportunity for health-care providers to obtain information that helps them care for transplant recipients on a case-by-case basis.
Abstract: The NTPR continues to maintain an ongoing active database as a resource for health professionals counseling recipients regarding pregnancy and for recipients themselves to contact the registry and request information. This includes female transplant recipients as well as male recipients who father pregnancies. Recipients who consent are entered into a database; analyses are ongoing, including long-term follow-up of the recipient, the graft and the offspring. The safety of pregnancy for parent and child remains the goal of the registry. Guidelines for counseling recipients proposed in 1976 remain applicable. Recipients should be in general good health and graft function should be stable and ideally rejection free. Comorbid conditions should be well controlled, especially hypertension and diabetes. While these counseling guidelines were formulated for kidney recipients, they may be extrapolated for other organ recipients. Analyses this year included pregnancy outcomes of recipients on newer agents, MMF and sirolimus. It remains unclear whether these adjunctive therapies should be altered for pregnancy. The balance of immunosuppression and the prevention of rejection need to be weighed against the potential for teratogenicity when counseling these recipients inquiring about pregnancy. Although there are periodic reports of recipients with graft dysfunction, rejection or graft loss possibly related to pregnancy events throughout all the organ groups, whether transplanted as adults or as pediatric patients, the majority of pregnancy outcomes reported to the NTPR appear favorable for parent and newborn. Whether recipients should breastfeed remains controversial. Recent reports in the literature as well as NTPR data appear favorable. This represents the last report from our initial established location at Thomas Jefferson University. In January of this year, the registry moved to Temple University School of Medicine, Department of Surgery, Philadelphia, PA. The NTPR remains committed to investigating outcomes of pregnancies reported by centers or self-referrals nationwide. Some of the active issues for the upcoming year include the potential for teratogenicity with combinations of newer agents, incidence of viral hepatitis, risk assessment for pregnancy in female lung recipients, and long-term maternal and pediatric follow-up.

560 citations

Journal Article
TL;DR: Based upon data reported to the UNOS Scientific Renal Transplant Registry regarding transplants performed between 1994-1998, the one- and 3-year graft survival rates for 16,288 recipients of living donor kidneys were 93% and 86%, respectively, with a half-life of 17 years.
Abstract: Based upon data reported to the UNOS Scientific Renal Transplant Registry regarding transplants performed between 1994-1998, the one- and 3-year graft survival rates for 16,288 recipients of living donor kidneys were 93% and 86%, respectively, with a half-life of 17 years Among those were 2,129 transplants from HLA-identical siblings with one- and 3-year graft survival rates of 96% and 93% and a 39-year half-life, 3,140 sibling donor grafts matched for one HLA haplotype with 94% and 87% one- and 3-year survival rates and a 16-year half-life and 2,071 transplants from living unrelated donors with 92% and 86% one- and 3-year graft survival rates and a 17-year half-life The overall results of 35,289 cadaver donor kidney transplants were 87% and 76% graft survival at one- and 3-years with a 10-year half-life There was a 13% difference in 3-year graft survival rates when recipients of kidneys from donors over or under age 55 were considered separately and the half-life was 11 years for younger donors and 6 years when the donor was older (p < 0001) A total of 4,688 (14%) of cadaver kidney recipients received an HLA-matched transplant Their graft survival rates were 89% and 83% at one and 3 years and their graft half-life was 16 years compared with 86% and 76% one- and 3-year graft survival and a 10-year half-life for recipients of HLA-mismatched kidneys (p < 0001) The recipient's age affected both graft survival and the cause of graft loss Recipients aged 19-45 had a 78% 3-year graft survival rate compared with 72% for recipients over age 60 or under 18 (p < 0001) However, 65% of graft losses after the first year among older recipients were due to death with a functioning graft compared with 18% among 19-45-year olds Acute rejections accounted for 16% of graft failures after the first year when the recipient was aged 6-18 Immune failures decreased with increasing recipient age The recipient's race also influenced graft survival rates Asian recipients of cadaver kidneys had the highest graft survival rates of 91% and 85% at one and 3 years with a half-life of 18 years The result for Whites and Blacks were significantly lower (87-86% at one year and 78% and 70% at 3 years, respectively; p < 0001) The graft half-life was 12 years for Whites and 7 years for Blacks DGF and acute rejection episodes during the early posttransplant period reduced 3-year survival of cadaveric transplants by 20% and reduced graft half-lives by 2 years (rejections) or 4 years (DGF) When rejections occurred in recipients with DGF, 3-year graft survival was 64% Induction therapy with anti-T-cell reagents did not affect graft survival rates among patients with DGF, but reduced the incidence of early rejections from 27-14% Rejections that occurred within the first 6 months had a more pronounced effect on subsequent graft half-lives (116 years without and 76 years with; p < 001) and increased the proportion of kidneys that failed because of chronic rejection from 31-43% between 1-3 years More than 50% of diabetics received a simultaneous pancreas kidney transplant during this period and the graft and patient survival rates were significantly higher for recipients of the SPK transplants When deaths with a functioning graft were censored, however, the graft failure rates were not significantly different The major causes of death among cadaver kidney transplant recipients were cardiovascular (26%) and infections (24%) during the first posttransplant year Between 1-3 years, the percentage of deaths due to infection fell to 15% and malignancies accounted for 13% of patient deaths

514 citations

Journal Article
TL;DR: In transplants performed between 1971 and 1986, first cadaver donor grafts had a half-life ranging from 6.6 to 7.5 years in the period after the first year, and for patients receiving kidneys with no HLA-A,B mismatches, the average half- life was 10.1 years.
Abstract: 1. In transplants performed between 1971 and 1986, first cadaver donor grafts had a half-life ranging from 6.6 to 7.5 years in the period after the first year. Second cadaver donor grafts had a half-life of 5.1 to 6.5 years. Parental donor grafts had a half-life of 9.3 to 11.8 years, whereas HLA identical sibling donor transplants had a half-life of 19.1 to 26.5 years. Siblings with no haplotype in common had an average half-life of 8.7 years. 2. Between 1971 and 1984, white recipients had an average half-life of 7.7 years, which increased to 9.3 years in 1985-1986. Black recipients' half-life decreased from 5.4 years in 1975-1976 to 3.5 years in 1985-1986. The reason for this decrease is not apparent. 3. The half-life of transplants of different recipient ages did not vary significantly. The average half-life during this period of study was 7.4 years for those younger than 21 years of age, 8.2 years for recipients 21 to 50 and 6.7 years for those older than 50. 4. In the early data, there was some evidence that the half-life of kidneys with cold ischemia below 13 hours was superior. However, in the latest period (between 1983 and 1986) the average half-life was 7.6 years for CIT below 13 hours, 7.2 years for those with 13 to 24 hours and 6.4 years for more than 24 hours. 5. For patients receiving kidneys with no HLA-A,B mismatches, the average half-life was 10.1 years. Those with A,B mismatches had a half-life of 6.7 years, and for those with no A,B antigens in common, the average half-life was 6 years. 6. In the period after 1981, the average half-life of patients with no A,B,DR mismatches was 9.1 years compared with 6.5 years for those with A,B,DR mismatches and 5.4 years for those with no A,B,DR antigens in common.

435 citations

Journal Article
TL;DR: Clinically attainable concentrations of MPA suppress the proliferation of human arterial smooth muscle cells and may decrease the risk of lymphoma development and proliferative arteriopathy in long-term recipients of MMF.
Abstract: Mycophenolate mofetil (MMF) is a novel immunosuppressive drug that shows promise in preventing the rejection of organ allografts and in the treatment of ongoing rejection. Orally administered MMF is hydrolyzed by esterases in the intestine and blood to release mycophenolic acid (MPA), a potent, selective, noncompetitive inhibitor of the type 2 isoform of inosine monophosphate dehydroxygenase (IMPDH) expressed in activated human T and B lymphocytes. By inhibiting IMPDH, MPA depletes the pool of dGTP required for DNA synthesis. MPA has a more potent cytostatic effect on lymphocytes than on other cell types, and this is the principal mechanism by which immunosuppressive activity is exerted. MPA also depletes pools of GTP in human lymphocytes and monocytes, thereby inhibiting the synthesis of fucose- and mannose-containing saccharide components of membrane glycoproteins. These are recognized by the family of adhesion molecules termed selectins. By this mechanism, MPA could decrease the recruitment of lymphocytes and monocytes into sites of graft rejection. In addition to preventing allograft rejection, MMF suppresses graft-versus-host reactions in lethal and nonlethal murine models. MMF inhibits primary antibody responses more efficiently than secondary responses. MPA inhibits the proliferation of human B lymphocytes transformed by Epstein-Barr virus and is not mutagenic. Clinically attainable concentrations of MPA suppress the proliferation of human arterial smooth muscle cells. These two properties of MPA may decrease the risk of lymphoma development and proliferative arteriopathy in long-term recipients of MMF.

353 citations

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