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Kidney transplantation is often the preferred treatment for those with end-stage renal disease. The discipline of kidney transplantation has grown tremendously over the past 50 years. Patients with end-stage renal disease have better long-term survival if they are placed on the waiting list and eventually undergo kidney transplantation than those who stay on dialysis. Furthermore, those who undergo transplantation often experience a better quality of life and a projected survival benefit of...
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Patients with advanced heart failure requiring mechanical circulatory support and inotropic support have a poor prognosis. Cardiac transplantation in a selected cohort of such patients can be the treatment of choice. The early experience with heart transplants was disappointing. In 1967, the first patient to receive a heart transplant died of an overwhelming infection after 17 days. However, with the advent of immunosuppressive therapies and a better understanding of human anatomy and...
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The first fruitful pancreatic transplant was carried out by WD Kelly in the year 1966. The results of pancreas transplantation have greatly improved as compared to the first one done in 1966, due to technical improvements and better immunosuppressive therapy over the last three decades. Transplantation of the pancreas is the only near cure treatment for type 1 diabetic patients. After the making of the International Pancreas Transplant Registry in 1984, data on more than 48000 pancreas...
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Multivisceral transplantation (MVT) can be categorized into many different organ combinations, but for this review, the focus will be on concurrent transplantation of the intestine, stomach, hepatobiliary system, and the pancreaticoduodenal complex – which can also be performed in a modified fashion by “cherry-picking” different organs that suit the recipient’s condition. Some approach MVT by the replacement of any organ that relies on the superior mesenteric and celiac artery. The concept...
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Cirrhosis and decompensated liver disease were the ninth leading cause of death for males in 2016 in the United States. Liver transplantation (LT) is a lifesaving gift and proven intervention in managing patients with acute and chronic end-stage liver disease. It restores normal health, lifestyle and extends lifespan by 15 years. The advent of liver transplantation came as a safety net to treat various liver diseases when all other medical interventions have failed. According to the...
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Lung transplantation is a well-established life-saving treatment to improve the quality of life of patients with end-stage respiratory failure not responding to other medical or surgical interventions. The 36th adult lung and heart-lung transplant report summarize data from 69,200 adult lung transplants that have been performed through June 30, 2018, and reported to the International Thoracic Organ Transplant Registry. The US Organ Procurement and Transplantation Network (OPTN) and the...
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Deceased donor and organ perfusion fluid cultures are obtained in order to inform recipient antimicrobial management and therefore reduce the risk of donor-derived bacterial and fungal infections. However, important heterogeneity exists in laboratory practice across organ procurement organizations and clinical management of culture results across transplant centers. While not standardized, the clinical approach to donors with positive bacterial and/or fungal cultures should be informed by...
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This updated section of the guideline from the Infectious Diseases Community of Practice of the American Society of Transplantation reviews the screening of donor and candidate prior to solid organ transplantation. Screening of donor and candidate is vital for optimizing post‐transplant outcomes. Risk assessment based on detailed history and appropriate diagnostic evaluation is essential. Serologic screening for certain viral infections is important and aids in immunization counseling and...
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These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation will review the current state of the art of donor-derived infections. Specifically, the guideline will summarize standardized definitions and approaches to defining imputability, updated data on the epidemiology of donor-derived infections, and approaches to risk mitigation against transmission of infections. This update will additionally provide guidance on the use of HIV+...