Deceased organ donors and PHS risk identification: impact upon organ usage and outcomes.

Background: In 2013, the PHS changed the criteria intended to identify organ donors that put the associated organ recipients at increased risk for acquiring HIV, HBV and HCV. The changing donor demographics, organ utilization and outcomes associated with this change is not known. Methods: A review of the OPTN database was performed to assess the impact of PHS donor designation upon organ utilization and outcomes. Results: After the 2013 modification, over 20% of all deceased organ donors in the US were identified as PHS increased risk. Compared to the standard risk deceased organ donor, the PHS donor was younger, male, died from anoxia, more likely to be HCV and HBcAb+ and less likely to have diabetes or hypertension. Organs from the 18 to 34-year-old deceased donors with PHS risks (but relatively few medical comorbidities) and tested negative for HCV were less frequently transplanted compared to the standard risk donors, 3.9 vs 4.2 OTPD. However, the transplant patient and graft survival as well as risk of unexpected transmission of HIV, HBV and HCV were equivalent, irrespective of PHS donor status. Conclusion: The rationale of using PHS donor designation that negatively impacts utilization of high quality organs without the benefit of identifying the subset of organs with demonstrable proclivity to transmit HIV, HBV or HCV needs to be re-examined. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Successful Transplantation of 2 Discolored Kidneys Caused by Myoglobin Casts from a Donor with Rhabdomyolysis.

No abstract available

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Timing is Everything: Managing Hepatitis C in Liver Transplant Candidates.

No abstract available

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Epitope-based HLA-matching: A Useful Strategy With Many Shortcomings to Overcome.

No abstract available

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Diffuse Extent of Peritubular Capillaritis in Late Antibody-mediated Rejection: Associations With Levels of Donor-specific Antibodies and Chronic Allograft Injury.

Background: Recently, diffuse peritubular capillaritis (ptc) has been suggested to independently predict chronic transplant injury and loss and while the ptc score is a diagnostic criterion for antibody-mediated rejection, the utility of diffuse ptc is under debate. Methods: We evaluated the diagnostic value of ptc characteristics in this cross-sectional study including 85 biopsies of patients with donor-specific antibodies (DSA). Biopsies were reevaluated for the extent (diffuse vs. focal), score and leukocytic composition in relation to DSA binding strength (MFI_max). Chronic allograft injury [transplant glomerulopathy (cg) or chronic lesion score (CLS)] were associated with ptc features. Results: Ptc was detected in 50% (76% mononuclear ptc). Ptc scores 1, 2, and 3 were present in 36%, 55% and 9 %, and focal or diffuse ptc in 36% or 64%. Diffuse ptc was associated with DSA MFI_max [median: 4407 vs. 2419 (focal ptc; p=0.04) or 1946 (no ptc; p=0.004)], cg [58% vs. no ptc 24% (p=0.02)] and higher CLS [mean: 6.81 vs. 4.67 (focal ptc, p=0.01) or 5.18 (no ptc, p=0.001)], respectively. The association of ptc score >=2 with cg was slightly better than with diffuse ptc. Diffuse ptc and ptc score >=2 remained independently related to cg after adjusting for DSA_MFI_max, C4d or previous rejection episodes, however lost their independent relation after adjusting for total microcirculation scores. Diffuse ptc was the only ptc characteristic independently related to CLS. Conclusion: Our results emphasize the clinical relevance of reporting diffuse ptc, which may relate to DSA binding strength and potentially to chronic graft injury. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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International Liver Transplant Society Consensus Statement on HEPATITIS C MANAGEMENT IN LIVER TRANSPLANT CANDIDATES.

No abstract available

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International Liver Transplant Society Consensus Statement on HEPATITIS C MANAGEMENT IN LIVER TRANSPLANT RECIPIENTS.

No abstract available

http://ift.tt/2mShPAS