Extended-criteria allografts a strategy to reduce waiting list mortality in selected hepatocellular carcinoma recipients

No abstract available

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No evidence for cross-reactivity of virus-specific antibodies with HLA allo-antigens

Background Antibodies directed against human leucocyte antigens (HLA) can develop through pregnancy, blood transfusions or organ transplants. Anecdotal evidence suggests that virus-specific antibodies may have the capacity to cross-react with HLA, a phenomenon called heterologous immunity, which is well described for T cell alloreactivity. Methods To determine whether antibody cross-reactivity between viral antigens and HLA is common, we tested 51 virus-specific human monoclonal antibodies (mAbs) specific for human immunodeficiency virus (HIV), varicella zoster virus (VZV), cytomegalovirus (CMV), and parvovirus, for reactivity against HLA class I and class II in single antigen bead assays. In addition, we tested the reactivity of 41 HLA-specific human mAbs against common viral antigens of CMV, VZV, HIV, Epstein-Barr virus, and BK polyomavirus. Results No cross-reactivity of any of the virus-specific mAbs with either HLA class I or class II molecules, as well as no cross-reactivity of any of the HLA-specific mAbs with any of the viral antigens was observed. Conclusions These findings indicate that the frequency of cross-reactivity on the antibody level between viral antigens and HLA, if present at all, is low. The emergence of HLA antibodies upon viral infection or vaccination is therefore probably due to bystander activation of dormant HLA-specific memory B cells. *Corresponding author: Dr. Sebastiaan Heidt, Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Albinusdreef 2 - 2333 ZA Leiden, the Netherlands. e-mail: S.Heidt@lumc.nl Conflict of interest: The authors have declared that no conflict of interest exists. Funding: None Authorship Sebastiaan Heidt: designed study, interpreted results, wrote manuscript Mariet C. Feltkamp: designed study, edited manuscript Gonca E Karahan: performed experiments, interpreted results Caroline S. de Brouwer: performed experiments, interpreted results Janneke Langerak-Langerak: performed experiments Arend Mulder: designed study, edited manuscript Frans HJ Claas: designed study, edited manuscript Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Prospective Validation of Prediction Model for Kidney Discard

Background Many kidneys are discarded every year, with 3631 kidneys discarded in 2016 alone. Identifying kidneys at high risk of discard could facilitate "rescue" allocation to centers more likely to transplant them. The Probability of Delay or Discard (PODD) model was developed to identify marginal kidneys at risk of discard or delayed allocation beyond 36 hours of cold ischemia time. However, PODD has not been prospectively validated, and patterns of discard may have changed following policy changes such as the introduction of Kidney Donor Profile Index and implementation of the Kidney Allocation System (KAS). Methods We prospectively validated the PODD model using SRTR data in the KAS era (1/1/15-3/1/18). C statistic was calculated to assess accuracy in predicting kidney discard. We assessed clustering in center's utilization of kidneys with PODD>0.6 ("high-PODD") using Gini coefficients. Using match run data 1/1/15-12/31/16, we examined distribution of these high-PODD kidneys offered to centers that never accepted a high-PODD kidney. Results PODD predicted discard accurately under KAS (C-statistic=0.87). Compared to utilization of low-PODD kidneys (Gini coefficient = 0.41), utilization of high-PODD kidneys was clustered more tightly among a few centers (Gini coefficient = 0.84 with >60% of centers never transplanted a high-PODD kidneys). In total 11,684 offers (35.0% of all high-PODD offers) were made to centers that never accepted a high-PODD kidney. Conclusions Prioritizing allocation of high-PODD kidneys to centers that are more likely to transplant them might help reduce kidney discard. Correspondence Information: Dorry Segev, M.D., Ph.D., Marjory K. and Thomas Pozefsky Professor of Surgery and Epidemiology, Associate Vice Chair, Department of Surgery, Director, Epidemiology Research Group in Organ Transplantation, Johns Hopkins University, 2000 E. Monument Street, Baltimore, MD 21205, 410-502-6115 (tel) 410-614-2079 (fax). dorry@jhmi.edu Authorship Dorry Segev and Allan Massie participated in the research design. Sheng Zhou, Allan Massie, Courtenay Holscher, Madeleine Waldram, Alvin Thomas, and Dorry Segev participated in the writing of the paper. Sheng Zhou and Tanveen Ishaque participated in the data analysis. Disclosure The authors declare no conflicts of interest. Funding This work was supported by grants number K24DK101882 (Segev) and F32DK109662 (Holscher) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and an American College of Surgeons Resident Research Scholarship (Holscher). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Every liver graft should be evaluated for transplantation

No abstract available

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Chikungunya on kidney transplant recipients: Is it the same?

Background Chikungunya virus (CHIKV) infection is an acute febrile illness with polyarthralgia and arthritis. There are few data about CHIKV infection in kidney transplant recipients (KTR). We report the largest case series of CHIKV infection in this population. Methods We retrospectively analyzed 32 cases of CHIKV infection in KTR between January 2016 and December 2017 at Hospital Universitário Walter Cantídio of Federal University of Ceará. Results All patients had been in endemic area before the beginning of the symptoms. All cases presented arthralgia, fifteen (46.9%) with joint inflammatory symptoms and 14 (43.8%) evolved to chronic arthralgia. Seven (21.9%) showed acute kidney injury (AKI) by KDIGO criteria during the acute phase. AKI was not related to prednisone use (OR 0.3, 95% CI 0.04 – 2.61, p=0.3) nor chronic arthralgia (OR 1.2, 95% CI 0.2 – 8.4, p=0.8) as well as male sex, chronic kidney disease and age above 60 years (OR 1.7, 95% CI 0.3 – 10.3, p=0.58; OR 0.4, 95% CI 0.1 – 2.7, p=0.4 and OR 2.1, 95% CI 0.3 – 14.9, p=0.45, respectively). Hospitalization was associated to AKI (OR 44.0, 95% CI 3.8 – 503.1, p=0.002), probably due to diarrhea or dehydration. One patient died during the study period, possibly not related to CHIKV infection. Conclusion The chance of CHIKV infection becoming chronic arthralgia in KTR was not different from data in literature. Seven patients presented AKI in the acute phase of infection, although that did not persist. Previous costicosteroids use did not relate with AKI or chronic arthralgia. Correspondence information: Bruno M. Tavares, Hospital São José de Doenças Infecciosas, Rua Nestor Barbosa, 315 – Parquelândia, Fortaleza – CE, Brazil 60455-610, E-mail: brunomelotavares@gmail.com. Telephone: +55-11-95981-1898 AUTHORSHIP PAGE Bruno M. Tavares: Participated in data collection, analysis and interpretation, preparing the figures and writing the article. Paula FCBC Fernandes: Participated in research design, data collection, analysis and interpretation and critical revision of the article. Cláudia Maria C. Oliveira: Participated in research design, data collection, analysis and interpretation, writing and critical revision of the article. Sônia L. Silva: Participated in data collection Márcia U. Mota: Participated in data collection Tacilla HS Andrade: Participated in data collection Samuel F. Cunha: Participated in data collection Evelyne S. Girão: Participated in research design, data collection, analysis and interpretation, writing and critical revision of the article. Disclosure: The authors declare no conflicts of interest. Funding: The authors declare no funding for this work. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Hepatic Dysfunction in Deceased Donors in the Age of the Opioid Epidemic

No abstract available

https://ift.tt/2uDQU14

Poor cardiorespiratory fitness is a risk factor for sepsis in patients awaiting liver transplantation

Background Patients with advanced liver disease are at increased risk of infection and other complications. A significant proportion of patients also have poor fitness and low muscle mass. The primary aim of this study was to investigate if cardiorespiratory fitness and body composition are risk factors for sepsis and other complications of advanced liver disease. Methods Patients being listed for liver transplantation underwent cardiopulmonary exercise testing to determine ventilatory threshold (VT). Computed tomography was used to measure skeletal muscle and subcutaneous and visceral adipose tissue indexes. All unplanned hospital admissions, deaths or delistings prior to transplantation were recorded. Results Eighty-two patients [aged 55.1 (50.6–59.4) years, median (interquartile range); male 87%] achieved a median VT of 11.7 (9.7–13.4) mL[BULLET OPERATOR]kg-1[BULLET OPERATOR]min-1. Their median MELD-Na score was 18 (14–22); and 37 had hepatocellular carcinoma. There were 50 admissions in 31 patients; with 16 admissions for sepsis in 13 patients. Patients with sepsis had a significantly lower VT [sepsis 9.5 (7.8–11.9), no sepsis 11.8 (10.5–13.8) mL[BULLET OPERATOR]kg-1[BULLET OPERATOR]min-1; P=0.003]. No body composition variables correlated with sepsis, nor were there any significant associations between VT and unplanned admissions for other indications. Multivariate logistic regression demonstrated that VT was independently associated with a diagnosis of sepsis (P=0.03). Poisson regression revealed that VT was a significant predictor for the number of septic episodes (P=0.02); independent of age, MELD-Na score, hepatocellular carcinoma diagnosis, presence of ascites, and beta-blocker use. Conclusion Poor cardiorespiratory fitness is an independent risk factor for the development of sepsis in advanced liver disease. Corresponding Author: Graeme A. Macdonald, MBBS, PhD, FAASLD, Senior Staff Specialist and Associate Professor of Medicine, Department of Gastroenterology and Hepatology, The Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland, 4011, Australia. Email: g.macdonald@uq.edu.au. Telephone: +61 (7) 3176 2613, Fax: +61 (7) 3176 5111 AUTHORSHIP PAGE Authorship: M.W. conceived and designed the research, performed and analysed the data, and wrote the article. A.W. performed data collection, contributed to writing and revised the article. A.H. performed data collection and revised the article. T.S. contributed to writing and revised the article. J.C. conceived and designed the research, advised on the research performance, contributed to writing and revised the article. G.M. conceived and designed the research, advised on the performance of the research and revised the article. Disclosures: MW, AH, and TS have no personal or funding interests to disclose. AW has received funding from the Royal Australasian College of Physicians for unrelated work. AW is also supported by the Princess Alexandra Hospital's Research Support Scheme postgraduate scholarship. JC has received an unrestricted research grant from Coca Cola and funding from Renew Corp, Pfizer, Cyanotech, Terumo, Gatorade, Numico, Northfields and Baxter for unrelated work. JC has also received honorariums to present at meetings from Novartis, Amgen and Roche. GM is on an advisory board for AbbVie and has received funding to speak on behalf of MSD and Gilead for unrelated work. Funding: None. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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