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George V Mazariegos - One of the best experts on this subject based on the ideXlab platform.
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cd154 expressing cmv specific t cells associate with freedom from dnaemia and may be protective in seronegative recipients after liver or Intestine Transplantation
Pediatric Transplantation, 2020Co-Authors: Chethan Ashokkumar, Kyle Soltys, George V Mazariegos, Brandon W. Higgs, Michael R Green, Marian G Michaels, Miguel Reyesmugica, Brianna Spishock, Madison Zaccagnini, Pradeep SethiAbstract:Cell-mediated immunity to CMV, if known, could improve antiviral drug therapy in at-risk children and young adults with LT and IT. Host immunity has been measured with CMV-specific T cells, which express IFNγ, but not those which express CD154, a possible substitute for IFNγ. CMV-specific CD154+ T cells and their subsets were measured with flow cytometry after stimulating PBL from recipient blood samples with an overlapping peptide mix of CMV-pp65 antigen for up to 6 hours. CMV-specific CD154+ T cells co-expressed IFNγ in PBL from three healthy adults and averaged 3.8% (95% CI 3.2%-4.4%) in 40 healthy adults. CMV-specific T cells were significantly lower in 19 CMV DNAemic LT or IT recipients, compared with 126 non-DNAemic recipients, 1.3% (95% CI 0.8-1.7) vs 4.1 (95% CI 3.6-4.6, P < .001). All T-cell subsets demonstrated similar between-group differences. In logistic regression analysis of 46 training set samples, 12 with DNAemia, all obtained between days 0 and 60 from transplant, CMV-specific T-cell frequencies ≥1.7% predicted freedom from DNAemia with NPV of 93%. Sensitivity, specificity, and PPV were 83%, 74%, and 53%, respectively. Test performance was replicated in 99 validation samples. In 32 of 46 training set samples, all from seronegative recipients, one of 19 recipients with CMV-specific T-cell frequencies ≥1.7% experienced DNAemia, compared with 8 of 13 recipients with frequencies <1.7% (P = .001). CMV-specific CD154+ T cells are associated with freedom from DNAemia after LT and IT. Among seronegative recipients, CMV-specific T cells may protect against the development of CMV DNAemia.
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mucosal plasma cell barrier disruption during Intestine transplant rejection
Transplantation, 2012Co-Authors: Mylarappa Ningappa, Chethan Ashokkumar, Qing Sun, George V Mazariegos, Brandon W. Higgs, Sarangarajan Ranganathan, Lori Schmitt, Maria F Branca, Adriana Zeevi, Kareem AbuelmagdAbstract:BACKGROUND Intestinal allograft mucosa undergoes repopulation with host immunocytes. However, critical changes within key immunocyte subsets are not known. METHODS To explain acute cellular rejection after Intestine Transplantation (ITx) on the basis of altered mucosal immunocytes, rejecting and rejection-free ITx allografts (n=17) were compared with genome-wide expression arrays. Cells identified by cell/lineage-specific genes were evaluated by immunohistochemistry. The corresponding phenotype and donor-specific alloreactivity were characterized in peripheral blood. Time-dependent changes in candidate cell(s) were evaluated in biopsies from an independent cohort of 12 children with ITx. RESULTS Among 107 differentially expressed genes, three B-cell lineage-specific genes, CCR10, STAP1, and IGLL1, were down-regulated during ITx rejection and were selected for and achieved technical quantitative reverse transcription polymerase chain reaction replication. Down-regulation of the immunoglobulin (Ig)A+ plasma cell-specific CCR10 gene correlated with decreased mature mucosal CD138+ plasma cell numbers in corresponding biopsy specimens (r=0.761, P=0.006) and inversely correlated with enhanced alloreactivity of CD154+ T-cytotoxic memory cells (r=-0.56, P=0.031), which predict acute cellular rejection with high sensitivity. An independent cohort of serial biopsy specimens from 12 ITx recipients (1) confirmed relative CD138+ plasma cell depletion during rejection (P=0.042) and (2) showed increased IgG+-to-IgA+ cell ratios within 4 hr of reperfusion in rejection-prone allografts (P=0.037) and during ITx rejection (P=0.025), compared with rejection-free allografts. No differences existed late after ITx. Increased peripheral IgG+ CD27+ CD19+ memory B cells (P=0.004) were seen during ITx rejection in archived peripheral blood lymphocyte from test and replication cohorts. CONCLUSIONS Protracted depletion of the mucosal CD138+ plasma cell barrier and early mucosal infiltration with memory IgG+ cells characterize the rejection-prone Intestine allograft. Mucosal IgA+ plasma cell barrier reconstitution may augur resolution of ITx rejection.
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Increased monocyte expression of sialoadhesin during acute cellular rejection and other enteritides after Intestine Transplantation in children.
Transplantation, 2012Co-Authors: Chethan Ashokkumar, Qing Sun, George V Mazariegos, Mylarappa Ningappa, Anna Gabriellan, Rakesh SindhiAbstract:BACKGROUND Sialoadhesin (CD169) facilitates T-cell priming when overexpressed on inflammatory monocytes. Monocyte-derived macrophages prime acute cellular rejection after Intestine Transplantation (ITx).The purpose of this study was to evaluate whether CD169-expressing activated monocytes associate with or predict ITx rejection. METHODS After informed consent (ClinicalTrials.gov NCT No. 01163578), activated CD169+CD14+monocytes were measured by flow cytometry in five normal healthy adult volunteers (group A), and 56 children with ITx sampled cross-sectionally (group B, 26), longitudinally (group C, 18), or during infection/inflammation without rejection (group D: acute enteritis, 9; Helicobacter pylori, 1; Streptococcal pharyngitis 1; and posttransplant lymphoma, 1). Activated monocytes were tested for correlations with donor-specific alloreactivity in simultaneous mixed lymphocyte co-cultures. RESULTS Median age was 3 years (range 0.5-21 yr), and distribution of ITx-alone:combined liver-ITx was 25:31. Higher frequencies (%) of activated monocytes were seen during rejection in group B and infection/inflammation without rejection in group D (58 ± 28 and 73 ± 26), compared with nonrejectors or normal controls (10.6 ± 7.9 or 10.7 ± 6.5, P=0.001). In longitudinal monitoring, rejectors also showed higher activated monocyte frequencies (%) before ITx (64 ± 26 vs. 13.4 ± 8.6, P=0.0007) and during acute cellular rejection (55 ± 28 vs. 22.4 ± 15, P=0.006) when compared with nonrejectors. Activated monocytes correlated significantly with allospecific CD154+T-cytotoxic memory cells (Spearman r=0.688, P=7.1E-05) and CD154+B cells (r=0.518, P=0.005) in ITx recipients without inflammation/infection but not in group D. CONCLUSIONS Monocytes overexpress sialoadhesin nonspecifically during ITx rejection and systemic or enteritic inflammatory states. When combined with allospecific T and B cells, this information may differentiate between rejection and other enteritides.
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NOD2 gene polymorphism rs2066844 associates with need for combined liver-Intestine Transplantation in children with short-gut syndrome.
The American journal of gastroenterology, 2010Co-Authors: Mylarappa Ningappa, Chethan Ashokkumar, Qing Sun, Kyle Soltys, Brandon W. Higgs, Daniel E. Weeks, Richard H. Duerr, Geoffrey J. Bond, Kareem Abu-elmagd, George V MazariegosAbstract:NOD2 Gene Polymorphism rs2066844 Associates With Need for Combined Liver–Intestine Transplantation in Children With Short-Gut Syndrome
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Intestine Transplantation in the united states 1999 2008
American Journal of Transplantation, 2010Co-Authors: George V Mazariegos, Simon Horslen, Jonathan P. Fryer, David R. Grant, D E Steffick, Douglas G. Farmer, Alan Norman Langnas, John C MageeAbstract:Note on sources: The articles in this report are based on the reference tables in the 2009 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in the figures and tables included here. All of the tables may be found online at: http://www.ustransplant.org. Improving short-term results with Intestine Transplantation have allowed more patients to benefit with nearly 700 patients alive in the United States with a functioning allograft at the end of 2007. This success has led to an increase in demand. Time to transplant and waiting list mortality have significantly improved over the decade, but mortality remains high, especially for infants and adults with concomitant liver failure. The approximately 200 Intestines recovered annually from deceased donors represent less than 3% of donors who have at least one organ recovered. Consent practice varies widely by OPTN region. Opportunities for improving Intestine recovery and utilization include improving consent rates and standardizing donor selection criteria. One-year patient and Intestine graft survival is 89% and 79% for Intestineonly recipients and 72% and 69% for liver-Intestine recipients, respectively. By 10 years, patient and Intestine survival falls to 46% and 29% for Intestine-only recipients, and 42% and 39% for liver-Intestine, respectively. Immunosuppression practice employs peri-operative antibody induction therapy in 60% of cases; acute rejection is reported in 30%–40% of recipients at one year. Data on long-term nutritional outcomes and morbidities are limited, while the cause and therapy for late graft loss from chronic rejection are areas of ongoing investigation.
Douglas G. Farmer - One of the best experts on this subject based on the ideXlab platform.
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Intestine Transplantation in the united states 1999 2008
American Journal of Transplantation, 2010Co-Authors: George V Mazariegos, Simon Horslen, Jonathan P. Fryer, David R. Grant, D E Steffick, Douglas G. Farmer, Alan Norman Langnas, John C MageeAbstract:Note on sources: The articles in this report are based on the reference tables in the 2009 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in the figures and tables included here. All of the tables may be found online at: http://www.ustransplant.org. Improving short-term results with Intestine Transplantation have allowed more patients to benefit with nearly 700 patients alive in the United States with a functioning allograft at the end of 2007. This success has led to an increase in demand. Time to transplant and waiting list mortality have significantly improved over the decade, but mortality remains high, especially for infants and adults with concomitant liver failure. The approximately 200 Intestines recovered annually from deceased donors represent less than 3% of donors who have at least one organ recovered. Consent practice varies widely by OPTN region. Opportunities for improving Intestine recovery and utilization include improving consent rates and standardizing donor selection criteria. One-year patient and Intestine graft survival is 89% and 79% for Intestineonly recipients and 72% and 69% for liver-Intestine recipients, respectively. By 10 years, patient and Intestine survival falls to 46% and 29% for Intestine-only recipients, and 42% and 39% for liver-Intestine, respectively. Immunosuppression practice employs peri-operative antibody induction therapy in 60% of cases; acute rejection is reported in 30%–40% of recipients at one year. Data on long-term nutritional outcomes and morbidities are limited, while the cause and therapy for late graft loss from chronic rejection are areas of ongoing investigation.
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Intestine Transplantation in the United States, 1999–2008
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2010Co-Authors: George V Mazariegos, Simon Horslen, Jonathan P. Fryer, David R. Grant, D E Steffick, Douglas G. Farmer, Alan Norman Langnas, John C MageeAbstract:Note on sources: The articles in this report are based on the reference tables in the 2009 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in the figures and tables included here. All of the tables may be found online at: http://www.ustransplant.org. Improving short-term results with Intestine Transplantation have allowed more patients to benefit with nearly 700 patients alive in the United States with a functioning allograft at the end of 2007. This success has led to an increase in demand. Time to transplant and waiting list mortality have significantly improved over the decade, but mortality remains high, especially for infants and adults with concomitant liver failure. The approximately 200 Intestines recovered annually from deceased donors represent less than 3% of donors who have at least one organ recovered. Consent practice varies widely by OPTN region. Opportunities for improving Intestine recovery and utilization include improving consent rates and standardizing donor selection criteria. One-year patient and Intestine graft survival is 89% and 79% for Intestineonly recipients and 72% and 69% for liver-Intestine recipients, respectively. By 10 years, patient and Intestine survival falls to 46% and 29% for Intestine-only recipients, and 42% and 39% for liver-Intestine, respectively. Immunosuppression practice employs peri-operative antibody induction therapy in 60% of cases; acute rejection is reported in 30%–40% of recipients at one year. Data on long-term nutritional outcomes and morbidities are limited, while the cause and therapy for late graft loss from chronic rejection are areas of ongoing investigation.
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liver and Intestine Transplantation in the united states 1997 2006
American Journal of Transplantation, 2008Co-Authors: Richard B. Freeman, Carl L Berg, D E Steffick, Douglas G. Farmer, M K Guidinger, Robert M. MerionAbstract:Liver Transplantation in 2006 generally resembled previous years, with fewer candidates waiting for deceased donor liver transplants (DDLT), continuing a trend initiated with the implementation of the model for end-stage liver disease (MELD). Candidate age distribution continued to skew toward older ages with fewer children listed in 2006 than in any prior year. Total transplants increased due to more DDLT with slightly fewer living donor liver transplants (LDLT). Waiting list deaths and time to transplant continued to improve. In 2006, there also were fewer DDLT for patients with MELD <15, fewer pediatric Status 1A/B transplants and more transplants from donation after cardiac death (DCD) donors. Adjusted patient and graft survival rates were similar for LDLT and DDLT. This article also contains in-depth analyses of Transplantation for hepatocellular carcinoma (HCC). Recipients with HCC had lower adjusted 3-year posttransplant survival than recipients without HCC. HCC recipients who received pretransplant ablative treatments had superior adjusted 3-year posttransplant survival compared to HCC recipients who did not. Intestinal Transplantation continued to slowly increase with the largest number of candidates on the waiting list since 1997. Survival rates have increased over time. Small children waiting for Intestine grafts continue to have the highest waiting list mortality.
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2003 report of the Intestine transplant registry: a new era has dawned.
Annals of surgery, 2005Co-Authors: David R. Grant, Olivier Goulet, Kareem Abu-elmagd, Andreas G. Tzakis, Alan Norman Langnas, Thomas M Fishbein, Jorge Reyes, Douglas G. FarmerAbstract:The Intestine is more difficult to transplant than other solid organs due to its strong expression of histocompatibility antigens, large numbers of resident leukocytes, and colonization with microorganisms.1 Early efforts to transplant the small bowel failed due to refractory graft rejection and sepsis.2 Outcomes improved during the early 1990s, but survival rates were still inferior to other organ transplants.3,4 Over the past 5 years, individual centers have reported improved outcomes with better long-term intestinal engraftment.5–8 Herein, we analyze registry data to determine the scope and success of Intestine Transplantation in the current era.
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Liver and Intestine Transplantation.
American Journal of Transplantation, 2003Co-Authors: John P. Roberts, Erick B Edwards, Robert S. Brown, Douglas G. Farmer, Richard B. Freeman, Russell H. Wiesner, Robert M. MerionAbstract:The most significant development in liver Transplantation in the USA over the past year was the full implementation of the MELD- and PELD-based allocation policy in March 2002, which shifted emphasis from waiting time within broad medical urgency status to prioritization by risk of waiting list death. The implementation of this system has led to a decrease in pretransplant mortality without increasing post-transplant mortality, despite a higher severity of illness at the time of transplant. The trend over the last few years of rapidly increasing numbers of adult living donor liver transplants was reversed in 2002 by a decline of more than 30% in the number of these procedures. In 2002, a greater percentage of women received livers from living donors (43%) than deceased donors (34%), possibly because of size considerations. From 1993 to 2001, the waiting list increased more than sixfold, from 2902 patients to 18,047 patients. For the first time since 1993, the waiting list size decreased in 2002, dropping 6% to 16,974 candidates. The percentage of temporarily inactive liver candidates also increased from 2001, thus the net decrease in the active waiting list for 2002 was 12%. This may reflect a trend toward less pre-emptive listing practices under MELD. Intestine Transplantation remains a low-volume procedure limited to a few transplant centers and is still accompanied by significant pre- and post-Transplantation risks. As this procedure matures, its application may increase to include recipients at an earlier stage of their disease with better likelihood of success.
John C Magee - One of the best experts on this subject based on the ideXlab platform.
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Intestine Transplantation in the united states 1999 2008
American Journal of Transplantation, 2010Co-Authors: George V Mazariegos, Simon Horslen, Jonathan P. Fryer, David R. Grant, D E Steffick, Douglas G. Farmer, Alan Norman Langnas, John C MageeAbstract:Note on sources: The articles in this report are based on the reference tables in the 2009 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in the figures and tables included here. All of the tables may be found online at: http://www.ustransplant.org. Improving short-term results with Intestine Transplantation have allowed more patients to benefit with nearly 700 patients alive in the United States with a functioning allograft at the end of 2007. This success has led to an increase in demand. Time to transplant and waiting list mortality have significantly improved over the decade, but mortality remains high, especially for infants and adults with concomitant liver failure. The approximately 200 Intestines recovered annually from deceased donors represent less than 3% of donors who have at least one organ recovered. Consent practice varies widely by OPTN region. Opportunities for improving Intestine recovery and utilization include improving consent rates and standardizing donor selection criteria. One-year patient and Intestine graft survival is 89% and 79% for Intestineonly recipients and 72% and 69% for liver-Intestine recipients, respectively. By 10 years, patient and Intestine survival falls to 46% and 29% for Intestine-only recipients, and 42% and 39% for liver-Intestine, respectively. Immunosuppression practice employs peri-operative antibody induction therapy in 60% of cases; acute rejection is reported in 30%–40% of recipients at one year. Data on long-term nutritional outcomes and morbidities are limited, while the cause and therapy for late graft loss from chronic rejection are areas of ongoing investigation.
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Intestine Transplantation in the United States, 1999–2008
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2010Co-Authors: George V Mazariegos, Simon Horslen, Jonathan P. Fryer, David R. Grant, D E Steffick, Douglas G. Farmer, Alan Norman Langnas, John C MageeAbstract:Note on sources: The articles in this report are based on the reference tables in the 2009 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in the figures and tables included here. All of the tables may be found online at: http://www.ustransplant.org. Improving short-term results with Intestine Transplantation have allowed more patients to benefit with nearly 700 patients alive in the United States with a functioning allograft at the end of 2007. This success has led to an increase in demand. Time to transplant and waiting list mortality have significantly improved over the decade, but mortality remains high, especially for infants and adults with concomitant liver failure. The approximately 200 Intestines recovered annually from deceased donors represent less than 3% of donors who have at least one organ recovered. Consent practice varies widely by OPTN region. Opportunities for improving Intestine recovery and utilization include improving consent rates and standardizing donor selection criteria. One-year patient and Intestine graft survival is 89% and 79% for Intestineonly recipients and 72% and 69% for liver-Intestine recipients, respectively. By 10 years, patient and Intestine survival falls to 46% and 29% for Intestine-only recipients, and 42% and 39% for liver-Intestine, respectively. Immunosuppression practice employs peri-operative antibody induction therapy in 60% of cases; acute rejection is reported in 30%–40% of recipients at one year. Data on long-term nutritional outcomes and morbidities are limited, while the cause and therapy for late graft loss from chronic rejection are areas of ongoing investigation.
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liver and Intestine Transplantation in the united states 1998 2007
American Journal of Transplantation, 2009Co-Authors: Carl L Berg, D E Steffick, Erick B Edwards, Julie K Heimbach, John C Magee, William Kenneth Washburn, George V MazariegosAbstract:Liver Transplantation numbers in the United States remained constant from 2004 to 2007, while the number of waiting list candidates has trended down. In 2007, the waiting list was at its smallest since 1999, with adults ≥50 years representing the majority of candidates. Noncholestatic cirrhosis was most commonly diagnosed. Most age groups had decreased waiting list death rates; however, children <1 year had the highest death rate. Use of liver allografts from donation after cardiac death (DCD) donors increased in 2007. Model for end-stage liver disease (MELD)/pediatric model for end-stage liver disease (PELD) scores have changed very little since 2002, with MELD/PELD <15 accounting for 75% of the waiting list. Over the same period, the number of transplants for MELD/PELD <15 decreased from 16.4% to 9.8%. Hepatocellular carcinoma exceptions increased slightly. The Intestine Transplantation waiting list decreased from 2006, with the majority of candidates being children <5 years old. Death rates improved, but remain unacceptably high. Policy changes have been implemented to improve allocation and recovery of Intestine grafts to positively impact mortality. In addition to evaluating trends in liver and Intestine Transplantation, we review in depth, issues related to organ acceptance rates, DCD, living donor Transplantation and MELD/PELD exceptions.
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Liver and Intestine Transplantation in the United States 1998-2007.
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2009Co-Authors: Carl L Berg, D E Steffick, Erick B Edwards, Julie K Heimbach, John C Magee, William Kenneth Washburn, George V MazariegosAbstract:Liver Transplantation numbers in the United States remained constant from 2004 to 2007, while the number of waiting list candidates has trended down. In 2007, the waiting list was at its smallest since 1999, with adults > or =50 years representing the majority of candidates. Noncholestatic cirrhosis was most commonly diagnosed. Most age groups had decreased waiting list death rates; however, children
Alan Norman Langnas - One of the best experts on this subject based on the ideXlab platform.
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Stool Calprotectin Monitoring After Small Intestine Transplantation
Transplantation, 2011Co-Authors: David F. Mercer, Luciano M. Vargas, Yimin Sun, Ane Miren Andrés Moreno, Wendy J. Grant, Jean F. Botha, Alan Norman Langnas, Debra L. SudanAbstract:Background. Small Intestine Transplantation is the only life-saving therapy available for patients with intestinal failure and life-threatening complications of parenteral nutrition, but it is still plagued by high levels of early acute rejection. The ability to diagnose rejection noninvasively, ideally before pathologic manifestations, would be a major advance in the care of intestinal transplant patients. Methods. We measured calprotectin levels in 732 stool samples collected, analyzed over from 72 patients having undergone 74 total transplants, and correlated them with clinical indications, ostomy output, and pathologic findings. Results. We found that overall patients with rejection have higher mean levels of stool calprotectin than those without, but because of significant interpatient variability, defining an effective general "cutoff" for the test is difficult. Each patient, in effect, has to act as their own control. Patients experiencing rejection episodes have greater fluctuations in calprotectin levels than those without, suggesting increased "reactivity" within the graft. Our most frequent clinical indicator for biopsy, an increase in ostomy output, had no real relationship to the discovery of rejection. Conclusion. Although more frequent prospective sampling could perhaps demonstrate an advantage in early indication of rejection, based on these data, routine stool calprotectin monitoring is not strongly supported.
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Intestine Transplantation in the united states 1999 2008
American Journal of Transplantation, 2010Co-Authors: George V Mazariegos, Simon Horslen, Jonathan P. Fryer, David R. Grant, D E Steffick, Douglas G. Farmer, Alan Norman Langnas, John C MageeAbstract:Note on sources: The articles in this report are based on the reference tables in the 2009 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in the figures and tables included here. All of the tables may be found online at: http://www.ustransplant.org. Improving short-term results with Intestine Transplantation have allowed more patients to benefit with nearly 700 patients alive in the United States with a functioning allograft at the end of 2007. This success has led to an increase in demand. Time to transplant and waiting list mortality have significantly improved over the decade, but mortality remains high, especially for infants and adults with concomitant liver failure. The approximately 200 Intestines recovered annually from deceased donors represent less than 3% of donors who have at least one organ recovered. Consent practice varies widely by OPTN region. Opportunities for improving Intestine recovery and utilization include improving consent rates and standardizing donor selection criteria. One-year patient and Intestine graft survival is 89% and 79% for Intestineonly recipients and 72% and 69% for liver-Intestine recipients, respectively. By 10 years, patient and Intestine survival falls to 46% and 29% for Intestine-only recipients, and 42% and 39% for liver-Intestine, respectively. Immunosuppression practice employs peri-operative antibody induction therapy in 60% of cases; acute rejection is reported in 30%–40% of recipients at one year. Data on long-term nutritional outcomes and morbidities are limited, while the cause and therapy for late graft loss from chronic rejection are areas of ongoing investigation.
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Intestine Transplantation in the United States, 1999–2008
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2010Co-Authors: George V Mazariegos, Simon Horslen, Jonathan P. Fryer, David R. Grant, D E Steffick, Douglas G. Farmer, Alan Norman Langnas, John C MageeAbstract:Note on sources: The articles in this report are based on the reference tables in the 2009 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in the figures and tables included here. All of the tables may be found online at: http://www.ustransplant.org. Improving short-term results with Intestine Transplantation have allowed more patients to benefit with nearly 700 patients alive in the United States with a functioning allograft at the end of 2007. This success has led to an increase in demand. Time to transplant and waiting list mortality have significantly improved over the decade, but mortality remains high, especially for infants and adults with concomitant liver failure. The approximately 200 Intestines recovered annually from deceased donors represent less than 3% of donors who have at least one organ recovered. Consent practice varies widely by OPTN region. Opportunities for improving Intestine recovery and utilization include improving consent rates and standardizing donor selection criteria. One-year patient and Intestine graft survival is 89% and 79% for Intestineonly recipients and 72% and 69% for liver-Intestine recipients, respectively. By 10 years, patient and Intestine survival falls to 46% and 29% for Intestine-only recipients, and 42% and 39% for liver-Intestine, respectively. Immunosuppression practice employs peri-operative antibody induction therapy in 60% of cases; acute rejection is reported in 30%–40% of recipients at one year. Data on long-term nutritional outcomes and morbidities are limited, while the cause and therapy for late graft loss from chronic rejection are areas of ongoing investigation.
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2003 report of the Intestine transplant registry: a new era has dawned.
Annals of surgery, 2005Co-Authors: David R. Grant, Olivier Goulet, Kareem Abu-elmagd, Andreas G. Tzakis, Alan Norman Langnas, Thomas M Fishbein, Jorge Reyes, Douglas G. FarmerAbstract:The Intestine is more difficult to transplant than other solid organs due to its strong expression of histocompatibility antigens, large numbers of resident leukocytes, and colonization with microorganisms.1 Early efforts to transplant the small bowel failed due to refractory graft rejection and sepsis.2 Outcomes improved during the early 1990s, but survival rates were still inferior to other organ transplants.3,4 Over the past 5 years, individual centers have reported improved outcomes with better long-term intestinal engraftment.5–8 Herein, we analyze registry data to determine the scope and success of Intestine Transplantation in the current era.
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Advances in small-Intestine Transplantation.
Transplantation, 2004Co-Authors: Alan Norman LangnasAbstract:Intestinal Transplantation has become the treatment of choice for patients who are experiencing life-threatening complications of intestinal failure. Early attempts with intestinal Transplantation were unsuccessful as a consequence of both technical and immunologic failures. The introduction of tacrolimus provided the immunologic foundation needed for the field to advance. Guidelines for patient selection combined with standardization of operative procedures and postoperative management has allowed for improved patient and graft survival. There has been a gradual improvement in patient survival over the past 10 years, most notably in the past 3 years. Nutritional autonomy has been achieved in hundreds of patients worldwide. Further advancements in the understanding of the immune response to the transplanted Intestine are still needed and will allow the use of new antirejection medications, resulting in improved outcomes.
D E Steffick - One of the best experts on this subject based on the ideXlab platform.
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Intestine Transplantation in the united states 1999 2008
American Journal of Transplantation, 2010Co-Authors: George V Mazariegos, Simon Horslen, Jonathan P. Fryer, David R. Grant, D E Steffick, Douglas G. Farmer, Alan Norman Langnas, John C MageeAbstract:Note on sources: The articles in this report are based on the reference tables in the 2009 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in the figures and tables included here. All of the tables may be found online at: http://www.ustransplant.org. Improving short-term results with Intestine Transplantation have allowed more patients to benefit with nearly 700 patients alive in the United States with a functioning allograft at the end of 2007. This success has led to an increase in demand. Time to transplant and waiting list mortality have significantly improved over the decade, but mortality remains high, especially for infants and adults with concomitant liver failure. The approximately 200 Intestines recovered annually from deceased donors represent less than 3% of donors who have at least one organ recovered. Consent practice varies widely by OPTN region. Opportunities for improving Intestine recovery and utilization include improving consent rates and standardizing donor selection criteria. One-year patient and Intestine graft survival is 89% and 79% for Intestineonly recipients and 72% and 69% for liver-Intestine recipients, respectively. By 10 years, patient and Intestine survival falls to 46% and 29% for Intestine-only recipients, and 42% and 39% for liver-Intestine, respectively. Immunosuppression practice employs peri-operative antibody induction therapy in 60% of cases; acute rejection is reported in 30%–40% of recipients at one year. Data on long-term nutritional outcomes and morbidities are limited, while the cause and therapy for late graft loss from chronic rejection are areas of ongoing investigation.
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Intestine Transplantation in the United States, 1999–2008
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2010Co-Authors: George V Mazariegos, Simon Horslen, Jonathan P. Fryer, David R. Grant, D E Steffick, Douglas G. Farmer, Alan Norman Langnas, John C MageeAbstract:Note on sources: The articles in this report are based on the reference tables in the 2009 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in the figures and tables included here. All of the tables may be found online at: http://www.ustransplant.org. Improving short-term results with Intestine Transplantation have allowed more patients to benefit with nearly 700 patients alive in the United States with a functioning allograft at the end of 2007. This success has led to an increase in demand. Time to transplant and waiting list mortality have significantly improved over the decade, but mortality remains high, especially for infants and adults with concomitant liver failure. The approximately 200 Intestines recovered annually from deceased donors represent less than 3% of donors who have at least one organ recovered. Consent practice varies widely by OPTN region. Opportunities for improving Intestine recovery and utilization include improving consent rates and standardizing donor selection criteria. One-year patient and Intestine graft survival is 89% and 79% for Intestineonly recipients and 72% and 69% for liver-Intestine recipients, respectively. By 10 years, patient and Intestine survival falls to 46% and 29% for Intestine-only recipients, and 42% and 39% for liver-Intestine, respectively. Immunosuppression practice employs peri-operative antibody induction therapy in 60% of cases; acute rejection is reported in 30%–40% of recipients at one year. Data on long-term nutritional outcomes and morbidities are limited, while the cause and therapy for late graft loss from chronic rejection are areas of ongoing investigation.
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liver and Intestine Transplantation in the united states 1998 2007
American Journal of Transplantation, 2009Co-Authors: Carl L Berg, D E Steffick, Erick B Edwards, Julie K Heimbach, John C Magee, William Kenneth Washburn, George V MazariegosAbstract:Liver Transplantation numbers in the United States remained constant from 2004 to 2007, while the number of waiting list candidates has trended down. In 2007, the waiting list was at its smallest since 1999, with adults ≥50 years representing the majority of candidates. Noncholestatic cirrhosis was most commonly diagnosed. Most age groups had decreased waiting list death rates; however, children <1 year had the highest death rate. Use of liver allografts from donation after cardiac death (DCD) donors increased in 2007. Model for end-stage liver disease (MELD)/pediatric model for end-stage liver disease (PELD) scores have changed very little since 2002, with MELD/PELD <15 accounting for 75% of the waiting list. Over the same period, the number of transplants for MELD/PELD <15 decreased from 16.4% to 9.8%. Hepatocellular carcinoma exceptions increased slightly. The Intestine Transplantation waiting list decreased from 2006, with the majority of candidates being children <5 years old. Death rates improved, but remain unacceptably high. Policy changes have been implemented to improve allocation and recovery of Intestine grafts to positively impact mortality. In addition to evaluating trends in liver and Intestine Transplantation, we review in depth, issues related to organ acceptance rates, DCD, living donor Transplantation and MELD/PELD exceptions.
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Liver and Intestine Transplantation in the United States 1998-2007.
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2009Co-Authors: Carl L Berg, D E Steffick, Erick B Edwards, Julie K Heimbach, John C Magee, William Kenneth Washburn, George V MazariegosAbstract:Liver Transplantation numbers in the United States remained constant from 2004 to 2007, while the number of waiting list candidates has trended down. In 2007, the waiting list was at its smallest since 1999, with adults > or =50 years representing the majority of candidates. Noncholestatic cirrhosis was most commonly diagnosed. Most age groups had decreased waiting list death rates; however, children
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liver and Intestine Transplantation in the united states 1997 2006
American Journal of Transplantation, 2008Co-Authors: Richard B. Freeman, Carl L Berg, D E Steffick, Douglas G. Farmer, M K Guidinger, Robert M. MerionAbstract:Liver Transplantation in 2006 generally resembled previous years, with fewer candidates waiting for deceased donor liver transplants (DDLT), continuing a trend initiated with the implementation of the model for end-stage liver disease (MELD). Candidate age distribution continued to skew toward older ages with fewer children listed in 2006 than in any prior year. Total transplants increased due to more DDLT with slightly fewer living donor liver transplants (LDLT). Waiting list deaths and time to transplant continued to improve. In 2006, there also were fewer DDLT for patients with MELD <15, fewer pediatric Status 1A/B transplants and more transplants from donation after cardiac death (DCD) donors. Adjusted patient and graft survival rates were similar for LDLT and DDLT. This article also contains in-depth analyses of Transplantation for hepatocellular carcinoma (HCC). Recipients with HCC had lower adjusted 3-year posttransplant survival than recipients without HCC. HCC recipients who received pretransplant ablative treatments had superior adjusted 3-year posttransplant survival compared to HCC recipients who did not. Intestinal Transplantation continued to slowly increase with the largest number of candidates on the waiting list since 1997. Survival rates have increased over time. Small children waiting for Intestine grafts continue to have the highest waiting list mortality.
