https://www.organscigroup.us/journals/archives-of-organ-transplantation A Peertechz Open Access Journal en-us 24 Jun, 2024 https://www.organscigroup.us/articles/AOT-9-123.php Background: The adjustment of immunosuppressive therapy after kidney transplantation (KT) to avoid graft rejection remains an important challenge for clinicians. It is difficult to achieve a good balance between under-immunosuppression (with an increased risk of graft rejection) and over-immunosuppression (with an increased risk of side effects) by only relying on the available information about immunosuppressive drugs (IMS). Immunobiogram® (IMBG) is a novel in vitro diagnostic test that provides clinicians with information about the patient’s sensitivity to individual IMS. Objective: To present a case report of a patient with renal transplant in the maintenance phase who presented several complications probably related to the immunosuppression during the follow-up, where the use of IMBG as complementary information helped clinicians to guide the therapeutical decision. Methods: IMBG is a first-in-class in vitro immunoassay that involves the culture of the patient peripheral blood mononuclear cells (PBMCs) in a semi-solid 3D matrix, then submitted to immune stimulation. It reveals the capacity of an IMS over a gradient to inhibit the activation of immune cells. The read-out allows the building of a dose-response curve per IMS tested, which is mathematically analyzed by a software using the key curve parameters and finally to be translated into a sensitivity map to IMS. Findings: We present a case report of a 72-year-old patient with a cadaveric donor kidney transplant receiving standard immunosuppressive treatment with mycophenolate, tacrolimus, and corticosteroids. The patient presented several episodes of infections during the follow-up (SARS-CoV2, Cytomegalovirus, spondylodisquitis by Staphylococcus aureus, and emphysematous cystitis) which were managed with different treatment adjustments such as de-escalation of mycophenolate and switching to mTOR. The information provided by the IMBG showed a lack of sensitivity to mTOR which allowed to confirm the final adjustment to a treatment with tacrolimus and corticosteroids, remaining the patient stable since then. Discussion: Despite various adjustments to the immunosuppressive therapy during the follow-up, the patient continued experiencing adverse effects that could be related to an over-immunosuppression state. The IMBG provided pharmacodynamic information that complemented the clinical and pharmacokinetic data available, facilitating the individualization of the treatment. Conclusion: The case highlights the potential of the IMBG as a complementary clinical tool for personalized treatment of kidney transplant patient management. 05 Jun, 2024 https://www.organscigroup.us/articles/AOT-9-122.php Calcium oxalate deposition in the kidney allograft remains an underappreciated cause of acute graft dysfunction. Diagnoses such as acute rejection, infection, hydronephrosis, and fluid collections are more immediately considered in the early post-transplant period. Risk factors include hyperoxaluria due to chronic fat malabsorption (post gastric bypass, inflammatory bowel disease), a diet rich in salt or animal protein, vitamin C ingestion, volume depletion, diabetes, and delayed graft function. We present the case of a patient who developed acute kidney injury secondary to oxalate nephropathy at 3 months post-transplant. Renal function improved with medical management, including volume repletion, calcium carbonate, and potassium citrate, without the need for hemodialysis. As more dialysis patients with morbid obesity requiring bariatric surgery, diabetes, and metabolic syndrome are being considered for renal transplantation, this entity merits more careful attention both prior to and after transplantation. 30 Dec, 2023 https://www.organscigroup.us/articles/AOT-8-121.php We evaluate the productivity of the Brazilian states and the Federal District in transforming potential organ donors into actual donations in the years immediately before and after the COVID-19 pandemic (2019-2022). The Brazilian National Health System (SUS) which is one of the largest public transplant systems in the world, provides full coverage of all costs involved in organ donation, transplants, and post-transplant. We applied Ordinary Least Squares Regression in data from 2019-2022 and the results indicate that there is significant room for improvement in terms of converting potential donors into actual donors. The number of donors with organs transplanted decreased during the pandemic as the productivity of the transplant was affected, although it seems that the structure of the Brazilian transplant system and its technology were not significantly affected permanently. 08 Sep, 2022 https://www.organscigroup.us/articles/AOT-7-120.php The use of immune checkpoint inhibitors in transplant recipients with malignancy is associated with the risk of graft failure due to acute rejection. There is limited literature regarding the use of Cemiplimab-rwlc (Libtayo) in kidney transplant patients. Here we present a case of using Cemiplimab-rwlc (Libtayo), a Programmed Death receptor-1 (PD-1) blocking antibody for locally advanced and metastatic Cutaneous Squamous Cell Carcinoma (CSCC), in a kidney transplant recipient. 25 May, 2022 https://www.organscigroup.us/articles/AOT-7-119.php Background: The extent that which immunosuppressive factors contribute to the antibody response to SARS-Cov-2 vaccination in solid organ transplant patients is being better understood. This study examined antibody formation against the spike SARS-CoV-2 protein (SA) when full vaccinations were up to 2 doses and boosters were not recommended. Immunosuppressive factors that affected the vaccine responsiveness in a cohort of 100 kidney and 50 heart transplant patients were evaluated. This study utilized a novel assay to detect antibodies against 4 different domains of the spike protein and the nucleocapsid protein (NC) of the SARS-CoV-2 virus on a multiplex, bead-based platform. Positive SARS-COV-2 antibodies (SA) response required identification of the receptor-binding domain and one of the three other spike protein domains. Prior SARS-CoV-2 infection could be determined by the presence of positive NC. Results: 150 patients were enrolled in the study (100 kidneys; 50 heart recipients). This study was performed when the Center for Disease Control and Prevention (CDC) recommended only two doses of Pfizer/BioNTech [BNT162b2] and Moderna [mRNA-1273 SARS-CoV-2] vaccine or 1 dose of Johnson & Johnson/Janssen [Ad26.COV2.S] vaccines for full SARS-CoV-2 vaccination in transplant recipients. Patients that reported a positive COVID-19 swab or had positive NC were excluded from the review because the prior infection may impact vaccine response (n = 134). Conclusions: SA were identified in 48/134 patients (36%); 25/46 heart (54%) and 23/88 kidney transplant patients (26%) (P = 0.0012). For the patients on prednisone therapy 25/93 responded with SA (27%) while for patients not on prednisone therapy, 23/41 responded with SA (56%) (P = 0.0012). The dose of steroids (5mg a day or greater) at the time of vaccination did not adversely affect vaccine efficacy (p = 0.054). Of the patients using antimetabolite therapy, 36/113 responded with SA (32%) while 12/21 patients not on antimetabolites responded with SA (57%) (P = .027). Time since transplant was not found to affect the rate of SA production when populations were separated by type of organ transplanted. T-cell depletion induction method, calcineurin inhibitor use, and type of SARS-CoV-2 vaccine were not found to be statistically significant. 24 Aug, 2021 https://www.organscigroup.us/articles/AOT-6-118.php Background: While early relaparotomy following living donor liver transplantation (LDLT) is an important event and its outcomes are still unclear, the aim of this retrospective study is to investigate the causes and outcomes of early relaparotomy in recipients of adult living donor liver transplantations. Materials and methods: Between April 2015 and April 2020 at Medipol University Medical Faculty Hospital Organ Transplantation Department, Istanbul, Turkey, 15 patients (9.3%) who underwent early relaparotomy were studied retrospectively. Results: Eight patients (53.3%) had a history of upper abdominal surgery in the early laparotomy group. The most common cause of early relaparotomy had postoperative bleeding in 9 patients (60%). The overall survival rate was 66.7%. Mortality was higher in the group over 60 years old and with a history of upper abdominal surgery. Conclusions: The history of upper abdominal surgery appears to be a risk factor for early relaparotomy. Also, previous upper abdominal surgery group and elderly patients group present with more mortality. We should be very careful in these groups. 26 Feb, 2021 https://www.organscigroup.us/articles/AOT-6-117.php We studied rates of cadaveric organ donation on transition from apnoeic-oxygenation to radioisotope brain perfusion scanning to diagnose brain death. We studied records of children who were organ donors and/or had Technetium Tc99m Exametazine brain scans over 1989-2018. Donation after Brain Death (DBD) commenced in 1989, Donation after Circulatory Death (DCD) in 2011. Brain scanning was adopted in 2002 and apnoeic-oxygenation abandoned in 2007. In total, 95 of 1930 children (4.9%) donated organs (81 DBD, 14 DCD). During 1989-2001, with brain death diagnosed by clinical tests including apnoeic-oxygenation, 40 of 1059 children (3.8%) donated organs at average 3.1/annum. During 2002-2007 when either apnoeic-oxygenation or scanning was used, 18 of 351 children (5.1%) donated organs at average 3.0/year. During 2008-2018 with scanning in lieu of apnoeic-oxygenation, 23 of 520 children (4.4%) donated organs at average 2.1/annum. The difference in DBD rate between eras was not significant (P=0.52). Of 77 children scanned, 65(84%) were diagnosed brain dead after 1 or 2 scans, and 29 (45%) of these donated organs. Of 12 children with limited brain perfusion (not brain dead), DCD proceeded in 8 (67%). DCD or DBD (death diagnosed by scanning) was performed during 2011-2018 in 35 of 370 children (9.5%) which is significantly more (P<0.0001) than DBD (death diagnosed by apnoeic-oxygenation) in 1989-2001. Transition from apnoeic-oxygenation to scanning to diagnose brain death did not change DBD and may facilitate DCD. Brain death can be diagnosed by radionuclide scanning in lieu of apnoeic-oxygenation. 26 Nov, 2020 https://www.organscigroup.us/articles/AOT-5-116.php Apart from basic language, different aspects of an individual’s culture can play its role in literacy and influence the ability of health workers to comprehend and follow instructions. The most critical goals for patients after organ transplantation are to optimize health and wellness. Low health literacy has significant health and well-being implications and increased risk to patients for negative health outcomes. The definition of death and especially brain death is a major issue in organ transplantation. The internal tendency of a particular society to donate organs is another major factor. The organ theft, organ transfers, the fragile balancing of live contributions between the recipient’s benefit and potential loss to the donor and others are among the crucial ethical concerns that require active intervention. In the following study, we address the several cultural challenges facing donation of organ around the world , and is literacy the reason of less organ transplants, particularly in India.  11 Sep, 2020 https://www.organscigroup.us/articles/AOT-5-115.php The apneic-oxygenation test is an integral part of clinical testing to determine brain death. The medical and legal criticisms of the test are presented together which make a strong argument that it should be abandoned. The requirement for hypercarbia to stimulate spontaneous respiration also causes intra-cranial hypertension and may exacerbate an existing brain injury and as such is a self-fulfilling test. Moreover in children, the onset of spontaneous respiration may commence at levels of blood carbon dioxide in excess of the minimum level used to define brain death. It is thus also unreliable. A number of legal cases in the United States have been adjudicated in favor of plaintiffs seeking to prevent performance of the test on the basis that it causes harm. Physicians have sought to perform the apneic-oxygenation test without consent of legal guardians but have failed. In lieu of the apneic-oxygenation test a brain scan using a lipophilic radionuclide is suggested. Demonstration of absent brain blood flow may be a more stringent test to determine brain death than apneic-oxygenation but is more reliable, less invasive, not harmful and not likely to reduce the rate of organ donation. 31 Jan, 2020 https://www.organscigroup.us/articles/AOT-5-114.php Background: Size matching between donor lungs and recipient chest space is an important technical problem that affects the outcome and survival following lung transplantation. The size of the lung can vary according to underlying disease, previous resections, and ethnicity, as well as height, age, and sex. Measurements of predicted total lung capacity according to height, age, and sex are frequently used, although other measurement methods are available. 04 Sep, 2019 https://www.organscigroup.us/articles/AOT-4-113.php Background: BK virus is the most common infectious causes of nephropathy and graft loss after kidney transplantation. In our study, we investigated the factors that may affect positive BK virus in the blood in patients with kidney transplantation. 11 Jul, 2019 https://www.organscigroup.us/articles/AOT-4-112.php The implications of ambimorphic archetypes in organ transplantation have been far-reaching and pervasive. After years of natural research into consistent hashing, we argue the simulation of public-private key pairs, which embodies the confi rmed principles of theory. Such a hypothesis might seem perverse but is derived from known results. Our focus in this paper is not on whether the well-known knowledge-based fact that humans breathe through their mouth or nose and the brain controls that critical function, so breathing would stop. The hardy vermin breathe through spiracles, or little holes in each body segment. Plus, the roach brain does not control this breathing and blood does not carry oxygen throughout the body. Overall, a new approach in succesful brain transplant have been developed. 22 Mar, 2019 https://www.organscigroup.us/articles/AOT-4-111.php Liver graft function depends on different biological factors that are related to the donor, the recipient and the potential damage arising from the organ preservation technique. However, adequate hepatic artery flow and portal vein flow rates ensure a sufficient flow of oxygen and nutrients in order to ensure a suitable cellular graft function after the extreme metabolic decrease condition induced by hypothermia and the preservation solution. Liver inflow is a highly complex system due to its double irrigation system. These two systems are connected by the well-known “hepatic arterial buffer response” concept. This mechanism explains changes in hepatic arterial flow (HAF) as a compensation for changes in the portal vein flow (PVF), so that the hepatic artery adjusts total flow in relation to alterations in the portal blood flow. At the moment, the minimum HAF and PVF required for an adequate regeneration and functional recovery of the liver graft have not been yet established. 20 Dec, 2018 https://www.organscigroup.us/articles/AOT-3-110.php Surgical complications are not uncommon after renal transplantation. They should always be in the differential diagnosis of renal graft dysfunction. While ruling out or confirming a surgical cause of graft dysfunction, a sequential approach should be undertaken starting from clinical examination and moving on to more invasive investigations as the clinical picture becomes clearer. Biochemical assay of drain fluid is important. Causes of a collection around/near the graft include abscess, hematoma, urinoma and lymphocele. Treatment of each of them is different. 15 Nov, 2017 https://www.organscigroup.us/articles/AOT-2-109.php As a key step in setting up the immunosuppression protocols for our kidney transplantation unit, still in its infancy, consideration of the choice of the steroid withdrawal strategy is important. We conducted a review of literature to ascertain a safe steroid withdrawal protocol that would be able to achieve a high allograft survival and function rate, low acute allograft rejection (AR) rate and advantageous in reducing a wide range of adverse effects associated with corticosteroids such as cardiovascular risks, growth retardation in pediatric patients, osteoporosis and other steroid-related complications. 27 Sep, 2017 https://www.organscigroup.us/articles/AOT-2-108.php A 30 years old gentleman with end-stage renal disease, secondary to lupus nephritis had been on haemodialysis for the last 5 years. There has been no history of blood transfusions or transplantation. Apart from renal failure, he had no major comorbidities and had a normal cardiac workup. He has been offered an organ from a deceased donor pool with a mismatch of 1-0-0. T and B cell cytotoxicity crossmatch was positive and flow cytometry was negative. The Luminex screen did not reveal any donor-specific antibodies. 28 Aug, 2017 https://www.organscigroup.us/articles/AOT-2-107.php Serotonin (5-hydroxytryptamine, 5-HT) is a regulatory and biologically active neurotransmitter and a hormone in the CNS and many organs, including the esophagus. It is known that serotonin as well as acetylcholine stimulates contractile activity of the esophageal muscles. However, role of different serotonin receptors in the 5-HT contractile activity of the esophagus is insufficiently known. 30 Jun, 2017 https://www.organscigroup.us/articles/AOT-2-106.php We report a case of rapid recurrence of immunotactoid glomerulopathy (ITG) with monoclonal IgG3κ deposits in a transplanted renal graft. A 55-year-old hemodialysis male patient due to ITG underwent an ABO-incompatible living-donor kidney transplantation. 10 Jun, 2017 https://www.organscigroup.us/articles/AOT-2-105.php Introduction: The term Split/Liver Transplantation involved the ex vivo division of an adult cadaver liver into a pediatric allograft and a remnant adult allograft. 31 Mar, 2017 https://www.organscigroup.us/articles/AOT-2-104.php Background: Hepatitis C (HCV) Infection is not uncommon in patients on maintenance hemodialysis (around 10% in our dialysis population). It is also known to increase morbidity and mortality in Renal Allograft Recipients more so in post-transplant period with various studies quoting mixed results. 22 Mar, 2017 https://www.organscigroup.us/articles/AOT-2-103.php Polyomavirus nephropathy (PVAN) has a negative impact on renal allograft survival. Therapy options include reduction of immunosuppression and antiviral drugs. 30 Nov, 2016 https://www.organscigroup.us/articles/AOT-1-102.php Luminex antibody detection, especially Luminex crossmatch is used frequently in India for pre transplant work up for patients with end stage renal disease. This test is often performed in lieu of single antigen bead assay in India due to its lower cost. We report on our experience with College of American Pathologist external proficiency test samples (CAP EQAS) for Luminex based antibody detection assays. 26 May, 2016 https://www.organscigroup.us/articles/AOT-1-101.php Recently, the incidence of brucellosis in immunocompromised patients has increased due to the parallel increase in the number of individuals with low immunity such as cancer patients and recipients of stem cell and solid organ transplantation. Additionally, the immunity of pregnant females is reduced and this makes them more susceptible to infections by various microorganisms including Brucella species.