Transplant Network Undercaptures Post-Transplant Skin Cancers

MedicalResearch.com Interview with:

Thuzar M.Shin MD, PhD Assistant Professor of Dermatology Hospital of the University of Pennsylvania

Dr. Shin

Thuzar M.Shin MD, PhD
Assistant Professor of Dermatology
Hospital of the University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Organ Procurement Transplant Network (OPTN) collects data on cancers that develop after organ transplantation. Previous studies have shown incomplete reporting to the OPTN for many cancers (including melanoma). Skin cancer is the most common malignancy in solid organ transplant recipients and the most common post-transplant skin cancer, cutaneous squamous cell carcinoma (cSCC), is not captured in standard cancer registries. We hypothesized that cSCC and melanoma are underreported to the OPTN. When compared to detailed medical record review obtained from the Transplant Skin Cancer Network database (JAMA Dermatol. 2017 Mar 1;153(3):296-303), we found that the sensitivity of reporting to the OPTN was only 41% for cSCC and 22% for melanoma. The specificity (99% for cSCC and 100% for melanoma) and negative predictive values (93% for cSCC and 99% for melanoma) were high. As a result, the OPTN database is unable to robustly and reliably distinguish between organ transplant recipients with and without these two skin malignancies.

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Microtransplantation Can Be Safe and Effective For Older AML Patients

MedicalResearch.com Interview with:
Huisheng Ai, MD, Director

Department of Hematology and Transplantation,
Affiliated Hospital of the Academy  of Military Medical Sciences,
Beijing, China 

MedicalResearch.com: Which of these results did you find most interesting or surprising?

Response: First, we must stress that microtransplant dramatically improved the outcome of older patients with AML.

As we know, older AML patients often possess unfavorable prognostic factors, organ dysfunction, and slow post-chemotherapy hematopoietic recovery. Therefore, the general treatment outcome is unsatisfactory even though the incidence is increasing by age with low complete remission (CR) rates (34% to 65%) and poor short-term survival (Two years overall survival was about 11% to 25%).

This study involved cases from multiple centers of China, USA and Spain, and found that microtransplant could not only significantly improve complete remission rate in older AML patients among all age groups from 60 to 85, but also improve 1-year and 2-year overall survival and disease free survival especially in patients aged 60 to 75. Second, microtransplant completely overcomes the restriction of HLA typing. The donor could be the patient’s haploidentical family member, or unrelated and fully mismatched one. The incidence of graft-versus-host disease (GVHD) was only 1.1%, even if no any GVHD prevention was given. Other treatment related complications and mortality were also decreased.

These results are much better than those of traditional chemotherapy, myeloablative and non-myeloablative transplant, which provides a more safe and effective treatment choice. We are looking forward to seeing the revision of NCCN guideline for older AML to make microtransplant benefit more older patients.

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IgG Endopeptidase Has Potential To Reduce Kidney Transplant Rejection

MedicalResearch.com Interview with:

Stanley C. Jordan, M.D Director, Division of Nephrology Medical Director, Kidney Transplant Program Medical Director, Human Leukocyte Antigen and Transplant Immunology Laboratory Cedars-Sinai, Los Angeles, CA

Dr. Jordan

Stanley C. Jordan, M.D
DirectorDivision of Nephrology
Medical DirectorKidney Transplant Program
Medical Director, Human Leukocyte Antigen and Transplant Immunology Laboratory
Cedars-Sinai, Los Angeles, CA 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for this study is as follows: Patients who are highly HLA sensitized have antibodies to transplant targets create an immunologic barrier to transplant. Currently, there are no approved therapies for elimination of these antibodies. Desensitization is available but is not always successful and most desensitized patients are still transplanted with a positive crossmatch. Thus, many patients are not able to receive life-saving kidney transplants unless newer therapies to remove antibodies are found.

The findings of our study published in the New England Journal of Medicine revealed that the use of the enzyme from streptococcal pyogenes called IdeS® (IgG endopeptidase) is very effective in eliminating donor specific antibodies and allowing transplantation to occur. Antibodies were eliminated from one week up to two months after one treatment with Ides® allowing a safe environment for the transplant to occur. Rejections episodes did occur in some of the patients but were generally mild and easily treatable. Only one patient of 25 lost his allograft during the study. Thus, the study shows promising results for a new approach for elimination of pathogenic antibodies that did not exist before.

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High Hepatitis C Cure Rate Using Elbasvir plus Grazoprevir In Chronic Kidney Disease

MedicalResearch.com Interview with:

Annette Bruchfeld MD, PhD Senior Consultant Associate Professor Karolinska Institute Dept of Renal Medicine, M99 Karolinska University Hospital Huddinge Stockholm, Sweden

Dr. Bruchfeld

Annette Bruchfeld MD, PhD Senior Consultant
Associate Professor
Karolinska Institute
Dept of Renal Medicine, M99
Karolinska University Hospital Huddinge
Stockholm, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In patients with stage 4–5 chronic kidney disease(CKD), hepatitis C virus (HCV) infection can accelerate the decline in kidney function, impair health-related quality of life (HRQOL), and decrease survival chances of both patients and grafts in transplantation recipients.

In this study additional data from patients with stage 4–5 chronic kidney disease undergoing treatment for HCV infection in the C-SURFER study, including HRQOL and resistance analyses was presented not previously reported for this patient population with gwnotype 1 infection.

The final virological analysis of this study indicated a high cure rate with sustained virological response at 12 weeks after the end of treatment (SVR12) in more than 98% of all treated patients. Even in patients with resistance-associated substitutions (RASs) the SVR was high in 11 (84·6%) of 13 patients genotype 1a infection.

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Food Costs Can Lead To Less Protein and Phosphorous in Indigent Kidney Transplant Patients

MedicalResearch.com Interview with:

Ms. Shifra Mincer Medical Student in the class of 2019 SUNY Downstate Medical School

Shifra Mincer

Ms. Shifra Mincer
Medical Student in the class of 2019
SUNY Downstate Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hypophosphatemia is commonly encountered in the post-transplant setting. Early post-transplant hypophosphatemia has been ascribed to excess FGF23 and hyperphosphaturia.

Many patients remain hypohosphatemic months or even years after their transplant and the mechanism was assumed to be the same, however, our group recently reported that patients with late post-transplant hypophosphatemia had very little phosphorous in their urine (Wu S, Brar A, Markell, MS. Am J Kidney Dis. 2016,67(5): A18). We hypothesized that they were not eating enough phosphorous to compensate for the acute phosphorous losses they experienced immediately post-transplant.

In this study, using both 3-day diet journals and 24-hour diet recall questionnaires, we found that mean intake of phosphorous and protein was barely at the Recommended Daily Allowance, and that despite 70% of the patients using EBT, 30% of those patients still reported concerns regarding food security. Patients who reported that the cost of food influenced their dietary choices ate 43% less protein (average 48,5 gms vs. 85.8 gms) and 29% less phosphorous (average 887 mg vs 1257 mg). When ability to rise from a chair over a 30 second period was evaluated, only patients who expressed food cost concerns were unable to complete the test.

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Comparison of Posttransplant Dermatologic Diseases by Race

MedicalResearch.com Interview with:
Christina Lee Chung, MD, FAAD
Associate Professor of Dermatology
Director, Center for Transplant Patients
Drexel University College of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It’s long been recognized immunosuppressed organ transplant recipients are at significantly increased risk for skin cancer and other types of skin disease.

But despite advances to improve skin cancer prevention for these patients, little is known about how skin conditions affect African-American, Asian and Hispanic transplant recipients. This is problematic given that, according to the U.S. Department of Health and Human Services, more than half of the 120,000 Americans on the waiting list for organs identify as nonwhite.

We compared medical records of 412 organ transplant recipients — including 154 white patients and 258 nonwhite (black, Asian or Hispanic) — who were referred to the Drexel Dermatology Center for Transplant Patients between 2011 and 2016. As one of the only models of its kind in the country, the center provides post-transplant dermatological care to every patient who is transplanted by and/or followed by the Drexel University and Hahnemann University Hospital Transplant Programs. That means that every patient, regardless of race, is screened annually for skin cancer, which provided a unique dataset for us to analyze.

Two hundred eighty-nine transplant recipients exhibited malignant, infectious or inflammatory conditions during their evaluation, but their primary acute diagnoses differed greatly by race. In 82 white patients, skin cancer was the most common acute problem requiring attention at first visit. Black and Hispanic patients, by contrast, were most often diagnosed with inflammatory or infectious processes, such as fungal infections, warts, eczema, psoriasis, and rashes that required immediate medical attention.

Overall, squamous cell carcinoma in situ was the most common type of skin cancer diagnosed in each racial or ethnic group. But the location of the cancerous lesions again depended on the race of the patient. Most lesions in white and Asian patients occurred in sun-exposed areas of the body, like the scalp, neck, chest and back. For black patients, the lesions were primarily found in the groin.  Moreover, six of the nine lesions found on black patients tested positive for high-risk HPV strains, suggesting an association between the virus and skin cancer for African Americans.

We also provided questionnaires to 66 organ transplant recipients to find out more about the patients’ awareness of skin cancer prevention. Seventy-seven percent of white patients were aware their skin cancer risk was increased, compared to 68 percent of nonwhites. Only 11 percent of nonwhite patients reported having regular dermatologic examinations, compared to 36 percent of whites. Finally, 45 percent of white patients but only 25 percent of nonwhite reported knowing the signs of skin cancer.

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Tocilizumab High Active For Refractory Graft vs Host Disease

MedicalResearch.com Interview with:

Dr. Alex Ganetsky

Dr. Alex Ganetsky

Alex Ganetsky, PharmD, BCOP
Clinical Pharmacy Specialist – Hematology/BMT
Hospital of the University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

• Allogeneic hematopoietic cell transplant (HCT) recipients with steroid-refractory gastrointestinal acute graft-versus-host disease (GI-GVHD) have poor outcomes.
• There is no consensus for optimal treatment of these patients.
• We retrospectively evaluated the efficacy of tocilizumab, an interleukin-6 receptor monoclonal antibody, for the treatment of steroid-refractory GI-GVHD.
• 10/11 (91%) patients achieved a complete response after a median time of 11 days (range, 2 – 18) from tocilizumab initiation.
• The median time to response onset, defined as improvement in GVHD stage by at least 1, was 1 day (range, 1 – 6).
• At a median follow-up of 3 months (range, 1.1 – 12.8) from tocilizumab initiation, 8 of 11 patients are alive and free of the their underlying hematologic malignancy.
• No associations between serum levels of IL-6 and tocilizumab response could be identified.
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A Novel Algorithm Utilizing Expanded Donor Criteria for the Allocation of Dual Kidneys in Adults

MedicalResearch.com Interview with:
Adam Johnson, MD, PhD, MBA, FACS

Thomas Jefferson University

Dr. Cataldo Doria, senior author and designer of the study, emphasized that the work was a team effort

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The goal was to develop an algorithm to identify which donors would be most suitably transplanted as dual kidneys instead of as single kidneys.

Dual kidney transplantation is a resource intensive procedure, but may make the most out of two kidneys whose function may be too marginal to transplant independently.

Currently allocation decisions are based on individual surgeon and institutional experience and without much available outcome data. This score provide decision support for which donor grafts would have the greatest benefit if transplanted as dual kidneys.

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Three Criteria To Identify Out-of-Hospital Cardiac Arrest Patients With No Chance of Survival

MedicalResearch.com Interview with:

Prof. Xavier Jouven Service de Cardiologie Hôpital Européen Georges Pompidou Paris

Prof. Xavier Jouven

Prof. Xavier Jouven
Service de Cardiologie
Hôpital Européen Georges Pompidou
Paris

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are many cardiac arrests (around 300 000 per year in United States). The possibility to collect organs from a certain proportion of those cardiac arrests represents an important opportunity to fill the gap of the organ shortage.

It is absolutely mandatory to identify patients with no chance of survival. This study showed 3 criteria which allow this early identification. Several thousands of patients die every year waiting for organ transplantation.

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After CPR, Some Donor Hearts Still Suitable For Heart Transplantation

MedicalResearch.com Interview with:

Jaimin Trivedi, MD, MPH Instructor Department of Cardiovascular and Thoracic Surgery University of Louisville Louisville, KY 40202

Dr. Jaimin Trivedi

Jaimin Trivedi, MD, MPH
Instructor
Department of Cardiovascular and Thoracic Surgery
University of Louisville
Louisville, KY 40202

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Trivedi: There is a donor heart shortage in United States and certain donor hearts are likely to be turned down because the donors required cardiopulmonary resuscitation (CPR) prior to procurement. The rationale behind conducting the study was to identify impact of donor CPR and its duration on recipient survival after transplantation.

Our findings show that presence of CPR and duration of CPR does not adversely impact the post heart transplant survival. The study also shows that ejection fraction and peak cardiac troponins between the CPR and non-CPR donors were comparable at time of transplant suggesting recovery of cardiac function.

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Females Tolerate Ischemia After Kidney Transplantion Better Than Males

MedicalResearch.com Interview with:

Matthew Levine, MD, PhD Associate professor of Transplant Surgery Perelman School of Medicine University of Pennsylvania

Dr. Mathew Levine

Matthew Levine, MD, PhD
Assistant Professor of Transplant Surgery
Perelman School of Medicine
University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Levine: This work stemmed from a known finding that female mice tolerate kidney injury better than males and this is true of mice that share exactly the same genes.  Therefore, the gender difference was the driving factor.  My basic science laboratory works at the intersection between scientific discovery and clinical application and this led us to question whether the same phenomenon was true in humans and whether we could identify a way in which this could be used to improve injury tolerance above what is seen in untreated subjects.  What we found was that the hormonal environment seems to impact ischemia tolerance, with female environment being protective and the male environment worsening injury tolerance in ischemia models where blood flow is interrupted and then restored.  The kidneys seemed to adapt to take on the injury response of the host after transplantation, indicating that the differences were not forged into the kidney itself and therefore could be altered.  We then found that estrogen therapy improved kidney injury tolerance when given to female mice in advance of injury, but no effect was seen in male mice.  And most importantly, we found that in a large cohort of transplant recipients that female recipients had better injury tolerance after transplant than male recipients, as shown by ability to avoid dialysis in the first week after transplant, otherwise known as delayed graft function (DGF). This is a fairly major finding since it has not been observed in the literature despite several decades of transplant data being carefully studied.

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Kidney Transplant Patients May Not Be Protected From HPV Strains in Vaccines

MedicalResearch.com Interview with:

Dr. Delphine Robotham MD Division of Pediatric Nephrology Johns Hopkins University School of Medicine Baltimore, Maryland

Dr. Robotham

Dr. Delphine Robotham MD
Division of Pediatric Nephrology
Johns Hopkins University School of Medicine
Baltimore, Maryland

Medical Research: What is the background for this study? What are the main findings?

Response: Cervical cancer is the second most common cancer in women worldwide and is almost entirely caused by high risk HPV genotypes.  Vaccines to high risk HPV genotypes have shown great success in protecting healthy women from the sequelae of infection, including cervical cancer and genital warts. Young women with a kidney transplant as well as those with chronic kidney disease have abnormal immune systems and as a result have a significantly increased burden of HPV-related disease making the potential health benefits of the HPV vaccine substantial in this particularly vulnerable population.  This study examined the immune response to the HPV vaccine among girls and young women with kidney disease.

The goal of this research was to determine if girls and young women with chronic kidney disease (abnormal kidney function, on dialysis, or post kidney transplant) showed evidence of immune response to the quadrivalent HPV vaccine.  Immune response was determined by measuring the amount of antibody made by the patients against each of the 4 HPV genotypes included in the vaccine.  There are established thresholds of antibody above which patients are believed to have protection from infection.  We found that study participants with chronic kidney disease and those on dialysis had antibody levels above the threshold, indicating the vaccine should be effective in protecting them from HPV related disease.  A significant proportion of patients with kidney transplants showed evidence of inadequate antibody response.  This is important information as it means patients with a kidney transplant, whom we know are at increased risk of developing cervical cancer from HPV infection, may not be protected from HPV infections from the HPV genotypes included in the vaccine.
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Genetic Engineering Platform Hopes To Develop Pig Hearts for Human Transplantation

MedicalResearch.com Interview with:
Muhammad M. Mohiuddin, MD
Cardiothoracic Surgery Research Program
National Heart, Lung, and Blood Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

 Dr. Mohiuddin: There are around 150,000 patients waiting for organ transplants. Unfortunately, the supply of human donor organs will never be able to meet this demand. We are trying to explore if animal (pig) organs can be used for these patients. Pig organs are rejected within a few minutes by humans or baboons. Therefore, we along with our industrial partner Revivicor Inc. have modified the pig genetics to knock out molecules harmful to humans and have also expressed some human genes in these pigs. Through these modifications, along with the use of novel target-specific immunosuppressive drugs, we have extended pig heart survival in the abdomen for almost 3 years. In this experimental model, the heart is transplanted in the abdomen while the original heart stays in the chest cavity. The major advantage of this model is that the baboon is kept alive, despite the rejection of the transplanted organ in the abdomen.

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Skin and Lip Cancer Risk Varies By Immunosuppression in Transplant Patients

MedicalResearch.com Interview with:

Claire M. Vajdic, PhD Center for Big Data Research in Health University of New South Wales Australian Graduate School of Management Bldg, Sydney Australia.

Dr. Claire Vajdic

Claire M. Vajdic, PhD
Center for Big Data Research in Health
University of New South Wales
Australian Graduate School of Management Bldg,
Sydney Australia on behalf of the authors.

Medical Research: What is the background for this study?

Dr. Vajdic: Lip cancer is one of the most common cancers in solid organ transplant recipients. Iatrogenic immunosuppression is a strong risk factor for lip cancer but the dose-related association between individual immunosuppressive agents and risk of lip cancer has not been examined. Therefore, we investigated the association between the type, dose and duration of immunosuppressive therapy and lip cancer risk in Australian liver, heart and lung transplant recipients.
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Transplantation Patients With Skin Cancer: Fewer New Tumors With Sirolimus

More on Dermatology from MedicalResearch.com 

Pritesh S. Karia, MPH Manager-Dermatologic Oncology Research Program Mohs and Dermatologic Surgery Center Brigham and Women's Hospital Boston, MA 02130

Pritesh Karia

MedicalResearch.com Interview with:
Pritesh S. Karia, MPH
Manager-Dermatologic Oncology Research Program
Mohs and Dermatologic Surgery Center
Brigham and Women’s Hospital
Boston, MA 02130 

Medical Research: What is the background for this study?

Response: Several recent studies have shown a reduced incidence of skin cancer in organ transplant recipients (OTR) treated with sirolimus as first-time therapy and those converted from calcineurin inhibitors to sirolimus. Although cancer formation is one of the main reasons for conversion to sirolimus, studies examining the effect of sirolimus on the risk of subsequent cancer formation in organ transplant recipients who have already been diagnosed with a post-transplant cancer are limited.
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Solid Organ Transplant Recipients Are At Increased Risk of Cancer Mortality

Sergio A. Acuna, MD Graduate Student at St. Michael's Hospital and IHPME University of Toronto

Dr.  Sergio Acuna

MedicalResearch.com Interview with:
Sergio A. Acuna, MD
Graduate Student at St. Michael’s Hospital and IHPME
University of Toronto

Medical Research: What is the background for this study?

Dr. Acuna: Solid organ transplant recipients are known to be at greater risk of developing cancers compared to the general population; however, because they are also at high increased risk of mortality from non-cancer causes, the risk of cancer morality in this population is unclear. As previous studies on this topic have reported disparate findings, the cancer mortality risk in this population remained uncertain.

Medical Research: What are the main findings?

Dr. Acuna: Our study provides conclusive evidence that solid organ transplant recipients are at increased risk of cancer mortality. Our findings demonstrate that solid organ transplant recipients are at increased risk of cancer death compared to the general population regardless of age, transplanted organ, and year of transplantation, and indicate cancer is a substantial cause of death in this population.

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Frailty Linked To Lower Survival in Lung Transplant Patients

Cassie Kennedy, M.D. Pulmonology and Critical Care Medicine Mayo Clinic

Dr. Cassie Kennedy

MedicalResearch.com Interview with:
Cassie Kennedy, M.D.
Pulmonology and Critical Care Medicine
Mayo Clinic 

Medical Research: What is the background for this study?

Dr. Kennedy: Lung transplant is a surgical procedure that can offer extended life expectancy and improved quality of life to selected patients with end-stage lung disease. However there are about 1700 patients awaiting lung transplant at any given time in the United States because transplant recipients far exceed potential donors.  In addition, even with carefully chosen candidates, lung transplant recipients live on average about 5.5 years.  It is therefore very important for transplant physicians to choose patients who will receive the most benefit from their lung transplant.

Frailty (defined as an increased vulnerability to adverse health outcomes) has typically been a subjective consideration by transplant physicians when choosing lung transplant candidates.  The emergence of more objective and reproducible frailty measures from the geriatric literature present an opportunity to study the prevalence of frailty in lung transplant (despite that subjective screening) and to determine whether the presence of frailty has any impact on patient outcomes.

Medical Research: What are the main findings?

Dr. Kennedy: Frailty is quite common –46 percent of our patient cohort was frail by the Frailty Deficit Index. We also saw a significant association between frailty and worsened survival following lung transplantation: one-year survival rate for frail patients was 71.7 percent, compared to 92.9 percent for patients who were not frail. At three years this difference in survival persisted–the survival rate for frail patients was 41.3 percent, compared to 66.1 percent for patients who were not frail.

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Obese and Normal Weight Patients Do Equally Well After Liver Transplantation

Barry Schlansky, M.D., M.P.H Assistant Professor of Medicine Oregon Health & Science University

Dr. Schlansky

MedicalResearch.com Interview with:
Barry Schlansky, M.D., M.P.H
Assistant Professor of Medicine
Oregon Health & Science University

Medical Research: What are the main findings and significance of this study?

Dr. Schlansky: This study examines how obese patients fare before and after liver transplantation. Similar to other researchers, we found that obese patients do just as well as normal weight patients after liver transplantation. We were surprised, however, to find that very obese patients died more often while on the wait list before liver transplant.

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NYU Reports Most Extensive Face Transplant To Hero Firefighter

Patrick Hardison was severely injured in September 2001 in Mississippi, while attempting to rescue a woman in a burning home. He had dozens of surgeries as he continued to try to work and care for his five children. These surgeries grafted skin from his legs onto his entire scalp and face.

Patrick Hardison before surgery (left) and in November 2015, nearly three months after the surgery

Patrick Hardison before surgery (left) and in November 2015, nearly three months after the surgery.

Mr. Hardison was referred to Dr. Eduardo D. Rodriguez, of NYU Langone Medical Center for consideration of facial transplantation.

Three months August 14, 2015 ago Dr. Rodriguez were able to give Patrick a new face, scalp, ears and ear canals, new eyelids and the muscles that control blinking.

 

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Insurance Issues Favor Wealthier Patients Receiving Multiple Transplants

Raymond Givens MD PhD Columbia University Medical Center

Dr. Givens
(photo Seth Wenig)

MedicalResearch.com Interview with:
Raymond Givens MD PhD 

Columbia University Medical Center 

Medical Research: What is the background for this study? What are the main findings?

Dr. Givens: Multiple listing- i.e., simultaneous placement on multiple organ transplant waiting lists- is allowed by the United Network for Organ Sharing (UNOS). Because insurance generally does not pay for the costs of transportation between multiple centers or of temporary housing, there has been concern that the multiple-listing policy gives an unfair advantage to wealthier patients. We examined the UNOS database from 2000-2013 and identified 33,928 patients who were listed for a first-time single-organ heart transplant, 2% of whom met our definition of multiple-listing. Compared to single-listed patients, multiple-listed patients lived in ZIP codes with significantly higher median incomes, and were more likely to have private insurance and less likely to be supported by Medicaid. They were also significantly more likely to have blood type O and to live in areas with higher predicted waiting times. Despite having lower listing priority at the start of the primary listing and lower predicted mortality, the multiple-listed patients were often upgraded at secondary listing and had a higher eventual transplant rate (74.4% vs 70.2%) and lower mortality rate while listed (8.1% vs 12.2%). When the multiple-listed cohort was compared against a propensity-score-matched single-listed subset the relative rare of transplant was 3.02. There were no differences in post-transplant survival.

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Why Are So Many Donor Kidneys Discarded?

MedicalResearch.com Interview with:
Sumit Mohan, MD, MPH
Assistant Professor of Medicine & Epidemiology
Director, Transplant Outcomes Research at CUMC
Division of Nephrology, Department of Medicine
Columbia University Medical Center  

Medical Research: What is the background for this study? What are the main findings?

Dr. Mohan: Kidney transplantation is the preferred treatment for End Stage Renal Disease but transplantation access is limited in part to the scarcity of organs in the United States. Despite this, currently 17% of all kidneys that are procured in the United States for transplant are discarded – a number that has been steadily increasing. The reasons for the discard of these kidneys is poorly understood and urgently needs to be studied.
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State Strategies Have Had Limited Effect On Organ Donations For Transplantation

Paula Chatterjee, MD, MPH Department of Medicine, Brigham and Women’s Hospital Harvard Medical School Boston, MassachusettsMedicalResearch.com Interview with:
Paula Chatterjee, MD, MPH
Department of Medicine, Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts

Medical Research: What is the background for this study? What are the main findings?

Dr. Chatterjee: Thousands of patients die every year due to organ shortages. Finding ways to address this public health issue is critical. States have designed a variety of strategies to promote organ donation and transplantation, however we don’t know if any of these strategies have been successful. The goal of our study was to try to figure out which strategies have been most successful in terms of increasing organ donation and transplantation.

We found that states have implemented a wide and creative set of strategies, but unfortunately, it seems that these strategies have had almost no effect on increasing organ donation and transplantation. In states that adopted these strategies compared to those that did not, the rates of donation and transplantation increased at nearly the same rate over the past two decades. The only strategy that seemed to have a small effect was when states created revenue pools dedicated toward organ donation activities.

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Combination Medication Effective For Hepatitis C Recurrence After Liver Transplantation

MedicalResearch.com Interview with:
Dr. Audrey Coilly MD
Fellow at the Centre Hepato-Biliaire
Paul Brousse Hospital
Villejuif, France

Medical Research: What is the background for this study? What are the main findings?

Dr.
Coilly: Hepatitis C (HCV) recurrence used to be a major issue during two decades for patients transplanted with an active HCV infection at the time of transplantation impacting both patient and graft survival. The combination of sofosbuvir and daclatasvir has not been studied after liver transplantation. The main findings are a high efficacy profile with an overall SVR12 rate of 95%. The safety profile is also good​. The most frequent adverse event is anemia, particularly when ribavirin is still used.

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HIV+ Donors Might Add To Available Kidney Donor Pool

Elmi Muller, M.B., Ch.B., M.Med. University of Cape Town–Surgery Groote Schuur Hospital Observatory Cape Town Cape Town, South Africa MedicalResearch.com Interview with:
Elmi Muller, M.B., Ch.B., M.Med.
University of Cape Town–Surgery
Groote Schuur Hospital Observatory Cape Town
Cape Town, South Africa

Medical Research: What is the background for this study?

Dr. Muller: South Africa currently offers dialysis and transplantation as a treatment option for patients with End Stage Renal Disease (ESRD). However, dialysis is not freely available to everyone, but severely limited and only available to a selected group of patients. This means that patients get assessed when they present with ESRD and they only get accepted onto a dialysis programme if they fulfill certain criteria. These criteria are criteria to assess the patient’s medical fitness in general as well as social criteria to assess whether the patient will be compliant with follow-up.  In most state hospitals, patients will only be accepted onto a dialysis program if they are also fit to receive a transplant in the long run.  The idea is that dialysis programs should naturally feed into transplant programs. Therefore a patient who is not a suitable transplant candidate will normally be turned down for dialysis.

In 2008, when the HIV positive-to-positive program started, patients with ESRD and HIV would be turned down for dialysis. The reason was that they were seen as unfit for transplantation and therefore not suitable dialysis patients. This meant that anybody with HIV and ESRD was doomed to die. This situation remained unchallenged for a number of years, especially as the rollout of antiretroviral therapy was quite slow in the state sector.

Because of very high HIV rates in the country, more and more HIV positive brain-dead donors presented to the Groote Schuur Hospital Transplant team. These donors were mostly braindead people who were worked up for organ donation (after consent was obtained from the family) and who then turned out to be HIV positive. In 2008 it made sense to try and marry this supply of donors with the group of HIV positive patients without any treatment options in the country.

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3D Printing Will Guide and Improve Face Transplantation

Frank J. Rybicki, MD PhD Director, Applied Imaging Science Laboratory Director, Cardiac CT and Vascular CT / MRI Brigham and Women's Hospital Associate Professor, Harvard Medical School Boston, MAMedicalResearch.com Interview with
Frank J. Rybicki, MD PhD
Director, Applied Imaging Science Laboratory
Director, Cardiac CT and Vascular CT / MRI
Brigham and Women’s Hospital
Associate Professor, Harvard Medical School
Boston, MA

Medical Research: What is the background for this study? What are the main findings?

Dr. Rybicki: Face transplantation restores form and function to patients with catastrophic facial injuries. To date, surgical planning a vascular anastamoses have been well described. While all 7 patients at BWH have had 3d printed models from their CT scans, to date the findings and impact of 3D printing has not been described. Also, the role of printing the soft tissues of the face has not been described.

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Over Half US Population Not Healthy Enough To Donate A Kidney

Anthony Bleyer, Jr.  Wake Forest University Class of 2015, Economics  President, Club Sports Union  Senior Captain, Wake Forest Men's Ultimate MedicalResearch.com Interview with:
Anthony Bleyer, Jr. 
Wake Forest University Class of 2015, Economics
President, Club Sports Union
Senior Captain, Wake Forest Men’s Ultimate

Medical Research: What is the background for this study? What are the main findings?

Response: There are over 100,000 individuals waiting for a kidney transplant, but each year only approximately 6,000 individuals have living donors who donate them a kidney; the rest of the individuals must remain on dialysis until they receive a kidney from an individual who has died and is a kidney donor.  A major limiting factor for kidney donation is that many individuals are not healthy enough to donate a kidney because they have  excessive obesity, diabetes mellitus, blood pressure that is too high, or they have other health conditions.  While it was known that obesity, hypertension, and other health conditions are contraindications to kidney transplant, there was no data about what percentage of the US population would be able to donate a kidney.  To study this, we (a team of kidney doctors and researchers at Wake Forest School of Medicine, Winston-Salem, NC) analyzed data from the National Health and Nutrition Survey. This study is a population-based sample that is representative of the US population.

Based on data from this study, we determined that 55.2% of the U.S. population would not have met eligibility criteria for kidney donation, often due to preventable health conditions.  19.2% of the population would have been unable to donate due to hypertension, 15% due to obesity, 11.6% due to excessive alcohol intake, and 11.5% due to diabetes.  60.1% of individuals with an adjusted family household income (AFHI) <$35,000 did not meet eligibility criteria vs. 49.3% for an AFHI > $100,000.   If one considers non-US citizenship and a family income below the poverty threshold as exclusion criteria, 68.5% of the US population would be unable to donate.
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Hematologic Cancers: Umbilical Cord Transplantation – One vs Two Units

John E. Wagner, M.D. Principal Investigator Professor Director, Division of Blood and Marrow Transplantation Department of Pediatrics McKnight Presidential Endowed Chair Hageboeck Family / Children's Cancer Research Fund Endowed Chair University of Minnesota Minneapolis, MN 55455MedicalResearch.com Interview with:
John E. Wagner, M.D.

Principal Investigator
Professor Director, Division of Blood and Marrow Transplantation Department of Pediatrics McKnight Presidential Endowed Chair Hageboeck Family / Children’s Cancer Research Fund Endowed Chair University of Minnesota Minneapolis, MN 55455

Medical Research: What is the background for this study? What are the main findings?

Dr. Wagner: Earlier studies of umbilical cord blood transplantation (UCB) in children with hematological malignancies demonstrated a survival rate of approximately 50%.  While single UCB transplant was very effective despite HLA mismatch, few adults had access to umbilical cord blood as a treatment option due to the cell dose requirement of 2. 5 x 10^6 nucleated cells per kilogram recipient body weight.  For this reason, at the University of Minnesota we explored the co-transplantation of two partially HLA matched umbilical cord blood units in adults as a straightforward strategy to achieving the cell dose requirement.  Early results were remarkable with survival rates higher than that observed in children.  This in turn led to the design of the BMT CTN 0501 study, a randomized trial comparing single versus double umbilical cord blood transplantation in children aged 2-21 years with hematological malignancies.  All patients received a uniform conditioning regimen of fludarabine, cyclophosphamide and total body irradiation and GVHD prophylaxis of cyclosporine A and mycophenylate mofetil.  224 patients were randomized.

There were four major findings:

  • 1) survival results overall, regardless of treatment arm, have improved,
  • 2) for children, an adequately dosed single umbilical cord blood unit is sufficient, giving a survival result of 72% at one year,
  • 3) double umbilical cord blood transplant is associated with more GVHD and poorer platelet recovery but survival is comparable to an adequately dosed single unit, and
  • 4) HLA mismatch is well tolerated with potentially better disease free survival in patients transplanted with HLA mismatched umbilical cord blood , a provocative finding that requires further investigation.

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Study Examines Risk of Alopecia Areata and Vitiligo in Stem Cell Recipients

MedicalResearch.com Interview with:
Rena Zuo, BA
MD Candidate at Duke University School of Medicine and

Edward W. Cowen, MD, MHSc
Senior Clinician
Head, Dermatology Consultation Service
Dermatology Branch
Center for Cancer Research National Cancer Institute
National Institutes of Health

MedicalResearch: What are the main findings of the study?


Answer: Chronic graft-vs-host disease (cGVHD) is a debilitating multisystem disease that occurs in patients receiving allogeneic hematopoietic stem cell transplantations as treatment for hematologic disorders. Although the diverse clinical presentations of cGVHD frequently mimic other autoimmune diseases such as Sjögren syndrome and systemic sclerosis, and low-titer antibodies are commonly found in patients with cGVHD, the exact pathogenesis and role of autoimmunity in cGVHD are incompletely understood.

Our study is the first to characterize and identify risk factors associated with the development of two uncommon autoimmune phenomena, specifically alopecia areata and vitiligo, in the setting of cGVHD. Laboratory markers, including 11 antibodies, transplant-related factors, and other cGVHD systemic manifestations were analyzed.

Several particularly interesting results were found:

  1. Among 282 patients with cGVHD, 15 demonstrated vitiligo (14 of 282; 4.9%) and/or alopecia areata (2 of 282; 0.7%).
  2. Female donor and female donor to male recipient sex mismatch, in particular, are significantly associated with the development of vitiligo and/or alopecia areata.
  3. Positive anti-cardiolipin (ACA) IgG was also significantly associated with development of vitiligo and/or alopecia areata.

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Small Changes Improve Geographic Disparity in Kidney Transplantation

Daniela P Ladner, MD, MPH, FACS Assistant Professor Transplant Surgery Department of Surgery, Division of Organ Transplantation Director Northwestern University Transplant Outcomes Research Collaborative (NUTORC) Comprehensive Transplant Center Feinberg School of Medicine, Northwestern UniversityMedicalResearch.com Interview with
Daniela P Ladner, MD, MPH, FACS
Assistant Professor Transplant Surgery
Department of Surgery, Division of Organ Transplantation
Director Northwestern University Transplant Outcomes Research Collaborative (NUTORC)
Comprehensive Transplant Center
Feinberg School of Medicine, Northwestern University

MedicalResearch: What are the main findings of the study?

Dr. Ladner: With the current kidney organ allocation system, there exists significant geographic disparity between the 58 Donor Services Areas (DSAs) in the US, which are distributed among 11 regions. This means that depending on where a patient lives it might take shorter or longer to receive a kidney organ for transplantation. Despite efforts, this has not improved over the course of 20 years and in most regions this has worsened. In 1991 and 1992 respectively, two states changed their kidney allocation system, such that kidneys would first be allocated with the DSA of procurement, then statewide, then regionally (which may include several states) and then nationally. Usually kidneys don’t get allocated statewide before regionally.

The main finding of this study is that in those two states (FL, TN), where a minor change to the kidney allocation was put into place, there was significant reduction in the geographic disparity between their Donor Services Areas. In other comparable states (equal numbers of DSAs within the state) the geographic disparity did not improve and in many the geographic disparity worsened. Continue reading

Organ Transplantation: What is the Risk of Cancer Transmission?

MedicalResearch.com Interview with:
Rajeev Desai
SpR Gastroenterology, City Hospital Birmingham
Honorary Clinical Research Fellow
University Hospital Birmingham / NHS Blood and Transplant, Bristol

MedicalResearch: What are the main findings of the study?

Dr. Desai: This study of a large national cohort of organ donors shows that, following careful assessment and selection, organs from some donors with a previous history of cancer can be used safely for transplantation. The risks of accepting such organs for transplantation should be balanced with risks of non-acceptance and its consequences including delayed transplantation or non-transplantation.

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Transplant Recipients Contracted Microsporidiosis From Donor

MedicalResearch.com Interview with:
Dr. Susan N. Hocevar MD
Centers for Disease Control and Prevention
Atlanta, GA 30333;

MedicalResearch.com:  What are the main findings of the study?

Dr. Hocevar: This public health investigation uncovered microsporidiosis transmitted to 3 organ recipients who received organs from a common donor. This illness cluster was the first recognized occurrence of donor-derived microsporidiosis.
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Improving Suceess of Corneal Transplantation

Dr. Jerry Y. Niederkorn, Ph.D. George A. and Nancy P. Shutt Professorship in Medical Sciences Royal C. Miller Chair in Age-Related Macular Degeneration Research Professor of Ophthalmology and Microbiology Vice Chair, Research (Department of Ophthalmology) Department of Ophthalmology, University of Texas Southwestern Medical Center Dallas, TXMedicalResearch.com Interview with:
Dr. Jerry Y. Niederkorn, Ph.D.
George A. and Nancy P. Shutt
Professorship in Medical Sciences
Royal C. Miller Chair in Age-Related Macular Degeneration Research Professor of Ophthalmology and Microbiology
Vice Chair, Research (Department of Ophthalmology)
Department of Ophthalmology, University of Texas Southwestern Medical Center
Dallas, TX

FN-γ Blocks CD4+CD25+ Tregs and Abolishes Immune Privilege of Minor Histocompatibility Mismatched Corneal Allografts

MedicalResearch.com: What are the main findings of the study?

Dr. Niederkorn: These findings indicate that a combination of two simple maneuvers increases the acceptance of corneal transplants. In the past, there was no clear benefit in performing tissue matching of the cornea donor’s major histocompatibility complex (MHC) with the recipient of the corneal transplant. However, our study in experimental animals revealed that blocking a single immune system molecule called interferon-gamma (IFN-γ) combined with matching the corneal transplant donor with the transplant recipient’s MHC gene complex reduced the risk of rejection to less than 10% in the total absence of anti-rejection drugs. This study revealed that blocking this single immune system molecule promoted the development of immune system cells called T regulatory cells (Tregs) that suppressed the lymphocytes that are responsible for attacking organ transplants.
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