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Introduction to organ transplantation
\"This second edition of the introduction to the field of organ transplantation provides an excellent overview of the tremendous progress made in recent decades, and gives a clear description of the current status of transplant surgery for students and trainees with an interest in this field. It opens with introductory chapters on the history of transplantation and the basic science of immunobiology, and then examines through an organ-based structure the practice of transplantation in each major system, from skin to intestine. This is a timely publication produced in line with the rapidly advancing field of transplantation.\" -- Publisher.
Book
The transplant imaginary
In The Transplant Imaginary, author Lesley Sharp explores the extraordinarily surgically successful realm of organ transplantation, which is plagued worldwide by the scarcity of donated human parts, a quandary that generates ongoing debates over the marketing of organs as patients die waiting for replacements. These widespread anxieties within and beyond medicine over organ scarcity inspire seemingly futuristic trajectories in other fields. Especially prominent, longstanding, and promising domains include xenotransplantation, or efforts to cull fleshy organs from animals for human use, and bioengineering, a field peopled with “tinkerers” intent on designing implantable mechanical devices, where the heart is of special interest. Scarcity, suffering, and sacrifice are pervasive and, seemingly, inescapable themes that frame the transplant imaginary. Xenotransplant experts and bioengineers at work in labs in five Anglophone countries share a marked determination to eliminate scarcity and human suffering, certain that their efforts might one day altogether eliminate any need for parts of human origin. A premise that drives Sharp’s compelling ethnographic project is that high-stakes experimentation inspires moral thinking, informing scientists’ determination to redirect the surgical trajectory of transplantation and, ultimately, alter the integrity of the human form.
eBook
Senolytics prevent mt-DNA-induced inflammation and promote the survival of aged organs following transplantation
Older organs represent an untapped potential to close the gap between demand and supply in organ transplantation but are associated with age-specific responses to injury and increased immunogenicity, thereby aggravating transplant outcomes. Here we show that cell-free mitochondrial DNA (cf-mt-DNA) released by senescent cells accumulates with aging and augments immunogenicity. Ischemia reperfusion injury induces a systemic increase of cf-mt-DNA that promotes dendritic cell-mediated, age-specific inflammatory responses. Comparable events are observed clinically, with the levels of cf-mt-DNA elevated in older deceased organ donors, and with the isolated cf-mt-DNA capable of activating human dendritic cells. In experimental models, treatment of old donor animals with senolytics clear senescent cells and diminish cf-mt-DNA release, thereby dampening age-specific immune responses and prolonging the survival of old cardiac allografts comparable to young donor organs. Collectively, we identify accumulating cf-mt-DNA as a key factor in inflamm-aging and present senolytics as a potential approach to improve transplant outcomes and availability.
Organ transplantation involving aged donors is often confounded by reduced post-transplantation organ survival. By studying both human organs and mouse transplantation models, here the authors show that pretreating the donors with senolytics to reduce mitochondria DNA and pro-inflammatory dendritic cells may help promote survival of aged organs.
Journal Article
The heart keeper
\"Two mothers. Two daughters. One heart. When Alison's beloved daughter Amalie drowns, her world turns impenetrably dark ... In another family, Amalie's passing is a new beginning. After years of severe health problems, young Kaia receives a new heart on the morning after Amalie drowns. Her mother Iselin has struggled to raise Kaia on her own and now things are finally looking up. She's even made an affluent new friend who's taken a special interest in her and her daughter. Alison knows she shouldn't interfere, but really, she's just trying to help Iselin and Kaia. She can give them the life they never had, and by staying close to them, she can still be with her daughter. Kaia is just like her, and surely, something of Amalie must live on in her. As her grief transforms into a terrifying obsession, Alison won't let anything stop her from getting back what she has lost\"-- Provided by publisher.
Book
Post-transplant diabetes mellitus in patients with solid organ transplants
Solid organ transplantation (SOT) is a life-saving procedure and an established treatment for patients with end-stage organ failure. However, transplantation is also accompanied by associated cardiovascular risk factors, of which post-transplant diabetes mellitus (PTDM) is one of the most important. PTDM develops in 10–20% of patients with kidney transplants and in 20–40% of patients who have undergone other SOT. PTDM increases mortality, which is best documented in patients who have received kidney and heart transplants. PTDM results from predisposing factors (similar to type 2 diabetes mellitus) but also as a result of specific post-transplant risk factors. Although PTDM has many characteristics in common with type 2 diabetes mellitus, the prevention and treatment of the two disorders are often different. Over the past 20 years, the lifespan of patients who have undergone SOT has increased, and PTDM becomes more common over the lifespan of these patients. Accordingly, PTDM becomes an important condition not only to be aware of but also to treat. This Review presents the current knowledge on PTDM in patients receiving kidney, heart, liver and lung transplants. This information is not only for transplant health providers but also for endocrinologists and others who will meet these patients in their clinics.Post-transplant diabetes mellitus (PTDM) is a common complication of solid organ transplantation that can result in increased mortality. This Review outlines the pathogenesis, diagnosis, treatment and prevention of PTDM.
Journal Article
The story of a heart
The first of our organs to form, the last to die, the heart is both a simple pump and the symbol of all that makes us human: as long as it continues to beat, we hope. One summer day, nine-year-old Keira suffered catastrophic injuries in a car accident. Though her brain and the rest of her body began to shut down, her heart continued to beat. In an act of extraordinary generosity, Keira's parents and siblings agreed that she would have wanted to be an organ donor. Meanwhile nine-year-old Max had been hospitalised for nearly a year with a virus that was causing his young heart to fail. When Max's parents received the call they had been hoping for, they knew it came at a terrible cost to another family. This is the unforgettable story of how one family's grief transformed into a lifesaving gift.
BOOK
Our bodies belong to God
Why has Egypt, a pioneer of organ transplantation, been reluctant to pass a national organ transplant law for more than three decades? This book analyzes the national debate over organ transplantation in Egypt as it has unfolded during a time of major social and political transformation—including mounting dissent against a brutal regime, the privatization of health care, advances in science, the growing gap between rich and poor, and the Islamic revival. Sherine Hamdy recasts bioethics as a necessarily political project as she traces the moral positions of patients in need of new tissues and organs, doctors uncertain about whether transplantation is a “good” medical or religious practice, and Islamic scholars. Her richly narrated study delves into topics including current definitions of brain death, the authority of Islamic fatwas, reports about the mismanagement of toxic waste predisposing the poor to organ failure, the Egyptian black market in organs, and more. Incorporating insights from a range of disciplines, Our Bodies Belong to God sheds new light on contemporary Islamic thought, while challenging the presumed divide between religion and science, and between ethics and politics.
eBook
The undead : organ harvesting, the ice-water test, beating-heart cadavers-- how medicine is blurring the line between life and death
Science writer Dick Teresi examines how death is determined by the medical community and explores organ trafficking, brain death, and near-death experiences.
Book
A propensity score-matched analysis of mortality in solid organ transplant patients with COVID-19 compared to non-solid organ transplant patients
In the context of COVID-19 pandemic, we aimed to analyze the epidemiology, clinical characteristics, risk factors for mortality and impact of COVID-19 on outcomes of solid organ transplant (SOT) recipients compared to a cohort of non transplant patients, evaluating if transplantation could be considered a risk factor for mortality. From March to May 2020, 261 hospitalized patients with COVID-19 pneumonia were evaluated, including 41 SOT recipients. Of these, thirty-two were kidney recipients, 4 liver, 3 heart and 2 combined kidney-liver transplants. Median time from transplantation to COVID-19 diagnosis was 6 years. Thirteen SOT recipients (32%) required Intensive Care Unit (ICU) admission and 5 patients died (12%). Using a propensity score match analysis, we found no significant differences between SOT recipients and non-transplant patients. Older age (OR 1.142; 95% [CI 1.08–1.197]) higher levels of C-reactive protein (OR 3.068 ; 95% [CI 1.22–7.71]) and levels of serum creatinine on admission (OR 3.048 95% [CI 1.22–7.57]) were associated with higher mortality. The clinical outcomes of SARS-CoV-2 infection in our cohort of SOT recipients appear to be similar to that observed in the non-transplant population. Older age, higher levels of C-reactive protein and serum creatinine were associated with higher mortality, whereas SOT was not associated with worse outcomes.
Journal Article