American Journal of Transplantation

UNOS has given its Kidney Transplantation Committee the green light to develop a new kidney allocation policy based on a concept intended to improve age-matching and survival rates. This month, “The AJT Report” takes a closer look at this concept and speaks with some of its supporters and opponents.

This month's “Literature Watch” highlights newly identified and potentially transformative genes for renal diseases with particular commentary on the limitations of genome wide association studies.

The results of the ORION trial, where two sirolimus-based therapeutic strategies were investigated, provide an opportunity to learn important lessons for the design of future studies and to critically review the role of mTOR inhibitors after transplantation. See article by Flechner et al on page 1633.

The author provides critical and contextual assessment of Clayton et al's study suggesting an increase in graft loss from recurrent IgA following steroid elimination. See page 1645.

This editorial highlights the complex relationship between race, gender and biology in understanding the risk of developing end stage renal disease after living kidney donation. See article by Cherikh et al on page 1650.

Prospective studies analyzing the potential influence of cyclosporine A versus tacrolimus following liver transplant for hepatitis C virus on the new anti-viral protease and polymerase inhibitors might help address the perennial debate of the best calcineurin inhibitor for this indication. See article by Irish et al on page 1676.

Given that influenza vaccination is an important preventive measure, studies showing association between vaccination and formation of HLA alloantibodies need to be interpreted with caution. See brief communication by Katarinis et al on page 1727.

Liver inflammation triggered by the insults of peri-transplant ischemia and reperfusion is an innate immune-dominated local response regulated by CD4⁺ T cells.

This paper reviews the role of surveillance kidney biopsies in routine clinical practice and clinical research studies.

This article reviews the role and training of the transplant pharmacist and provides guidance for implementation of novel pharmacy services.

Transplant dermatologists and skin cancer researchers present a snapshot of the current state of research on transplant-associated skin cancers discussed at the Biennial Scientific Retreat of the International Transplant Skin Cancer Collaborative and Skin Care in Organ Transplant Patients Europe held in October 2010.

The authors present an algorithm that manages sensitized patients on the waiting list based on a predicted probability of transplantation at the lowest risk of HLA antibodies.

Selectively blocking CD28 using a monovalent non-activating antibody fragment in conjunction with a short course of CD154 or calcineurin inhibition synergistically promotes long-term graft acceptance and intra-graft Tregs, and this effect is prevented by CTLA-4 blockade.

Allospecific regulatory T cells with different T cell receptor functional avidity appear to have differential regulatory capacities in graft survival.

Using a large animal model of heart transplantation, the authors show that hearts from donation after cardiac death donors recover sufficient metabolic and contractile function to support the circulation of a recipient animal.

Two sirolimus-based regimens are compared to tacrolimus in de novo kidney transplant recipients, and the intention to treat outcomes at two years are not improved for the sirolimus treated groups. See editorial by Budde on page 1551.

A large registry study finds that steroid use is associated with a significantly lower risk of graft loss from recurrent IgA nephropathy. See editorial by Cohney on page 1553.

This study utilizes the OPTN and CMS databases to demonstrate that although the ESRD rates after living kidney donation are higher for Black compared to White donors and for male compared to female donors, these ethnic- and gender-related differences compare favorably to those reported in the general population. See editorial by Srinivas on page 1656.

Rapamycin influences phosphate homeostasis and insulin resistance modulating klotho expression in epithelial tubular cells and this event is mediated by mTORC2 through AKT phosphorylation.

A randomized study of an early cyclosporine to sirolimus conversion at 3 months after transplantation (the CONCEPT study) shows that the renal benefit observed at 1 year is maintained and even more pronounced at 4 years.

Administration of cyclosporine maintenance immunosuppression to HCV-infected liver transplant recipients at time of hospital discharge is associated with an increased risk of graft failure compared to administration of tacrolimus. See editorial by Forns and Navasa on page 1559.

An early diagnosis of fibrosing cholestatic hepatitis, which develops after liver transplantation in 19% of a cohort of HIV/HCV coinfected patients, is feasible.

Data from recipients with hepatocellular carcinoma are reviewed and show that the higher the dropout probability while on waiting list, the lower the predicted survival after transplantation, a relationship that is worsened by hepatitis C positivity.

Findings from this study show that not all patients are willing to accept liver transplantation using an expanded criteria donor, although most patients were willing to accept moderately or substantially higher one-year mortality risk for expanded criteria donor transplantation relative to standard criteria donor transplantation.

This article examines graft survival and transplant distributions by race and ethnicity, both before and after the 2003 change in the US kidney allocation system that eliminated priority for HLA-B similarity.

A regional analysis of donation after cardiac death policies reveals a great deal of variability, which may impact donation rates, transplantation rates and clinical outcomes.

This study demonstrates an unexpectedly high rate of transient de novo anti-HLA antibody after pandemic H1N1 and seasonal influenza immunization in kidney transplant recipients. See editorial by Kumar and Danziger-Izakov on page 1561.

This study describes lower suppressive capability of human regulatory T cells on autologous responder cells, which is of relevance to the design of clinical trials of cell therapy for the induction of tolerance to transplanted tissues.

Inadequate portal flows during liver transplant can be successfully ameliorated by ligating the left renal vein when a surgical or spontaneous shunt is present.

NK cells may contribute to transplant-associated thrombotic microangiopathy and its progression.

Updated information is provided by the CDC regarding the European E. coli O104 outbreak, which may have relevance for transplant recipients and donors.