American Journal of Transplantation

An artificial pancreas that would automatically monitor and respond to blood glucose would be life altering for insulin-dependent diabetics. While past safety concerns have stalled FDA approval for clinical trials, development now appears to be progressing again. Also this month, a look at the surge in organ donor designations through the Facebook “Donate Life America” initiative.

Several new reports further the understanding of the role of commensal microbes in reducing and shaping the T cell receptor repertoire of intestinal induced regulatory T cells, which in turn prevent inflammation at environmental interfaces, providing knowledge that may relate to the optimal care of transplant patients.

Increasing the use of kidneys recovered from diabetic deceased donors is an important alternative with potential to reduce the growing disparity between patients on the wait list and the number of organs available for transplantation. See article by Mohan et al on page 2098.

The author opines that the Kidney Donor Risk Index better predicts the outcomes and utilization of deceased donor kidneys when compared to the currently used standard and expanded criteria donor labels. See article by Woodside et al on page 2106.

This editorial highlights the need for stakeholders to clarify acceptable trade-offs as a prerequisite to assessment of different deceased donor kidney allograft algorithms, such as that proposed by Ross et al. See page 2115.

Inspired by the recently issued warning from the FDA regarding simvastatin use, the authors evaluate the therapeutic options for treating dyslipidemia in renal transplant recipients and summarize specific recommendations for this population from the current literature.

This article uses the recent decision of the US Court of Appeals for the Ninth Circuit in Flynn v. Holder, which upholds the National Organ Transplant Act of 1984 from a constitutional challenge but finds it inapplicable to “peripheral blood stem cells” obtained through apheresis, to better understand the history and future trajectory of the laws governing the selling of human organs and tissues.

This report describes the results of a consensus conference on the Scientific Registry of Transplant Recipients' program-specific reports and the recommendations for change.

Using in vitro animal and human studies, the authors demonstrate that Nox2, the classic phagocytic NADPH oxidase, plays an important role in calcineurin inhibitor (CNI)-induced renal fibrosis.

The authors show that adjunctive low-dose rapamycin therapy potentiates the ability of ex vivo expanded human regulatory T cells to inhibit allograft rejection in a humanized mouse model of arterial transplantation, and further demonstrate that this effect is mediated by suppression of T cell proliferation and induction of CD4+ cell apoptosis.

Anti–class I antibodies induce graft expression of perforin, CCL5 and myeloperoxidase during antibody-mediated rejection of single class I MHC-disparate allografts in a mouse model.

Using a model of allograft arteriosclerosis, this study shows that medial smooth muscle cell apoptosis induces stromal cell–derived factor 1α production thus contributing to the recruitment of mesenchymal stem cells and the development of transplant arteriosclerosis.

Luminal polyethylene glycol reduces intestinal preservation injury by delaying tight junction alterations and dissolution, as revealed by superior morphology, immunohistochemistry and electrophysiology in treated intestines.

Suppressed regeneration of small-for-size liver grafts is associated with decreased amphiregulin synthesis after mouse liver transplantation, and supplementation of amphiregulin improves the outcome of small-for-size liver transplantation.

The authors use a gene-therapy approach to demonstrate that low-level chimerism generated with nonmyeloablative conditioning is sufficient to promote tolerance and treat mice with experimental autoimmune encephalomyelitis.

The authors demonstrate that B cells are necessary for tolerance induction in some transplant models, and also may confer tolerance induction upon adoptive transfer.

2C10, a novel antagonistic monoclonal antibody to CD40, inhibits antigen-specific T cell–dependent antibody responses and significantly prolongs islet allograft survival in nonhuman primates.

The authors demonstrate the presence of expanded B cell clones producing polyreactive antibodies that cross-react to HLA and self-antigens in the blood of a kidney transplant recipient experiencing rejection.

The authors perform registry analysis of outcomes associated with kidneys from deceased diabetic donors over a 10-year period and compare them to outcomes from other marginal donors in the same period. See editorial by Tedesco on page 1969.

Analysis of the Scientific Registry of Transplant Recipients data demonstrates that the expanded criteria donor designation does not adversely affect kidney utilization or kidney transplant outcomes beyond that predicted by the Kidney Donor Risk Index score. See editorial by Friedewald on page 1971.

The authors develop a multiprinciple approach to ethically justify allocation of younger deceased donor kidneys to younger adult recipients meeting the National Organ Transplant Act criteria of balancing equity and efficiency. See editorial by Gill on page 1973.

The authors report that a single-center kidney paired donation program can substantially increase live donor transplantation and advantage highly sensitized recipients with a low rate of rejection.

The authors' analysis demonstrates that tax breaks for living donation do not lead to increases in donation rates.

The results of a national survey of the background, training, responsibilities and practices of independent living donor advocates suggest considerable variability; the authors therefore recommend the development of practice guidelines.

Early results of pancreas transplantation from donors after circulatory death in the United Kingdom suggest that this cohort may have a larger application potential than previously recognised.

In this single-center retrospective study, a majority of pediatric heart transplant recipients demonstrate evidence of presumed sinus reinnervation, which is associated with enhanced exercise performance and overall improved patient and graft survival.

The authors find that a significant proportion of patients develop antibodies to K-α 1 tubulin and collagen V after lung transplantation, and that persistence of these antibodies is associated with an increased risk of bronchiolitis obliterans syndrome.

The authors demonstrate an association between human cytomegalovirus DNA plasma loads and specific CD8+ T cell interferon-gamma responses in lung transplant recipients.

A unique integration of longitudinal data from a transplant center and integrated healthcare delivery organization shows that the duration of diabetes, but not hypertension or hyperlipidemia, is a significant predictor of long-term mortality for adult liver transplant recipients.

The analysis of patients listed for liver transplant in United Network of Organ Sharing Region 4 reveals a strong association between wait-list mortality and patients' residence distance from the transplant center.

Full right and full left grafts from split liver procedures can be shared among different centers of the same area in the context of a collaborative activity, being safely and effectively transplanted in adult patients, thus optimizing the use of deceased donor livers.

Temporary auxiliary partial orthotopic liver transplantation followed by remnant native liver resection is suggested as a possible treatment for patients with familial amyloid polyneuropathy.

Loss of the immunoregulatory serine/threonine kinase DRAK2 in T cells enhances allograft survival, acting synergistically with CTLA4-Ig to promote transplant survival.

Posterior reversible encephalopathy syndrome occurs in 1% of adult liver transplant recipients with seizure as the most common clinical presentation.

The authors report three cases of atrial masses post cardiac transplantation and highlight the challenges involved in their correct diagnosis and management.

Use of vascularized rectus sheath is successful in facilitating abdominal closure in two cases of pediatric multivisceral transplantation.

Cryptosporidiosis is an uncommon but important cause of diarrhea in immunocompromised hosts; recreational swimming may be a source of this organism.