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Topic Review
Volatile Anesthetic-Induced Organ Protection
Ischemia reperfusion injury (IRI) is inevitable in kidney transplantation and negatively impacts graft and patient outcome. Reperfusion takes place in the recipient and most of the injury following ischemia and reperfusion occurs during this reperfusion phase; therefore, the intra-operative period seems an attractive window of opportunity to modulate IRI and improve short- and potentially long-term graft outcome. Commonly used volatile anesthetics such as sevoflurane and isoflurane have been shown to interfere with many of the pathophysiological processes involved in the injurious cascade of IRI. 
  • 481
  • 29 Apr 2021
Topic Review
Ischemia-Reperfusion Injury Driving Oxidative Stress in Organ Transplantation
During organ procurement, redox-stress triggered ischemia-reperfusion injury (IRI) is inevitable, which in addition to pre-existing damage negatively affects such organs. 
  • 469
  • 09 Jan 2023
Topic Review
Endothelial Dysfunction Syndromes after Allogeneic Stem Cell Transplantation
Hemato-poietic stem cell transplantation is associated with significant endothelial dysfunction, which may result in severe complications. Endothelial dysfunction induces the expression of multiple substances including, cell adhesion molecules, pro-inflammatory cytokines, and coagulation factors resulting in activation of the complement system, and promoting a procoagulant and proinflammatory state. The pathophysiological process that mediates the endothelial damage is not clearly understood and the aim of this study is a comprehensive review of the existing knowledge. Moreover, the levels of soluble molecules released in the systemic circulation as a result of endothelial damage may serve as biomarkers for the early diagnosis and the pre-emptive treatment of post-transplant syndromes. The review of the existing literature presented in detail shows that the ideal biomarker with sufficient sensitivity and specificity for the early diagnosis of post-transplant complications does not currently exist. Future studies should focus on the identification of novel biomarkers with sufficient specificity and sensitivity. 
  • 459
  • 10 Feb 2023
Topic Review
Operational Tolerance in Liver Transplantation
More than half a century ago, Billingham and Medawar described the phenomenon of acquired immunologic tolerance to transplant antigens by successfully grafting the skin of a calf onto its fraternal twin. Induction of immune tolerance decreases the risk of graft rejection after solid organ transplantation and thus reduces the need for immunosuppression and improves the survival of transplanted organs. Billingham’s work was followed by the first successful kidney transplant in 1954, and so launched the worldwide search for methods to induce immune tolerance and to hold graft rejection at bay. Transplant tolerance represents the holy grail for transplant immunology: a state where the allograft is accepted by the recipient in the absence of IS treatment. There are multiple types of tolerance including full immunological tolerance, operational tolerance (OT), or IS minimization, sometimes referred to as “prope tolerance”.
  • 454
  • 05 May 2021
Topic Review
Immunosuppression and Liver Transplantation
In liver transplant patients, solid tumors and post-transplant lymphoproliferative disorders (PTLD) have emerged as significant long-term mortality causes. Additionally, it is assumed that de novo malignancy (DNM) after liver transplantation (LT) is the second-leading cause of death after cardiovascular complications. Well-established risk factors for PTLD and solid tumors are calcineurin inhibitors (CNIs), tacrolimus (TAC), and cyclosporine, the cornerstones of all immunosuppressive (IS) therapies used after LT.
  • 450
  • 05 Jul 2021
Topic Review
Immunometabolic Therapeutic Targets of Graft-versus-Host Disease
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative option in the treatment of aggressive malignant and non-malignant blood disorders. However, the benefits of allo-HSCT can be compromised by graft-versus-host disease (GvHD), a prevalent and morbid complication of allo-HSCT. GvHD occurs when donor immune cells mount an alloreactive response against host antigens due to histocompatibility differences between the donor and host, which may result in extensive tissue injury. The reprogramming of cellular metabolism is a feature of GvHD that is associated with the differentiation of donor CD4+ cells into the pathogenic Th1 and Th17 subsets along with the dysfunction of the immune-suppressive protective T regulatory cells (Tregs). The activation of glycolysis and glutaminolysis with concomitant changes in fatty acid oxidation metabolism fuel the anabolic activities of the proliferative alloreactive microenvironment characteristic of GvHD. Thus, metabolic therapies such as glycolytic enzyme inhibitors and fatty acid metabolism modulators are a promising therapeutic strategy for GvHD.
  • 440
  • 22 Nov 2021
Topic Review
Ex Vivo Lung Perfusion
Compared to static cold storage (SCS), ex vivo lung perfusion (EVLP) offers clinicians unrivalled opportunity for rigorous objective assessment of donor lungs in conditions replicating normal physiology, thus allowing for better informed decision-making in suitability assessments. EVLP additionally offers a platform for the delivery of intravascular or intrabronchial therapies to metabolically active tissue aiming to treat existing lung injuries. In the future, EVLP may be employed to provide a pre-transplant environment optimized to prevent negative outcomes such as primary graft dysfunction (PGD) or rejection post-transplant.
  • 430
  • 09 Oct 2021
Topic Review
Contemporary Biomarkers for Renal Transplantation
Renal transplantation (RT) is the preferred treatment for end-stage renal disease. However, clinical challenges persist, i.e., early detection of graft dysfunction, timely identification of rejection episodes, personalization of immunosuppressive therapy, and prediction of long-term graft survival. Biomarkers have emerged as valuable tools to address these challenges and revolutionize RT patient care. 
  • 410
  • 09 Aug 2023
Topic Review
Deep Learning in Liver Transplantation
Liver transplantation outcomes have improved. Looking for the best Donor-Recipient matching (D-R matching) as always been a challenge for the liver transplantation surgeons. Most of the proposed scores based on conventional biostatistics are not good classifiers of a problem that is considered “unbalanced.” The implementation of artificial intelligence in medicine has experienced exponential growth. Deep learning, a branch of artificial intelligence with capability to handle a large number of variables with speed and multi-objective analysis. Artificial neural networks and random forests are the most widely used deep-learning classifiers in this field. Both classifiers have been able to show a high predictive ability in the graft survival of a D-R pair compared to traditional classifiers. There are even researchers that have successfully created a matching model based on one of them.
  • 397
  • 28 Jan 2023
Topic Review
Microbiota in Liver Transplantation and Related Biliary Complications
Liver transplantation as a treatment option for end-stage liver diseases is associated with a relevant risk for complications. On the one hand, immunological factors and associated chronic graft rejection are major causes of morbidity and carry an increased risk of mortality due to liver graft failure. On the other hand, infectious complications have a major impact on patient outcomes. In addition, abdominal or pulmonary infections, and biliary complications, including cholangitis, are common complications in patients after liver transplantation and can also be associated with a risk for mortality. Thereby, these patients already suffer from gut dysbiosis at the time of liver transplantation due to their severe underlying disease, causing end-stage liver failure. Despite an impaired gut-liver axis, repeated antibiotic therapies can cause major changes in the gut microbiome.
  • 389
  • 21 Apr 2023
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