The coronavirus disease 2019(COVID-19)pandemic has upended healthcare systems worldwide and led to an inevitable decrease in liver transplantation(LT)activity.During the first pandemic wave,administrators and clinicia...The coronavirus disease 2019(COVID-19)pandemic has upended healthcare systems worldwide and led to an inevitable decrease in liver transplantation(LT)activity.During the first pandemic wave,administrators and clinicians were obliged to make the difficult decision of whether to suspend or continue a lifesaving procedure based on the scarce available evidence regarding the risk of transmission and mortality in immunosuppressed patients.Those centers where the activity continued or was heavily restricted were obliged to screen donors and recipients,design COVID-safe clinical pathways,and promote telehealth to prevent nosocomial transmission.Despite the ever-growing literature on COVID-19,the amount of high-quality literature on LT remains limited.This review will provide an updated view of the impact of the pandemic on LT programs worldwide.Donor and recipient screening,strategies for waitlist prioritization,and posttransplant risk of infection and mortality are discussed.Moreover,a particular focus is given to the possibility of donor-to-recipient transmission and immunosuppression management in COVID-positive recipients.展开更多
Utilizing kidneys from donors with hepatitis B is one way to alleviate the current organ shortage situation.However,the risk of hepatitis B virus(HBV)transmission remains a challenge that undermines the chance of orga...Utilizing kidneys from donors with hepatitis B is one way to alleviate the current organ shortage situation.However,the risk of hepatitis B virus(HBV)transmission remains a challenge that undermines the chance of organs being used.This is particularly true with hepatitis B surface antigen(HBsAg)positive donors despite the comparable long-term outcomes when compared with standard donors.To reduce the risk of HBV transmission,a comprehensive approach is needed.This includes assessment of donor risk,optimal allocation to the proper recipient,appropriate immunosuppressive regimen,optimizing the prophylactic therapy,and post-transplant monitoring.This review provides an overview of current evidence of kidney transplants from donors with HBsAg positivity and outlines the challenge of this treatment.The topics include donor risk assessment by adopting the nucleic acid test coupled with HBV DNA as the HBV screening,optimal recipient selection,importance of hepatitis B immunity,role of nucleos(t)ide analogues,and hepatitis B immunoglobulin.A summary of reported long-term outcomes after kidney transplantation and proposed criteria to utilize kidneys from this group of donors was also defined and discussed.展开更多
The new kidney allocation scheme(KAS) in effect since December 4th 2014 was designed to overcome the shortcomings of previous system. A key feature of the new KAS is preferential allocation of best quality organs to w...The new kidney allocation scheme(KAS) in effect since December 4th 2014 was designed to overcome the shortcomings of previous system. A key feature of the new KAS is preferential allocation of best quality organs to wait-list candidates with the longest predictivesurvival in a concept called longevity matching. Highly sensitized recipients would get extra points and enjoy widespread sharing of organs in order to increase accessibility to transplant. Wait-list candidates with blood group B will be offered organs from donors with A2 and A2 B blood type in order to shorten their wait-list time. Time on the wait list will start from day of listing or date of initiation of dialysis whichever comes first which should benefit candidates with limited resources who might be late to get on the transplant list. Pay back system has been eliminated in the new KAS. These changes in organ allocation policy may lead to increase in median half-life of the allograft and increase the number of transplants; thus resulting in better utilization of a scarce resource. There could be unintended negative consequences which may become evident over time.展开更多
文摘The coronavirus disease 2019(COVID-19)pandemic has upended healthcare systems worldwide and led to an inevitable decrease in liver transplantation(LT)activity.During the first pandemic wave,administrators and clinicians were obliged to make the difficult decision of whether to suspend or continue a lifesaving procedure based on the scarce available evidence regarding the risk of transmission and mortality in immunosuppressed patients.Those centers where the activity continued or was heavily restricted were obliged to screen donors and recipients,design COVID-safe clinical pathways,and promote telehealth to prevent nosocomial transmission.Despite the ever-growing literature on COVID-19,the amount of high-quality literature on LT remains limited.This review will provide an updated view of the impact of the pandemic on LT programs worldwide.Donor and recipient screening,strategies for waitlist prioritization,and posttransplant risk of infection and mortality are discussed.Moreover,a particular focus is given to the possibility of donor-to-recipient transmission and immunosuppression management in COVID-positive recipients.
文摘Utilizing kidneys from donors with hepatitis B is one way to alleviate the current organ shortage situation.However,the risk of hepatitis B virus(HBV)transmission remains a challenge that undermines the chance of organs being used.This is particularly true with hepatitis B surface antigen(HBsAg)positive donors despite the comparable long-term outcomes when compared with standard donors.To reduce the risk of HBV transmission,a comprehensive approach is needed.This includes assessment of donor risk,optimal allocation to the proper recipient,appropriate immunosuppressive regimen,optimizing the prophylactic therapy,and post-transplant monitoring.This review provides an overview of current evidence of kidney transplants from donors with HBsAg positivity and outlines the challenge of this treatment.The topics include donor risk assessment by adopting the nucleic acid test coupled with HBV DNA as the HBV screening,optimal recipient selection,importance of hepatitis B immunity,role of nucleos(t)ide analogues,and hepatitis B immunoglobulin.A summary of reported long-term outcomes after kidney transplantation and proposed criteria to utilize kidneys from this group of donors was also defined and discussed.
文摘The new kidney allocation scheme(KAS) in effect since December 4th 2014 was designed to overcome the shortcomings of previous system. A key feature of the new KAS is preferential allocation of best quality organs to wait-list candidates with the longest predictivesurvival in a concept called longevity matching. Highly sensitized recipients would get extra points and enjoy widespread sharing of organs in order to increase accessibility to transplant. Wait-list candidates with blood group B will be offered organs from donors with A2 and A2 B blood type in order to shorten their wait-list time. Time on the wait list will start from day of listing or date of initiation of dialysis whichever comes first which should benefit candidates with limited resources who might be late to get on the transplant list. Pay back system has been eliminated in the new KAS. These changes in organ allocation policy may lead to increase in median half-life of the allograft and increase the number of transplants; thus resulting in better utilization of a scarce resource. There could be unintended negative consequences which may become evident over time.
