Clinical transplantation
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Clinical transplantation · Oct 2020
Multicenter StudyPediatric transplantation in Europe during the COVID-19 pandemic: Early impact on activity and healthcare.
The current pandemic SARS-CoV-2 has required an unusual allocation of resources that can negatively impact chronically ill patients and high-complexity procedures. Across the European Reference Network on Pediatric Transplantation (ERN TransplantChild), we conducted a survey to investigate the impact of the COVID-19 outbreak on pediatric transplant activity and healthcare practices in both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT). The replies of 30 professionals from 18 centers in Europe were collected. ⋯ Only two moderate-severe cases were reported, both in HSCT setting. These survey results demonstrate the limitations in healthcare resources for pediatric transplantation patients during early stages of this pandemic. COVID-19 disease is a major worldwide challenge for the field of pediatric transplantation, where there will be a need for systematic data collection, encouraging regular discussions to address the long-term consequences for pediatric transplantation candidates, recipients, and their families.
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Clinical transplantation · Oct 2020
Attenuated early inflammatory response in solid organ recipients with COVID-19.
Immunosuppression leaves transplanted patients at particular risk for severe acute respiratory syndrome 2 (SARS-CoV-2) infection. The specific features of coronavirus disease 2019 (COVID-19) in immunosuppressed patients are largely unknown and therapeutic experience is lacking. Seven transplanted patients (two liver, three kidneys, one double lung, one heart) admitted to the Ludwig-Maximilians-University Munich because of COVID-19 and tested positive for SARS-CoV-2 were included. ⋯ Compared to non-transplanted patients at the ICU (n = 19) the inflammatory response was attenuated in transplanted patients, which was proven by decreased IL-6 blood values. This analysis might provide evidence that continuous immunosuppression is safe and probably beneficial since there was no hyperinflammation evident. Although transplanted patients might be more susceptible to an infection with SARS-CoV-2, their clinical course seems to be similar to immunocompetent patients.
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Clinical transplantation · Sep 2020
ReviewRole of hematopoietic cell transplantation in relapsed acute promyelocytic leukemia.
The use of all trans-retinoic acid and arsenic trioxide combination as the induction regimen for acute promyelocytic leukemia (APL) has revolutionized the management and outcomes of this disease. Modern risk-adapted frontline therapy has provided excellent therapeutic results. ⋯ Once remission has been achieved, consolidation with autologous HCT for APL patients with negative minimal residual disease (MRD) status, and with allogeneic HCT for APL patients with positive MRD status appear to offer the best long-term outcomes. In this article, we provide a comprehensive review of existing literature on the efficacy of HCT in treatment of relapse/refractory APL and we discuss the appropriate use of this modality.
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Clinical transplantation · Aug 2020
Implementation of a mobile team to provide normothermic regional perfusion in controlled donation after circulatory death: Pilot study and first results.
Normothermic regional perfusion (NRP) in controlled donation after circulatory death is becoming a popular method due to the favorable results of the grafts procured under this technique. This procedure requires experience, and, sometimes, the availability of extracorporeal membrane oxygenation (ECMO) machines to implement NRP is limited to tertiary hospitals. In order to provide support with NRP in controlled donation after circulatory death across the different hospitals of the Autonomous Community of Madrid, a mobile NRP team was created. ⋯ A total of 39 kidneys, 12 livers, and 5 bilateral lungs were recovered and transplanted. None of the livers were discarded due to an elevation in transaminases during NRP. A mobile NRP team is a feasible option and, in our series, aided in the optimization and recovery of organs from donors after controlled circulatory death in centers where ECMO technology was not available.