Subject(s)
Antibodies, Monoclonal/therapeutic use , Antibodies, Neoplasm/therapeutic use , Chemokine CXCL10/blood , Chemokine CXCL9/blood , Graft Rejection/immunology , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/adverse effects , Recombinant Fusion Proteins/therapeutic use , Acute Disease , Alemtuzumab , Antibodies, Monoclonal, Humanized , Basiliximab , Biomarkers/blood , Graft Rejection/blood , Humans , Preoperative Period , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Currently, acute allograft rejection can only be detected reliably by deterioration of graft function confirmed by allograft biopsy. A huge drawback of this method of diagnosis is that substantial organ damage has already taken place at the time that rejection is diagnosed. Discovering and validating noninvasive biomarkers that predict acute rejection, and chronic allograft dysfunction, is of great importance. Many studies have investigated changes in the peripheral blood in an attempt to find biomarkers that reflect changes in the graft directly or indirectly. Herein, we will review the promises and limitations of the peripheral blood biomarkers that have been described in the literature so far.
Subject(s)
Biomarkers/blood , Graft Rejection/blood , Graft Rejection/diagnosis , Acute Disease , Chemokines/blood , Chronic Disease , Endothelial Cells/immunology , Flow Cytometry , Gene Expression Profiling , Graft Rejection/genetics , Graft Rejection/immunology , Humans , Interferon-gamma/blood , Isoantibodies/blood , Ki-1 Antigen/blood , Lymphocyte Activation , MicroRNAs/blood , MicroRNAs/genetics , Monitoring, Immunologic/methods , Transplantation ImmunologyABSTRACT
PURPOSE OF REVIEW: The current era of organ shortage has necessitated expansion of the currently available organ donor pool, to increase the number of pancreases available for transplant. This review summarizes the cumulative efforts of various centers in making this possible. RECENT FINDINGS: Various centers are consistently reporting their experience with marginal donors; recent additions to the cohort have been increase in pancreases from donors after cardiac death (controlled and uncontrolled), update on long-term outcomes of live pancreas donors, as well as efforts at objectively assessing donor risk. SUMMARY: It has become important for the transplanting surgeon to make difficult decisions on organ suitability and appropriateness depending upon the recipient's status. Further more, limiting further damage to these vulnerable grafts is important in improving utilization as well as successful transplantation.
Subject(s)
Living Donors/supply & distribution , Pancreas Transplantation , Tissue Donors/supply & distribution , HumansABSTRACT
Thrombosis of the transplanted pancreas is a common and often catastrophic event. Predisposing factors include the hypercoagulable state of many patients with diabetic renal failure, preservation-related graft endothelial injury, and low-velocity venous flow. Clinical management includes optimization of modifiable risk factors, controlled anticoagulation, graft monitoring, and early therapeutic intervention.
