73 results match your criteria: "Edinburgh Transplant Centre[Affiliation]"

Background & Aims: Tacrolimus has been associated with recurrence of primary biliary cholangitis (PBC) after liver transplantation (LT), which in turn may reduce survival. This study aimed to assess the association between the type of calcineurin inhibitor used and long-term outcomes following LT in patients with PBC.

Methods: Survival analyses were used to assess the association between immunosuppressive drugs and graft or patient survival among adult patients with PBC in the European Liver Transplant Registry.

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Background & Aims: Biliary complications are a major cause of morbidity and mortality in liver transplantation. Up to 25% of patients that develop biliary complications require additional surgical procedures, re-transplantation or die in the absence of a suitable regraft. Here, we investigate the role of the primary cilium, a highly specialised sensory organelle, in biliary injury leading to post-transplant biliary complications.

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Article Synopsis
  • - The study investigates the relationship between donor time to death (TTD) and outcomes in liver transplantation from donors after circulatory death (DCD), analyzing data from the UK Transplant Registry for recipients between 2006 and 2021.
  • - Results indicated that a TTD of 14 minutes or less significantly increased the risk of graft loss, while longer TTD did not affect outcomes; additionally, prolonged surgery time was associated with graft loss but not the duration of functional warm ischemia.
  • - The findings suggest that allowing longer stand down periods before organ procurement may enhance the use of donor livers without compromising transplant success rates.
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Effect of recipient age on prioritisation for liver transplantation in the UK: a population-based modelling study.

Lancet Healthy Longev

May 2024

Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK; Scottish Liver Transplant Unit, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK. Electronic address:

Background: Following the introduction of an algorithm aiming to maximise life-years gained from liver transplantation in the UK (the transplant benefit score [TBS]), donor livers were redirected from younger to older patients, mortality rate equalised across the age range and short-term waiting list mortality reduced. Understanding age-related prioritisation has been challenging, especially for younger patients and clinicians allocating non-TBS-directed livers. We aimed to assess age-related prioritisation within the TBS algorithm by modelling liver transplantation prioritisation based on data from a UK transplant unit and comparing these data with other regions.

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Multimodal decoding of human liver regeneration.

Nature

June 2024

Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK.

The liver has a unique ability to regenerate; however, in the setting of acute liver failure (ALF), this regenerative capacity is often overwhelmed, leaving emergency liver transplantation as the only curative option. Here, to advance understanding of human liver regeneration, we use paired single-nucleus RNA sequencing combined with spatial profiling of healthy and ALF explant human livers to generate a single-cell, pan-lineage atlas of human liver regeneration. We uncover a novel ANXA2 migratory hepatocyte subpopulation, which emerges during human liver regeneration, and a corollary subpopulation in a mouse model of acetaminophen (APAP)-induced liver regeneration.

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Choroidal and retinal thinning in chronic kidney disease independently associate with eGFR decline and are modifiable with treatment.

Nat Commun

December 2023

Edinburgh Kidney, University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.

In patients with chronic kidney disease (CKD), there is an unmet need for novel biomarkers that reliably track kidney injury, demonstrate treatment-response, and predict outcomes. Here, we investigate the potential of retinal optical coherence tomography (OCT) to achieve these ends in a series of prospective studies of patients with pre-dialysis CKD (including those with a kidney transplant), patients with kidney failure undergoing kidney transplantation, living kidney donors, and healthy volunteers. Compared to health, we observe similar retinal thinning and reduced macular volume in patients with CKD and in those with a kidney transplant.

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The European Society of Organ Transplantation (ESOT) strives to promote equity, diversity, and inclusion (EDI) across all its activities. We surveyed the transplant community's experiences and perspectives regarding EDI within ESOT as an organization and its educational activities, and research in general. A total of 299 respondents completed the questionnaire.

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Kidney transplantation is the optimal treatment for end-stage renal disease, but it is still severely limited by a lack of suitable organ donors. Kidneys from donation after circulatory death (DCD) donors have been used to increase transplant rates, but these organs are susceptible to cold ischemic injury in the storage period before transplantation, the clinical consequence of which is high rates of delayed graft function (DGF). Normothermic machine perfusion (NMP) is an emerging technique that circulates a warmed, oxygenated red-cell-based perfusate through the kidney to maintain near-physiological conditions.

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Whole-organ pancreas and islets transplantations are two therapeutic options to treat type 1 diabetic patients resistant to optimised medical treatment in whom severe complications develop. Selection of the best option for β-cell replacement depends on several factors such as kidney function, patient comorbidities, and treatment goals. For a patient with end-stage kidney disease, the treatment of choice is often a simultaneous transplant of the pancreas and kidney (SPK).

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Unlabelled: This report provides recommendations from the Research and Innovation domain as part of the International Donation and Transplantation Legislative and Policy Forum (hereafter the Forum) to provide expert guidance on the structure of an ideal organ and tissue donation and transplantation system. The recommendations focus on deceased donation research and are intended for clinicians, investigators, decision-makers, and patient, family, and donor (PFD) partners involved in the field.

Methods: We identified topics impacting donation research through consensus using nominal group technique.

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Implausible algorithm output in UK liver transplantation allocation scheme: importance of transparency.

Lancet

March 2023

Department of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh EH14 4SA, UK; Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK. Electronic address:

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Background & Aims: Liver graft utilization rates are a hot topic due to the worldwide organ shortage and the increasing number of transplant candidates on waiting lists. Liver perfusion techniques have been introduced in several countries, and may help to increase the organ supply, as they potentially enable the assessment of livers before use.

Methods: Liver offers were counted from donation after circulatory death (DCD) donors (Maastricht type III) arising during the past decade in eight countries, including Belgium, France, Italy, the Netherlands, Spain, Switzerland, the UK, and the US.

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Living donation challenges the ethical principle of non-maleficence in that it exposes healthy persons to risks for the benefit of someone else. This makes safety, informed consent (IC) and education a priority. Living kidney donation has multiple benefits for the potential donor, but there are also several known short- and long-term risks.

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Contemporary Management of Median Arcuate Ligament in Liver Transplantation.

Transplant Direct

August 2022

Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.

Unlabelled: Median arcuate ligament (MAL) can impair arterial inflow during orthotopic liver transplantation (OLT). Furthermore, approaches to ensure optimal vascular inflow in the presence of MAL is not standardized.

Methods: We undertook a systematic review according to the Cochrane systematic review protocol and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

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Lack of knowledge about living donor kidney transplant and difficulties in approaching potential donors constitute barriers for many patients and may contribute to inequality of access. Renal Education and Choices at Home was a UK single-centre pilot of home education; an initiative aiming to overcome barriers by increasing knowledge among patients and support networks and by facilitating living donation discussion in the patient's home. This was a pre-post comparison of knowledge, attitude, and ability to communicate about transplant.

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External Validation of the United Kingdom Transplant Benefit Score in Australia and New Zealand.

Prog Transplant

March 2023

Victorian Liver and Intestinal Transplant Unit, 3805Austin Health, Heidelberg, Victoria, Australia.

In Australia and New Zealand, liver allocation is needs based (based on model for end-stage liver disease score). An alternative allocation system is a transplant benefit-based model. Transplant benefit is quantified by complex waitlist and transplant survival prediction models.

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Article Synopsis
  • Liver transplantation is the best way to treat patients with severe liver disease, but problems can happen after the surgery, like damage to bile ducts that can lead to losing the new liver.
  • Scientists studied how keeping livers cold before surgery affects liver cells and found that cold storage can hurt the cells and stop them from healing properly.
  • They discovered a specific receptor in the liver cells that can help with cell growth and lessen damage, and using certain treatments before and during liver storage can help keep the liver healthier for the transplant.
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Liver transplantation (LT) is a major surgical undertaking but, in a carefully selected population, it provides excellent outcomes in terms of prolongation of life and improvements in quality of life. This article outlines the processes of referral, assessment, operative course and post-transplant complications of LT, in the UK context. Specific consideration is also given to immunosuppressive medications and considerations around their prescription.

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Due to the shortage of deceased and genetically- or emotionally-related living donors, living unrelated paid donor (LURpD) kidney transplantation has been considered; however, this practice may result in medical, ethical and social dilemmas, induce organ trading (commodification), and even criminal activities. Commodification also risks undermining public trust in the transplant system and impeding the development of proper altruistic or deceased donor programs by ignoring altruism, volunteerism, and dignity. However, despite many objections by authoritative organizations, black market practices are involved in up to 10% of all transplants worldwide.

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Mass disasters are characterized by a disparity between health care demand and supply, which hampers complex therapies like kidney transplantation. Considering scarcity of publications on previous disasters, we reviewed transplantation practice during the recent COVID-19 pandemic, and dwelled upon this experience for guiding transplantation strategies in the future pandemic and non-pandemic catastrophes. We strongly suggest continuing transplantation programs during mass disasters, if medical and logistic operational circumstances are appropriate.

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Background: . We evaluated whether the use of normothermic regional perfusion (NRP) was associated with increased organ recovery and improved transplant outcomes from controlled donation after circulatory death (cDCD).

Methods: .

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Salvage of Declined Extended-criteria DCD Livers Using In Situ Normothermic Regional Perfusion.

Ann Surg

October 2022

Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.

Objective: This study investigates whether liver grafts donated after circulatory death (DCD) that are declined by the entire Eurotransplant region can be salvaged with abdominal normothermic regional perfusion (aNRP).

Background: aNRP is increasingly used for DCD liver grafts because it prevents typical complications. However, it is unclear whether aNRP is capable to rescue pretransplant declined liver grafts by providing the opportunity to test function during donation.

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