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Tag: Transplantation

  • Potato starch supplements could be solution to bone marrow transplant complications

    Potato starch supplements could be solution to bone marrow transplant complications

    BYLINE: Tessa Roy

    Newswise — Experts at the University of Michigan Health Rogel Cancer Center have found a potential solution for preventing a common and dangerous complication in patients that receive stem cell transplants from a donor’s blood or bone marrow.  

    Approximately 18,000 people per year in the United States are diagnosed with life threatening illnesses, including blood cancers where a blood or bone marrow stem cell transplant from a donor is their best treatment option.

    About 9,000 such transplants are performed yearly in the U.S. 

    When patients receive a stem cell transplant, they get a new immune system from the donor whose job is to attack cells that don’t belong there including cancer cells. 

    Sometimes, however, those donor immune cells (the graft) begin to see the patient’s own body (the host) as unfamiliar and foreign. As a result, the donor cells may attack the patient’s own organs and tissues, causing Graft versus Host Disease. 

    GVHD develops in up to half of patients who receive stem cell transplants from a donor’s blood or bone marrow. It can affect many parts of the body and can range from mild or moderate to more severe and even life threatening.

    The way to prevent and treat GVHD is by using strong medicines to suppress the immune system which can cause patients to get infections which can also be life-threatening. Therefore, while bone marrow and blood stem cell transplants from a donor are lifesaving for many patients with various serious illnesses, the development of GVHD can cause injury or even death and the treatments available for GVHD are risky.  

    Previous research showed that the bacteria that normally live in the intestines and their products can affect whether or not GVHD happens after a transplant. 

    Researchers have found that a food supplement made from potato starch, when given to ten patients who received stem cell transplants from a donor, changed the products of intestinal bacteria in a way that could potentially prevent GVHD from happening.   

    “GVHD is a major limitation to the lifesaving capability of blood or marrow stem cell transplants. It is exciting to think of the prospect of potentially finding a simple, low-cost, and safe approach to mitigating this dangerous complication for patients who need a stem cell transplant, but researching this approach in more patients is still needed to confirm,” said Mary Riwes, D.O., assistant professor of internal medicine and medical director of the inpatient adult stem cell transplant unit of the Medical Directors Partnering to Lead Along with Nurse Managers program.   

    Investigators are currently enrolling more patients for a second phase of this study to determine whether taking potato starch will indeed result in less GVHD after stem cell transplant. Sixty patients undergoing a blood or bone marrow stem cell transplant from a donor who are ten years or older will be randomized to take potato starch or placebo starch in addition to taking all the usual medications for preventing GVHD with 80% receiving potato starch and 20% placebo starch. This phase II clinical trial will help researchers learn whether or not taking potato starch is an effective intervention for preventing GVHD. 

    More information about this Phase II trial can be found on Clinicaltrials.gov identifier: NCT02763033 

    Additional authors include Jonathan L. Golob, John Magenau, Mengrou Shan, Gregory Dick, Thomas Braun, Thomas M. Schmidt, Attaphol Pawarode, Sarah Anand, Monalisa Ghosh, John Maciejewski, Darren King, Sung Choi, Gregory Yanik, Marcus Geer, Ethan Hillman, Costas A. Lyssiotis, Muneesh Tewari and Pavan Reddy

    Funding/disclosures: Thanks to the volunteers who participated in the study and the clinical and research staff of the University of Michigan Bone Marrow Transplant program. This work was supported by the National Heart, Lung, and Blood Institute (grant no. P01 HL149633, P.R., M.T., M.M.R.) which facilitated all bio sample analyses. The funder had no role in the design and analysis of the study. Resistant starch was purchased using institutional startup funds (M.M.R). 

    Paper cited: “Feasibility of a dietary intervention to modify gut microbial metabolism in patients with hematopoietic stem cell transplantation,” Nature. DOI: 10.1038/s41591-023-02587-y

    Michigan Medicine – University of Michigan

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  • Cleveland Clinic Researchers Develop New Model for Prioritizing Lung Transplant Candidates

    Cleveland Clinic Researchers Develop New Model for Prioritizing Lung Transplant Candidates

    Newswise — CLEVELAND: A team from Cleveland Clinic has developed a new model for prioritizing patients waiting for a lung transplant, aimed at improving outcomes and reducing deaths among those in need of donor lungs. The new method offers an improved strategy for organ allocation by taking into account how the time a patient has spent on the waiting list could impact the severity of their disease and the urgency of their need for a transplant.

    The results of a study looking at this new method were published today in The American Journal of Respiratory and Critical Care Medicine.

    Currently, lung transplant candidates are ranked by a scoring equation called the Composite Allocation Score (CAS). Candidates are assigned a number based on factors including how stable they are while waiting, chances of survival after receiving a new organ, and how easily they can be matched for available organs. Those with the highest scores are given priority and offered donor lungs first. However, the scores are based on tests given twice a year at transplant centers. That means that unless a patient’s health suddenly and drastically changes, their score will remain the same for at least six months.

    “The problem with this method is that the scoring equations fail to consider how a patient’s health status changes as they spend more time on the list,” said Maryam Valapour, M.D., M.P.P., director of Lung Transplant Outcomes at Cleveland Clinic. “The longer a patient lives with a severe lung disease, the more their risk of developing severe complications increases. This is something clinicians observe every day – that our patients’ risk of developing complications changes over time. Therefore, some patients’ scores may not reflect how urgently they need a transplant.”

    To determine how the amount of time on the waitlist affects clinical outcomes, the team of researchers analyzed data from 12,000 American adults listed for lung transplant between 2015 to 2020. The study showed that for many patients, their risk of death prior to transplant increased as they spent longer times waiting for donor lungs.

    When the team looked at patients who died on the waiting list, they found that many had not been given enough priority in the CAS. To more accurately score the candidates, the team developed a more dynamic method called the multistate composite model that accounted for the type of lung disease and time on the waiting list. When they recalculated the original scores with their new equation, it consistently marked those patients as high priority. However, for patients who originally received low-priority scores and remained stable over time, using the new method did not change their scores. 

    “The approaches we present in our paper are capable of identifying whose trajectory is more stable on the waiting list versus those whose trajectory is worsening between six-month clinical updates. The estimates in our model more closely align with observed trends in individual U.S. lung transplant patients,” says Jarrod Dalton, Ph.D., director of Lerner Research Institute’s Center for Populations and Health Research, who is first author of the paper. “This approach may allow us to more accurately prioritize time-sensitive lung transplant candidates and decrease waitlist mortality for patients with end-stage lung disease.”

    This study was done with the support of the National Institutes of Health.

    “This research advances us towards development of a more comprehensive prediction model for risk of mortality among lung transplant candidates that could help guide decisions about patients who are in greater need for lung transplant and increase their odds for survival,” said James P. Kiley, Ph.D., director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute (NHLBI).

    In 2022, there were over 3,000 candidates added to the lung transplant waitlist with over 2,600 lung transplants performed, according to UNOS. While the numbers of donors and transplants are improving, there is still a shortage of available organs in the United States.

    Research reported in this publication was supported by the National Institutes of Health under Award Number R01HL153175. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health.

     

    About Cleveland Clinic 

    Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. Cleveland Clinic is consistently recognized in the U.S. and throughout the world for its expertise and care. Among Cleveland Clinic’s 77,000 employees worldwide are more than 5,658 salaried physicians and researchers, and 19,000 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,699-bed health system that includes a 173-acre main campus near downtown Cleveland, 23 hospitals, more than 275 outpatient facilities, including locations in northeast Ohio; southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2022, there were 12.8 million outpatient encounters, 303,000 hospital admissions and observations, and 270,000 surgeries and procedures throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org. 

     

    Editor’s Note: Cleveland Clinic News Service is available to provide broadcast-quality interviews and B-roll upon request.

     

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    Cleveland Clinic

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  • Cell Therapy That Repairs Cornea Damage with Patient’s Own Stem Cells Achieves Positive Phase I Trial Results

    Cell Therapy That Repairs Cornea Damage with Patient’s Own Stem Cells Achieves Positive Phase I Trial Results

    Newswise — BOSTON– A team led by researchers from Mass Eye and Ear, a member of Mass General Brigham, reports the results of a phase I trial of a revolutionary stem cell treatment called cultivated autologous limbal epithelial cell transplantation (CALEC), which was found to be safe and well-tolerated over the short term in four patients with significant chemical burns in one eye. According to the study published August 18 in Science Advances, the patients who were followed for 12 months experienced restored cornea surfaces — two were able to undergo a corneal transplant and two reported significant improvements in vision without additional treatment.

    While the phase I study was designed to determine preliminary safety and feasibility before advancing to a second phase of the trial, the researchers consider the early findings promising.

    “Our early results suggest that CALEC might offer hope to patients who had been left with untreatable vision loss and pain associated with major cornea injuries,” said principal investigator and lead study author Ula Jurkunas, MD, associate director of the Cornea Service at Mass Eye and Ear and an associate professor of ophthalmology at Harvard Medical School. “Cornea specialists have been hindered by a lack of treatment options with a high safety profile to help our patients with chemical burns and injuries that render them unable to get an artificial cornea transplant. We are hopeful with further study, CALEC can one day fill this crucially needed treatment gap.”

    In CALEC, stem cells from a patient’s healthy eye are removed via a small biopsy and then expanded and grown on a graft via an innovative manufacturing process at the Connell and O’Reilly Families Cell Manipulation Core Facility at Dana-Farber Cancer Institute. After two to three weeks, the CALEC graft is sent back to Mass Eye and Ear and transplanted into the eye with corneal damage.

    The CALEC project is a collaboration between Jurkunas and colleagues in the Cornea Service at Mass Eye and Ear, researchers at Dana-Farber Cancer Institute, led by Jerome Ritz, MD, Boston Children’s Hospital, led by Myriam Armant, PhD, and the JAEB Center for Health Research. The clinical trial represents the first human study of a stem cell therapy to be funded by the National Eye Institute (NEI), a part of the National Institutes of Health (NIH).

    Expanding one’s own stem cells to address limitations in existing treatments

    People who experience chemical burns and other eye injuries may develop limbal stem cell deficiency, an irreversible loss of cells on the tissue surrounding the cornea. These patients experience permanent vision loss, pain and discomfort in the affected eye. Without limbal cells and a healthy eye surface, patients are unable to undergo artificial cornea transplants, the current standard of vision rehabilitation.

    Existing treatment strategies have limitations and associated risks the CALEC procedure aims to address through its unique approach of using a small amount of a patient’s own stem cells that can then be grown and expanded to create a sheet of cells that serves as a surface for normal tissue to grow back.

    According to the authors, despite landmark studies describing an autologous stem cell approach over the past 25 years and similar methods being utilized in Europe, no U.S. research team had successfully developed a manufacturing process and quality control tests that met U.S. Food and Drug Administration (FDA) requirements or showed any clinical benefit.

    “It was challenging to develop a process for creating limbal stem cell grafts that would meet the FDA’s strict regulatory requirements for tissue engineering,” said Ritz, executive director of the Connell and O’Reilly Families Cell Manipulation Core Facility at Dana-Farber and professor of medicine at Harvard Medical School. “Having developed and implemented this process, it was very gratifying to see encouraging clinical outcomes in the first cohort of patients enrolled on this clinical trial.”

    Studies like this show the promise of cell therapy for treating incurable conditions. Mass General Brigham’s Gene and Cell Therapy Institute is helping to translate scientific discoveries made by researchers into first-in-human clinical trials and, ultimately, life-changing treatments for patients. The Institute’s multidisciplinary approach sets it apart from others in the space, helping researchers to rapidly advance new therapies and pushing the technological and clinical boundaries of this new frontier.

    Case studies hold early promise as clinical trial advances

    In the phase I study, five patients with chemical burns to one eye were enrolled and biopsied. Four received CALEC; a series of quality control tests determined the cells in the fifth patient were unable to adequately expand. The CALEC patients were tracked for 12 months.

    The first patient treated, a 46-year-old male, experienced a resolution of his eye surface defect, which primed him to undergo an artificial cornea transplant for vision rehabilitation. The second, a 31-year-old male, experienced a complete resolution of symptoms with vision improving from 20/40 to 20/30. The third, a 36-year-old male, had his corneal defect resolved and his vision improved from hand motion – only being able to see broad movements like waving – to 20/30 vision. The fourth, a 52-year-old male, initially did not have a successful biopsy that resulted in a viable stem cell graft. After re-attempting CALEC three years later, he underwent a successful transplant and his vision improved from hand motion to being able to count fingers. He then received an artificial cornea.

    The researchers are finalizing the next phase of the clinical trial in 15 CALEC patients they are tracking for 18 months to better determine the procedure’s overall efficacy. Their hope is that CALEC can one day become a treatment option for patients who previously had to endure long-term deficits when existing treatment options were not an option given the severity of their injuries.

    “The CALEC project is a wonderful example of the mission that drives our clinician-scientists of bringing work from the laboratory to patients,” said Joan W. Miller, MD, chair of Ophthalmology at Mass Eye and Ear and Mass General Hospital, ophthalmologist-in-chief at Brigham and Women’s Hospital, and chair of Ophthalmology and the David Glendenning Cogan Professor of Ophthalmology at Harvard Medical School. “We are inspired by a desire to provide patients who have limited treatment options with better possibilities for care, and Dr. Jurkunas and her colleagues at Mass Eye and Ear and across multiple academic centers have dedicated nearly two decades worth of work towards one day achieving this goal for people with significant corneal injuries.”

    This study was funded by NEI/NIH grants UG1EY026508 [Massachusetts Eye and Ear], UG1EY027726 [Cell Manipulation Core Facility at Dana-Farber Cancer Institute], UG1EY027725 [Coordinating Center at the Jaeb Center for Health Research]. Pre-trial work (Boston Children’s Hospital) was also funded by PACT, an initiative of the of the NIH’s National Heart, Lung, and Blood Institute.

    In addition to Drs. Jurkunas, Ritz, and Armant, additional investigators include Jia Yin, MD, PhD,MPH, Reza Dana, MD,  Lynette Johns, OD, Sanming Li, PhD, Ahmad Kheirkhah, MD, Kishore Katikireddy, PhD, Alex Gauthier, PhD, Stephan Ong Tone, MD, PhD and Stacey Ellender, PhD of Mass Eye and Ear, Hélène Negre, PharmD, PhD, Kit L. Shaw, PhD, Diego E. Hernandez Rodriguez, PhD, Heather Daley, BS, of Dana-Farber Cancer Institute, and Allison Ayala, MS, Maureen Maguire, PhD and Lassana Samarakoon, MPH, of Jaeb Center for Health Research.

    The CALEC procedure is patent pending. Jurkunas and Dana also disclose equity in Ocucell, a company interested in developing cell-based therapies for the eye.

    About Mass Eye and Ear

    Massachusetts Eye and Ear, founded in 1824, is an international center for treatment and research and a teaching hospital of Harvard Medical School. A member of Mass General Brigham, Mass Eye and Ear specializes in ophthalmology (eye care) and otolaryngology–head and neck surgery (ear, nose and throat care). Mass Eye and Ear clinicians provide care ranging from the routine to the very complex. Also home to the world’s largest community of hearing and vision researchers, Mass Eye and Ear scientists are driven by a mission to discover the basic biology underlying conditions affecting the eyes, ears, nose, throat, head and neck and to develop new treatments and cures. In the 2023–2024 “Best Hospitals Survey,” U.S. News & World Report ranked Mass Eye and Ear #4 in the nation for eye care and #7 for ear, nose and throat care. For more information about life-changing care and research at Mass Eye and Ear, visit our blog, Focus, and follow us on Instagram, Twitter and Facebook.

     

    Massachusetts Eye and Ear

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  • Race-Neutral Testing Could Have Given Access to Life-Saving Lung Transplants for More Black Patients

    Race-Neutral Testing Could Have Given Access to Life-Saving Lung Transplants for More Black Patients

    Newswise — June 21, 2023 – NEW YORK, NY— Race-neutral lung function interpretation could increase access to lung transplants for Black patients with respiratory disease, according to new research published in the Annals of the American Thoracic Society online ahead of print.

    In “Race-Specific Interpretation of Spirometry: Impact on the Lung Allocation Score,” lead researcher J. Henry Brems, MD, MBE of the Johns Hopkins School of Medicine, and colleagues investigated how race-specific versus race-neutral equations alter the lung allocation score (LAS) and the priority for lung transplant across races. The lung allocation score determines which patients get priority on the lung transplant listing.

    A group of 8,982 patients were selected from the United Network for Organ Sharing database and the LAS calculated for each patient from both a race-specific and race-neutral approach. Dr. Brems noted that “that a race-specific approach to lung function interpretation has the potential to systematically bias care to the disadvantage of Black patients with respiratory disease.”

    He added that, “our results support the recent shift in ATS recommendations to use race-neutral equations as a way to advance the equitable care of respiratory disease.”  In a press release announcing the American Thoracic Society’s official statement on race, ethnicity and pulmonary function test interpretation, the lead author of the statement noted: “Reviews of clinical algorithms throughout medicine in the past decade have spawned concerns about bias and harm when race is used as a variable and has led to revisions of these algorithms.”

    The degree of harm that may result from bias is critical to examine as lives literally hang in the balance. Lung transplantation is a life-saving option for people with end-stage lung disease. Candidates for a transplant are assigned an LAS score, which is based on – among other things – age, oxygen requirement and lung function test results. A high LAS score will give a patient a higher priority on the transplant list.

    In this latest study, the researchers found that “Compared to a race-neutral approach, a race-specific approach resulted in a lower LAS for Black patients and higher LAS for white patients, which may have contributed to racially biased allocation of lung transplants.”

    As medicine shifts to a race-neutral approach in disease evaluation and management, more studies will be needed to understand the impact on patient care. “We may need to develop alternative or more holistic approaches to replace current threshold-based decisions, which are used for some diagnostic criteria, treatments, referrals, disability benefits, and even employment eligibility for some occupations,” said Dr. Brems.

     

    Share via Twitter: Race-neutral testing could give access to life-saving #lung transplants for more Black patients. Read the latest now. [link to study] @AnnalsATS @HenryBrems @HopkinsMedicine

     

     

    American Thoracic Society (ATS)

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  • Loyola Medicine Improves Health Equity by Increasing Access to Kidney Transplants for Patients with Obesity

    Loyola Medicine Improves Health Equity by Increasing Access to Kidney Transplants for Patients with Obesity

    Newswise — MAYWOOD, IL – Diabetes and high blood pressure are among the primary causes of renal failure. They also contribute to obesity which poses a major obstacle to qualifying for a transplant, particularly for minority communities disproportionately affected by obesity. Fortunately, minimally invasive robotic surgical technology can improve access for patients who might otherwise be ineligible for a kidney transplant. Loyola Medicine’s advanced robotic surgery program makes it one of the few hospitals in the country to offer kidney transplantation to patients with obesity.

    Raquel Garcia-Roca, MD, surgical director of the kidney, pancreas and living donor kidney transplant programs, said, “in the majority of the transplant centers, not only here in Chicago, but nationwide, there is limited access to transplantation when the patient’s body mass index is above 35, an indication of obesity.” Patients with high BMIs are typically ruled ineligible for transplantation due to the increased risk of complications that comes with obesity and its comorbid conditions, including increased infection rates.

    However, the advanced technology of robotic surgery allows surgeons to operate using keyhole surgery, which improves outcomes with faster recovery and reduced infection risk compared with open surgery. “Most transplant centers will ask potential kidney recipients to lose weight before they can get a transplant,” said Garcia-Roca. “This can be difficult for patients who already have limited dietary options due to their renal disease and whose condition often makes it hard to exercise. Loyola is one of the very few centers in the nation that has not included obesity as a limitation for transplantation.”

    Dr. Garcia-Roca says the ability to provide transplants for patients with obesity helps improve health equity in minority communities disproportionately affected by obesity. According to the CDC, non-Hispanic Black adults had the highest age-adjusted prevalence of obesity (49.9%), followed by Hispanic adults (45.6%) and non-Hispanic White adults (41.4%).

    Loyola’s ability to perform transplants for patients with obesity proved to be lifesaving for Israel Sanchez, a patient with end-stage renal failure. When Sanchez was a child living in Mexico, he developed an infection that damaged his kidneys. At age 12, he came to the United States, and at 21 years old, he was told he would need a kidney transplant and hemodialysis in the next few years.

    At 216 pounds, and having experienced lifelong symptoms, Sanchez thought there were no further options. But five years after he began dialysis, he sought treatment at Loyola Medicine. With a BMI of 42, he might have been turned away from another center, but was able to receive a transplant at Loyola. Sanchez described finding out about the transplant as one of the happiest days of his life. “I felt, this is unbelievable,” said Sanchez. “This is probably a dream. This is impossible that it’s happening to me.”

    Sanchez also said he felt most comfortable with Loyola because so many people on the transplant team spoke Spanish. More than half of Loyola Medicine’s abdominal transplant team are Spanish speakers, including surgeons, nurses, social workers and transplant coordinators of Hispanic origin. Dr. Garcia-Roca said, “we also work around a lot of the barriers to access that make it very difficult for members of the Hispanic community to reach a transplant center.”

    Since his surgery and recovery, Sanchez has lost around 30 pounds. He says he’s motivated to eat healthier and has the energy to work out and take walks outside. “It’s things that I haven’t experienced that people take for granted that I want to do,” Sanchez said. “I’m just grateful for this opportunity that I have to experience a life that I never experienced.”

    Dr. Garcia-Roca is encouraged by his progress. “Israel has made huge, huge changes in his life and lost a lot of weight. This is all super beneficial because he will maintain a very good, healthy condition for this new kidney to continue to work for a very long time.”

    To watch a video about Israel Sanchez’s journey and robotic transplant technology at Loyola, click this link. B-roll of Mr. Sanchez and Dr. Garcia-Roca is available to download here. B-roll with additional conversations in Spanish is available here.

    Loyola Medicine

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  • خبير من مايو كلينك: 3 تطورات تؤدي إلى مزيد من عمليات زراعة الأعضاء المنقذة للحياة

    خبير من مايو كلينك: 3 تطورات تؤدي إلى مزيد من عمليات زراعة الأعضاء المنقذة للحياة

    مدينة روتشستر، ولاية مينيسوتا – في كثير من الأحيان، لا يمكن لمن ينتظرون عمليات زراعة الأعضاء المنقذة للحياة الحصول عليها. من أكبر التحديات التي تواجههم: الافتقار إلى الأعضاء الصالحة المُتبرع بها.  يقول ماوريسيو فيلافيسينسيو، دكتور الطب، مدير جراحات زراعة القلب والرئة في مايو كلينك في مدينة روتشستر: إن التطورات الطبية الواعدة تفتح الأبواب لمزيد من عمليات زراعة الأعضاء ولإنقاذ المزيد من الأرواح.

    “فشل القلب أمرٌ شائع للغاية في الولايات المتحدة وحول العالم. وزراعة القلب هي المعيار الذهبي لعلاج فشل القلب المتقدم. فضلًا عن أن أعداد من يموتون على قائمة الانتظار آخذة في الارتفاع. ونأمل في تغيير ذلك عبر الاستفادة من هذه التطورات الطبية” – حسبما يقول دكتور فيلافيسينسيو.

    فيما يلي ثلاث طرق يتم من خلالها توسيع نطاق التبرع بالأعضاء لإنقاذ المزيد من الأروح:

    1. المزيد من عمليات التبرع عقب موت القلب وتوقف الدورة الدموية:

    جرت العادة بأن يأتي التبرع بالأعضاء بصفة رئيسية من المتبرعين الذين يموتون إثر الموت الدماغي وما تزال قلوبهم تنبض. وثمة المزيد من الأعضاء المُتبرع بها تأتي ممن يموتون عقب توقف قلوبهم عن النبض، بشكل متزايد. في الماضي، كانت القلوب والرئتين من حالات الوفيات تلك غير مستخدمة في الغالب. إلا إن التطورات الطبية باتت الآن تسمح لخبراء زراعة الأعضاء باستخدام هذه الأعضاء. حيث يمكن لخبراء زراعة الأعضاء إنعاش القلب على جهاز المجازة القلبية الرئوية أو جهاز التروية خارج الجسم ليتم التبرع بهذا القلب. قرابة 20 إلى 30 في المئة من جميع عمليات التبرع بالأعضاء تأتي من أولئك المتبرعين.

    .2 أنظمة التروية الدموية للأعضاء:

    لقد أدى إنشاء أنظمة التروية الدموية للأعضاء إلى تغيير عمليات زراعة الأعضاء – وهي أجهزة ميكانيكية تساعد الأعضاء على أن تبقى حية خارج الجسم. من الأمثلة على ذلك تقنية “القلب في الصندوق”، وهو جهاز محمول ينعش القلب المتوقف ويُبقي نبضه مستمرًا حتى يمكن زراعته.

    “إن تقنية القلب في الصندوق تسمح بنقل القلب لزراعته من مسافات طويلة. فعندما يُوضع القلب في خزان التبريد، يجب زراعته في غضون أربع ساعات. أما تقنية القلب في الصندوق فتضاعف هذا الوقت ليصل إلى ثماني ساعات على الأقل” – حسبما يقول دكتور فيلافيسينسيو.

    يتوفر للرئتين نظام مماثل لتروية الأعضاء، يسمى تروية الرئتين خارج الجسم الحي. إنه نظام يحافظ على الرئة المُتبرع بها في جهاز خارج الجسم. أيضًا، يمكن إعادة الرئتين إلى حالة تكون فيها مناسبة للزراعة.

    .3 أعضاء من متبرعين مصابين بالتهاب الكبد C:

    يمكن الآن نقل أعضاء متبرعين مصابين بالتهاب الكبد C بأمان إلى المرضى المدرجين في قوائم الانتظار. لقد صار هذا التغيير ممكنًا بفضل الجيل الجديد من الأدوية المضادة للفيروسات عالية الفعالية. يقول الدكتور فيلافيسينسيو: إنه بعد زراعة الأعضاء، يبدأ المرضى العلاج بالمضادات الفيروسية والذي يقضي في العادة على الفيروس من داخل الجسم في غضون سبعة أيام. في الماضي، كان يتم إهدار أعضاء مثل هؤلاء المتبرعين المحتملين..

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    نبذة عن مايو كلينك
    مايو كلينك هي مؤسسة غير ربحية تلتزم بالابتكار في الممارسات السريرية والتعليم والبحث وتوفير التعاطف والخبرة لكل مَن يحتاج إلى الاستشفاء والرد على استفساراته. لمعرفة المزيد من أخبار مايو كلينك، تفضَّل بزيارة شبكة مايو كلينك الإخبارية.

    Mayo Clinic

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  • Immigration experts on Title 42, analysis of immigration policies, and other migrant news in the Immigration Channel

    Immigration experts on Title 42, analysis of immigration policies, and other migrant news in the Immigration Channel

    Title 42, the United States pandemic rule that had been used to immediately deport hundreds of thousands of migrants who crossed the border illegally over the last three years, has expired. Those migrants will have the opportunity to apply for asylum. President Biden’s new rules to replace Title 42 are facing legal challenges. The US Homeland Security Department announced a rule to make it extremely difficult for anyone who travels through another country, like Mexico, to qualify for asylum. Border crossings have already risen sharply, as many migrants attempted to cross before the measure expired on Thursday night. Some have said they worry about tighter controls and uncertainty ahead. Immigration is once again a major focus of the media as we examine the humanitarian, political, and public health issues migrants must face. 

    Below are some of the latest headlines in the Immigration channel on Newswise.

    Expert Commentary

    Experts Available on Ending of Title 42

    George Washington University Experts on End of Title 42

    ‘No one wins when immigrants cannot readily access healthcare’

    URI professor discusses worsening child labor in the United States

    Biden ‘between a rock and a hard place’ on immigration

    University of Notre Dame Expert Available to Comment on House Bill Regarding Immigration Legislation, Border Safety and Security Act

    American University Experts Available to Discuss President Biden’s Visit to U.S.-Mexico Border

    Title 42 termination ‘overdue’, not ‘effective’ to manage migration

    Research and Features

    Study: Survey Methodology Should Be Calibrated to Account for Negative Attitudes About Immigrants and Asylum-Seekers

    A study analyses racial discrimination in job recruitment in Europe

    DACA has not had a negative impact on the U.S. job market

    ASBMB cautions against drastic immigration fee increases

    Study compares NGO communication around migration

    Collaboration, support structures needed to address ‘polycrisis’ in the Americas

    TTUHSC El Paso Faculty Teach Students While Caring for Migrants

    Immigrants Report Declining Alcohol Use during First Two Years after Arriving in U.S.

    How asylum seeker credibility is assessed by authorities

    Speeding up and simplifying immigration claims urgently needed to help with dire situation for migrants experiencing homelessness

    Training Individuals to Work in their Communities to Reduce Health Disparities

    ‘Regulation by reputation’: Rating program can help combat migrant abuse in the Gulf

    Migration of academics: Economic development does not necessarily lead to brain drain

    How has the COVID-19 pandemic affected immigration?

    Immigrants with Darker Skin Tones Perceive More Discrimination

     

    Newswise

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  • Professor and students seek to uncover Nature’s chilling secret

    Professor and students seek to uncover Nature’s chilling secret

    Newswise — Eric Bredahl, PhD, and his team of undergraduate research assistants are trusting that Nature, if asked nicely, or at least insistently, will yield another of her secrets.

    What happens, they want to know, when hibernating animals settle in for their long winter nap? They know hibernators experience a surge of a chemical known as adenosine, that heartbeats subsequently slow dramatically — in the case of a squirrel declining from 300 beats a minute to a few beats per minute, and that the burning of sugars is replaced by the metabolism of lipids.

    But how does this extreme state of relaxation last so long without reducing muscle mass or causing heart damage through reduced blood flow, or through the damage that sometimes occurs when normal blood flow resumes?

    The answers to these questions carry important implications for the preservation and successful transplantation of a human heart on its speedy journey from donor to recipient. That journey typically takes four to five hours, during which time the heart’s temperature is lowered and metabolism slowed through the use of a chilled organ preservation solution.

    Imagine, though, that a hibernation-like process could be used to improve organ storage and double the transport window, thus allowing for a larger donor and recipient pool. The dramatic slowing of function could potentially double its transportation window to 10 or 12 hours, thus allowing residents of difficult-to-reach rural areas better accessibility to donor hearts.

    “How and why can the heart of a hibernator function at such a low temperature for such an extended period without any ill effects?” — Eric Bredahl, PhD

    “How do you keep a hibernating animal alive for four months in the absence of food without a reduction in function having any negative effects?” asks Bredahl. “Nature has evolved all these unique mechanisms, unique pathways, and the more we understand about them the more we might be able to take those same mechanisms and apply them to a clinical condition.

    “In our case, what we are really interested in is how and why the heart of a hibernator can function at such a low temperature for such an extended period without any ill effects. We have an idea of how that happens. Now we are taking those same processes and applying them to a clinical application like transporting hearts for cardiac transplant.”

    Can it be done? Bredahl is hopeful.

    “Preliminary data says it may be possible,” he says. “But we are still doing basic research. Every couple of days we add more data and more data. It’s very exciting stuff.”

    Bredahl, an associate professor in exercise science, is aided in this quest by a $112,000 grant from the Great Plains IDeA Clinical Translational Research Program. The study is formally titled “Expanding the Cardiac Transplant Window: Treatments Derived from Hibernators,” and uses rat hearts to study the response of hearts to hibernation-like influences. It is a joint project of Bredahl and Matt Andrews, PhD, professor in the School of Natural Resources at the University of Nebraska-Lincoln.

    And, of course, a group of undergraduates availing themselves of Creighton’s many opportunities for adventures in research.

    “This project would not have been possible without our undergrads,” Bredahl says. “Liz Kettler (BS’23) and Nik Johnson (BS’22), for example, put almost a year’s worth of work into this project. It is phenomenal what they did.” 

    Furthermore, this project received significant help from Frazer Heinis, a post-doctoral researcher at the University of Nebraska-Lincoln.

    The incoming cohort of undergraduate students will have similar opportunities, Bredahl said.

    “I have about seven of them, and they are going to do a whole variety of things,” he says. “Some of them will work with me on cardiac tissue doing functional assessments. Some of them will do molecular assessment where we try to quantify how much damage is happening from storage, and others will do protein analysis to see if there is any change in regulatory protein expression.

    “It will basically be groups of three, and they will have their own research project and every one of them will have something that they can present, hopefully something that they can publish and give them experience that will be second to none.”

    Creighton University

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  • Clinical Outcomes of more than 500 Lung Transplants using Ex vivo Lung Perfusion: A Large-Volume, Single-Center Retrospective Analysis

    Clinical Outcomes of more than 500 Lung Transplants using Ex vivo Lung Perfusion: A Large-Volume, Single-Center Retrospective Analysis

    Newswise — To compare the outcomes of patients receiving lungs transplanted after undergoing ex vivo lung perfusion (EVLP) versus those transplanted conventionally at the Toronto General Hospital, Aadil Ali, PhD, and coauthors looked at 14 years of data from the Toronto Lung Transplant Database. 

    Patients were separated based on whether they received lungs that underwent EVLP or whether they were transplanted conventionally (controls). They were matched 1:1 based on medical diagnosis, recipient status, recipient sex, recipient age, BMI, donor age, and calendar year. The group found no differences in the incidence of Primary Graft Dysfunction (PGD) Grade 3 at 72h, post-transplant mechanical ventilation, post-transplant hospital length of stay, intensive care unit (ICU) length of stay, allograft survival analysis, and CLAD-Free survival analysis.

    Dr. Ali and his associates report that “EVLP has been successfully incorporated in our program for more than a decade and is an effective method to expand the organ donor pool without compromising post-transplant outcomes.”

    Dr. Ali will present the results of this study Sunday, May 7, at the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting in Los Angeles.

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    Attribution to the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting is requested in all coverage.

     

    ABOUT AATS

    The American Association for Thoracic Surgery (AATS) is an international organization that encourages, promotes, and stimulates the scientific investigation of cardiothoracic surgery. Founded in 1917 by a respected group of the earliest pioneers in the field, its original mission was to “foster the evolution of an interest in surgery of the Thorax.” Today, the AATS is the premier association for cardiothoracic surgeons in the world and works to continually enhance the ability of cardiothoracic surgeons to provide the highest quality of patient care. Its more than 1,500 members have a proven record of distinction within the specialty and have made significant contributions to the care and treatment of cardiothoracic disease. Visit aats.org to learn more.

     

    American Association for Thoracic Surgery (AATS)

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  • Safety and Efficacy of Delaying Nighttime Lung Transplantation

    Safety and Efficacy of Delaying Nighttime Lung Transplantation

    Newswise — Lung transplantation is routinely performed at night because of the unpredictability of donor organ procurement. Late start-times for complex operations such as lung transplantation have been associated with adverse outcomes. There are numerous reasons that delaying transplantation to the morning is preferable: Rested teams perform better; the well-being of the entire team is affected by long after-hours work; and during the day, more help is available for any intraoperative complications. 

    But is it safe to wait? Can cross clamp and cold ischemia times be extended? How does delaying the surgery impact the outcomes?

    Samuel T. Kim and colleagues at the University of California Los Angeles hypothesized that for donors with cross clamp times occurring after 1:30 a.m., the recipient operation could be delayed until morning with acceptable outcomes. Consented adult lung transplant recipients from March 2018 to May 2022 with donor cross-clamp times between 1:30 a.m. and 5:00 a.m. were prospectively enrolled in this study (34 patients; Night cohort); and their skin incision times were set at 6:30 a.m. A control group was identified and included recipients of donors with cross clamp times occurring at any other time of day (68 patients; Day cohort).

    Dr. Kim and his team examined short- and medium-term outcomes, including early mortality, a composite of post-operative complications, lengths of stay (ICU and total), 1- and 3-yr survival,) and chronic lung allograft dysfunction at 3-years between the two groups. The results for each of these comparisons were statistically similar.

    The group concluded that lung transplant recipients with donor cross clamp times scheduled after 1:30 a.m. can have their operations delayed safely until 6:30 a.m. with acceptable outcomes. And in experienced lung transplant centers, adoption of such a policy may lead to alternative workflow and improved team well-being.

    Dr. Kim will present this study Saturday, May, 6, at the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting in Los Angeles.

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    Attribution to the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting is requested in all coverage.

     

    ABOUT AATS

    The American Association for Thoracic Surgery (AATS) is an international organization that encourages, promotes, and stimulates the scientific investigation of cardiothoracic surgery. Founded in 1917 by a respected group of the earliest pioneers in the field, its original mission was to “foster the evolution of an interest in surgery of the Thorax.” Today, the AATS is the premier association for cardiothoracic surgeons in the world and works to continually enhance the ability of cardiothoracic surgeons to provide the highest quality of patient care. Its more than 1,500 members have a proven record of distinction within the specialty and have made significant contributions to the care and treatment of cardiothoracic disease. Visit aats.org to learn more.

    American Association for Thoracic Surgery (AATS)

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  • The Early Outcome of Lung Transplantation from Donors who Tested Positive for COVID-19

    The Early Outcome of Lung Transplantation from Donors who Tested Positive for COVID-19

    Newswise — The effects of the COVID-19 pandemic have rumbled through every piece of society, and nowhere more dramatically than in the medical communities.

    Takashi Harano, MD, and colleagues at Keck Medicine, University of Southern California, analyzed lung transplantation data from April 2020 to June 2022, to identify the early outcomes for patients who received lungs from COVID-19–positive donors. 

    Of the 29,944 donors identified by the Organ Procurement and Transplantation Network/United Network for Organ Sharing during that time, 1,297 were COVID-19 positive (4.3%). Lungs were transplanted from 47 donors.

    The recipients of allografts from those 47 donors had higher Lung Allocation Scores and more frequently underwent double lung transplantation (43/47). The post-transplant length of hospital stay, needs of Extracorporeal membrane oxygenation at 72 hours after transplantation, and survival outcomes were comparable between the two groups.

    This study reports that carefully selected lung allografts from COVID-19–positive donors had comparable early post-transplant outcomes to the lung allografts from COVID-19-negative donors. 

    Dr. Harano will present the results of this study Saturday, May 6, at the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting in Los Angeles.

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    Attribution to the American Association for Thoracic Surgery (AATS) 103rd Annual Meeting is requested in all coverage.

     

    ABOUT AATS

    The American Association for Thoracic Surgery (AATS) is an international organization that encourages, promotes, and stimulates the scientific investigation of cardiothoracic surgery. Founded in 1917 by a respected group of the earliest pioneers in the field, its original mission was to “foster the evolution of an interest in surgery of the Thorax.” Today, the AATS is the premier association for cardiothoracic surgeons in the world and works to continually enhance the ability of cardiothoracic surgeons to provide the highest quality of patient care. Its more than 1,500 members have a proven record of distinction within the specialty and have made significant contributions to the care and treatment of cardiothoracic disease. Visit aats.org to learn more.

     

    American Association for Thoracic Surgery (AATS)

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  • Loyola University Medical Center hosts Flag Raising Ceremony to Commemorate Donors

    Loyola University Medical Center hosts Flag Raising Ceremony to Commemorate Donors

    Newswise — MAYWOOD, IL – In recognition of Donate Life Month, Loyola University Medical Center will host a ceremony to raise the Gift of Hope flag and light candles in honor of organ and tissue donors and their families. Loyola Medicine staff will gather at 12 p.m. Friday, April 21 with transplant recipients, their families and donor families to remember those who gave the gift of life and encourage others to become organ donors.

    “This flag raising ceremony is a wonderful way to honor those who, in the midst of immeasurable grief, have chosen to give the gift of life to others,” said Julie Fitzgerald, MD, Chair of Loyola University Medical Center’s Organ and Tissue Donation Committee. “Organ and tissue donation is truly the ultimate gift and provides the opportunity for something positive to come from tragedy.”

    Walter Wiegand and his family will be attending in memory of the donor who gave him a chance at a new life. Mr. Weigandreceived a heart transplant at Loyola on July 5, 2022 after two months on the waiting list. He says he and his family were organ donors themselves long before he needed a heart. “It’s horrible that for me to get this heart, someone died,” he said. “It really it humbles you, but then you have to remember the person is dead, so why not give the heart to someone where it can change their life?”

    As of December 2021, more than 100,000 people in the United States are on the waiting list for a life-saving organ, including nearly 4,000 in Illinois. Wiegand will also be participating in the ceremony to express his gratitude for all of the Loyola caregivers who helped him on his journey. “The doctors, the therapists, the nurses, they were all incredible. You cannot believe what it’s like to have people who are energetic, personable and kind when you’re there a long time. When I got the call from one of the heart transplant coordinators, all the nurses just jumped up and down and cheered. I think they were almost happier than I was. So it was incredible.”

    The event will also feature ambassadors from Gift of Hope which coordinates the organ and tissue donation process and provides education about the importance of organ and tissue donation to the public and healthcare professionals in Illinois and northwest Indiana.

    Loyola Medicine

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  • American Society of Nephrology Statement on the United Network for Organ Sharing Clarifying Promise to Living Donors

    American Society of Nephrology Statement on the United Network for Organ Sharing Clarifying Promise to Living Donors

    Newswise — The American Society of Nephrology (ASN) is grateful that the United Network for Organ Sharing (UNOS) has responded to urgent requests from living donors, patients, their families, and ASN, to commit to honoring promises to living donors in its forthcoming new kidney allocation system.

    Kidneys donated by a living donor confer the best outcomes for people with kidney failure and can uniquely help address the gap between wait-listed patients and kidneys from deceased donors. At present, approximately 75,000 Americans are wait-listed for a kidney, yet fewer than 6,500 people became a living donor in 2022.

    More than 37 million Americans suffer from chronic kidney conditions and acute diseases that impact virtually every aspect of their lives as well as their families and communities.

    “Living donors deserve more support than the current system provides for them, not less,” said ASN President Michelle A. Josephson, MD, FASN, in a recent letter urging UNOS to clarify its position regarding living donors. Dr. Josephson “implored OPTN to clarify that it would continue to honor commitments to ensure rapid access to a kidney to prior living kidney donors and extend that commitment to future living kidney donors, should the donors ever need a kidney transplant themselves.”

    “I am grateful to OPTN for addressing calls from concerned patients and other advocates, including ASN,” she added. ASN appreciates UNOS and the Organ and Procurement and Transplantation Network’s commitment to working towards a kidney allocation system that delivers a more equitable approach to matching kidney candidates and donors, and stands ready to work with UNOS, OPTN, and the OPTN Kidney and Pancreas Committees to achieve this goal.

     

    About ASN

    Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge and advocating for the highest quality care for patients. ASN has more than 20,000 members representing 132 countries. For more information, visit www.asn- online.org and follow us on Facebook, Twitter, LinkedIn, and Instagram.

    American Society of Nephrology (ASN)

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  • ARVO Foundation Announces 2022 Point of View Award Winner

    ARVO Foundation Announces 2022 Point of View Award Winner

    Newswise — Rockville, Md.—The Association for Research in Vision and Ophthalmology (ARVO) congratulates Tasneem Khatib DM, FRCOphth—recipient of the 2022 Point of View Award.

    Established by the Point of View Foundation (Fundació Punt de Vista), the award provides a $20,000 cash prize in recognition of an outstanding scholarly article related to efforts to restore vision through regenerative ophthalmology, biotechnology, whole eye transplantation or other approaches. Khatib’s article is entitled:

    • Receptor-ligand replacement via a self-cleaving 2A peptide-based gene therapy promotes CNS axonal transport with functional recovery; Science Advances; March 31, 2021 (Corresponding author: Keith Martin, MA, DM, MRCP, FRCOphth, FRANZCO, FARVO)

    “The axons of nerve cells function like a railway system, where the cargo is essential components required for the cells to survive and function,” noted Khatib. “In neurodegenerative diseases, this railway system can get damaged or blocked. We reasoned that replacing two molecules that we know work effectively together would help to repair this transport network more effectively than delivering either one alone, and that is what we found. Rather than using the standard gene therapy approach of replacing or repairing damaged genes, we used the technique to supplement these molecules in the retina…The combined approach leads to a much more sustained therapeutic effect, which is very important for a treatment aimed at a chronic degenerative disease.”

    “We are very honoured to receive this award which will help us to continue to develop translatable therapies for patients with blinding disease,” says Khatib. “While this paper reports early stage research, we believe it shows promise for helping to treat neurodegenerative diseases that have so far proved intractable. Gene therapy has already proved effective for some rare monogenic conditions, and we hope it will be similarly useful for these more complex diseases which are much more common.”

    Khatib completed her doctoral research in neurobiology and glaucoma at the Centre for Brain Repair (University of Cambridge) and her ophthalmology residency at Cambridge University Hospitals NHS Foundation Trust. She then undertook further subspecialty surgical fellowship training in glaucoma at Moorfields Eye Hospital, London. Currently, she is a postdoctoral scholar at Byers Eye Institute (Stanford Medicine) in Stanford, Calif.

    For more information about the Point of View Award, visit ARVO’s website

    # # #

    The Association for Research in Vision and Ophthalmology (ARVO) is the largest eye and vision research organization in the world. Members include approximately 10,000 eye and vision researchers from over 75 countries. ARVO advances research worldwide into understanding the visual system and preventing, treating and curing its disorders. Learn more at ARVO.org.

    Established in 2001, the ARVO Foundation for Eye Research raises funds through partnerships, grants and sponsorships to support ARVO’s world-class education and career development resources for eye and vision researchers of all stages of career and education. Learn more at ARVOFoundation.org.

    Based in Spain, the Point of View Foundation (Fundació Punt de Vista) is dedicated to advancing scientific research related to disease and injuries of the eye and visual system. To learn more about their work, visit the Fundació Punt de Vista website.

    Association for Research in Vision and Ophthalmology (ARVO)

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  • The Society of Thoracic Surgeons 59th Annual Meeting – January 20-23, San Diego

    The Society of Thoracic Surgeons 59th Annual Meeting – January 20-23, San Diego

    Newswise — Credentialed press representatives are invited to attend The Society of Thoracic Surgeons’ 59th Annual Meeting and Exhibition, which will include late-breaking scientific research, thought-provoking lectures, cutting-edge technologies, and innovative cardiothoracic surgery products. This meeting is the preeminent educational event in cardiothoracic surgery.

    When: Saturday, January 21, to Monday, January 23, 2023

    Where: San Diego Convention Center – Press office is Room 27A

    STS 2023 Highlights:

    • Scientific sessions that cover hot, top-of-mind subjects such as controversies in transplant practices, the future of coronary revasularization, and CABG vs. multivessel percutaneous intervention.
    • Keynote lectures from high-profile speakers:
      • Francisco G. Cigarroa, MD, a renowned transplant surgeon and the first Hispanic to be named Chancellor of The University of Texas System, will share his experiences as a third-generation physician. (Vivien T. Thomas Lecture, Saturday, January 21, 8-9 a.m. PT. Livestream available.)
      • Peter K. Smith, MD, from the Duke University School of Medicine, will describe the evolution of the evidence base available for treatment selection for coronary artery disease. (C. Walton Lillehei Lecture, Monday, January 23, 9-9:45 a.m. PT. Livestream available.)
      • Vivien Thomas Symposium will focus on putting diversity, equity, and inclusion into action and mitigating health disparities. (Monday, January 23, 2:45-3:45 p.m. PT.)
    • A recorded press briefing that spotlights some of the most exciting research from the meeting.

    More details are available in the Annual Meeting program: https://www.eventscribe.net/2023/STS/

    Registered reporters will have access to:

    • Complimentary meeting registration
    • Renowned experts within the cardiothoracic surgery specialty
    • Embargoed press materials, abstracts, and presentation slides, and recorded press briefing

    The press office (Room 27A) can be made available for media use upon request during meeting hours, Saturday, January 21 through Monday, January 23. If no STS staff member is present in the press office,

    Press releases and abstracts will be available in advance of the meeting. Please contact STS Media Relations staff directly to schedule interviews and locate experts before and during the meeting, as well as to learn more information on the guest lecturers.

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    Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing approximately 7,700 cardiothoracic surgeons, researchers, and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.

    The Society of Thoracic Surgeons

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  • Scars mended using transplanted hair follicles in Imperial College London study

    Scars mended using transplanted hair follicles in Imperial College London study

    Newswise — In a new study involving three volunteers, skin scars began to behave more like uninjured skin after they were treated with hair follicle transplants. The scarred skin harboured new cells and blood vessels, remodelled collagen to restore healthy patterns, and even expressed genes found in healthy unscarred skin.  

    The findings could lead to better treatments for scarring both on the skin and inside the body, leading to hope for patients with extensive scarring, which can impair organ function and cause disability.  

    Lead author Dr Claire Higgins, of Imperial’s Department of Bioengineering, said: “After scarring, the skin never truly regains its pre-wound functions, and until now all efforts to remodel scars have yielded poor results. Our findings lay the foundation for exciting new therapies that can rejuvenate even mature scars and restore the function of healthy skin.” 

    The research is published today in Nature Regenerative Medicine. 

    Hope in hair 

    Scar tissue in the skin lacks hair, sweat glands, blood vessels and nerves, which are vital for regulating body temperature and detecting pain and other sensations. Scarring can also impair movement as well as potentially causing discomfort and emotional distress. 

    Compared to scar tissue, healthy skin undergoes constant remodelling by the hair follicle. Hairy skin heals faster and scars less than non-hairy skin– and hair transplants had previously been shown to aid wound healing. Inspired by this, the researchers hypothesised that transplanting growing hair follicles into scar tissue might induce scars to remodel themselves. 

    To test their hypothesis, Imperial researchers worked with Dr Francisco Jiménez, lead hair transplant surgeon at the Mediteknia Clinic and Associate Research Professor at University Fernando Pessoa Canarias, in Gran Canaria, Spain. They transplanted hair follicles into the mature scars on the scalp of three participants in 2017. The researchers selected the most common type of scar, called normotrophic scars, which usually form after surgery. 

    They took and microscope imaged 3mm-thick biopsies of the scars just before transplantation, and then again at two, four, and six months afterwards. 

    The researchers found that the follicles inspired profound architectural and genetic shifts in the scars towards a profile of healthy, uninjured skin. 

    Dr Jiménez said: “Around 100 million people per year acquire scars in high-income countries alone, primarily as a result of surgeries. The global incidence of scars is much higher and includes extensive scarring formed after burn and traumatic injuries. Our work opens new avenues for treating scars and could even change our approach to preventing them.” 

    Architects of skin 

    After transplantation, the follicles continued to produce hair and induced restoration across skin layers. 

    Scarring causes the outermost layer of skin – the epidermis – to thin out, leaving it vulnerable to tears. At six months post-transplant, the epidermis had doubled in thickness alongside increased cell growth, bringing it to around the same thickness as uninjured skin.  

    The next skin layer down, the dermis, is populated with connective tissue, blood vessels, sweat glands, nerves, and hair follicles. Scar maturation leaves the dermis with fewer cells and blood vessels, but after transplantation the number of cells had doubled at six months, and the number of vessels had reached nearly healthy-skin levels by four months. This demonstrated that the follicles inspired the growth of new cells and blood vessels in the scars, which are unable to do this unaided. 

    Scarring also increases the density of collagen fibres – a major structural protein in skin – which causes them to align such that scar tissue is stiffer than healthy tissue. The hair transplants reduced the density of the fibres, which allowed them to form a healthier, ‘basket weave’ pattern, which reduced stiffness – a key factor in tears and discomfort. 

    The authors also found that after transplantation, the scars expressed 719 genes differently to before. Genes that promote cell and blood vessel growth were expressed more, while genes that promote scar-forming processes were expressed less. 

    Multi-pronged approach 

    The researchers are unsure precisely how the transplants facilitated such a change. In their study, the presence of a hair follicle in the scar was cosmetically acceptable as the scars were on the scalp. They are now working to uncover the underlying mechanisms so they can develop therapies that remodel scar tissue towards healthy skin, without requiring transplantation of a hair follicle and growth of a hair fibre. They can then test their findings on non-hairy skin, or on organs like the heart, which can suffer scarring after heart attacks, and the liver, which can suffer scarring through fatty liver disease and cirrhosis. 

    Dr Higgins said: “This work has obvious applications in restoring people’s confidence, but our approach goes beyond the cosmetic as scar tissue can cause problems in all our organs. 

    “While current treatments for scars like growth factors focus on single contributors to scarring, our new approach tackles multiple aspects, as the hair follicle likely delivers multiple growth factors all at once that remodel scar tissue. This lends further support to the use of treatments like hair transplantation that alter the very architecture and genetic expression of scars to restore function.” 

    This work was funded by the Medical Research Council and Engineering and Physical Sciences Research Council (part of UKRI). 

    Imperial College London

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  • Inoculation from the vaccine does not transfer over to blood transfusion patient

    Inoculation from the vaccine does not transfer over to blood transfusion patient

    Fact Check By:
    Newswise

    Truthfulness: False

    Claim:

    The parents of Baby Will are right to insist on unvaccinated blood. The safety of the blood supply is unknown. We have a medical community which is not trustable on anything vax related.

    Claim Publisher and Date: Steve Kirsch, among others on 2022-12-04

    In New Zealand, the parents of a baby who needs life-saving open heart surgery insist that his blood transfusion comes from donors who haven’t had the COVID-19 vaccine. Anti-vaccine campaigners have recently used this case to focus on the lingering claim that those who have not been vaccinated against COVID-19 have “clean blood” or “pure blood” and that it’s dangerous for them to receive a transfusion from someone who is vaccinated.  For example, anti-vaccine activist Steve Kirsch claims that because of COVID-19 vaccination, “The safety of the blood supply is unknown.” The parents of the baby have appeared on far-right conspiracy theorist Alex Jones’ Infowars podcast, defending their position. 

    The claim is completely false. Blood from an inoculated person cannot transfer any of the messenger RNA to the blood recipient. The vaccines that are available in the U.S. would not pose any risk of infecting either the recipient of the vaccine with the virus that causes COVID-19 or anyone who might receive a blood transfusion from that person, since none of the available vaccines use a live attenuated virus. The Association for the Advancement of Blood & Biotherapies have issued guidance to help doctors answer patient questions on the issue.

    “There is absolutely no contraindication,” says Edward Michelson – Professor and Chairman, Department of Emergency Medicine, Paul L. Foster School of Medicine (PLFSOM), Texas Tech University Health Sciences Center El Paso.

    “There is no increased risk in receiving blood from vaccinated donors. When it comes to your medical care, you should listen to your doctor, not Alex Jones,” says Dr. Brian Labus, Assistant Professor, School of Public Health at the University of Nevada, Las Vegas. 

     

     

    Newswise

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  • Livers have the potential to function for more than 100 years

    Livers have the potential to function for more than 100 years

    Key takeaways 

    • Understanding the characteristics of livers that live to 100 could potentially expand the donor pool by using older liver donors more often. 
    • New surgical techniques and advances in immunosuppression lead to better outcomes for patients receiving a liver from an older donor.  
    • Optimizing both donor and recipient factors allow for much greater longevity for certain livers. 

    Newswise — SAN DIEGO: There is a small, but growing, subset of livers that have been transplanted and have a cumulative age of more than 100 years, according to researchers from University of Texas (UT) Southwestern Medical Center, Dallas, and TransMedics, Andover, Massachusetts. They studied these livers to identify characteristics to determine why these organs are so resilient, paving the way for considering the potential expanded use of older liver donors. The research team presented their findings at the Scientific Forum of the American College of Surgeons (ACS) Clinical Congress 2022. 

    The researchers used the United Network for Organ Sharing (UNOS) STARfile to identify livers that had a cumulative age (total initial age at transplant plus post-transplant survival) of at least 100 years. Of 253,406 livers transplanted between 1990-2022, 25 livers met the criteria of being centurion livers—those with a cumulative age over 100 years. 

    “We looked at pre-transplant survival—essentially, the donor’s age—as well as how long the liver went on to survive in the recipient,” said lead study author Yash Kadakia, a medical student at UT Southwestern Medical School. “We stratified out these remarkable livers with over 100-year survival and identified donor factors, recipient factors, and transplant factors involved in creating this unique combination where the liver was able to live to 100 years.” 

    Centurion livers came from older donors 

    For these centurion livers, the average donor age was significantly higher, 84.7 years compared with 38.5 years for non-centurion liver transplants. The researchers noted that for a liver to make it to 100, they expected to find an older average donor age as well as healthier donors. Notably, the donors from the centurion group had lower incidence of diabetes and fewer donor infections. 

    “We previously tended to shy away from using livers from older donors,” said study coauthor Christine S. Hwang, MD, FACS, associate professor of surgery, UT Southwestern Medical Center. “If we can sort out what is special amongst these donors, we could potentially get more available livers to be transplanted and have good outcomes.”  

    There are 11,113 patients on liver transplant waiting list as of September 22, 2022.* As Dr. Hwang noted, using older liver donors more often could potentially expand the liver donor pool. 

    Further study details 

    Centurion liver donors had lower transaminases, which are enzymes that play a key role in the liver. Elevated transaminases can cause problems in liver transplantation. Additionally, the recipients of centurion livers had significantly lower MELD scores (17 for the centurion group, 22 for the non-centurion group). A higher MELD score indicates that a patient is more urgently in need of a transplant.  

    “The donors were optimized, the recipients were optimized, and it takes that unique intersection of factors to result in a really good outcome,” Mr. Kadakia said. 

    The researchers found that no grafts in the centurion group were lost to primary nonfunction or vascular or biliary complications. There was notably no significant difference in rates of rejection at 12 months between the centurion group and the non-centurion group. Further, outcomes for the centurion group had significantly better allograft and patient survival.  

    “The existence of allografts over 100 years old is revealing of the dramatic resilience of the liver to senescent events,” the study authors concluded.  

    “Livers are incredibly resilient organs,” said Mr. Kadakia. “We’re using older donors, we have better surgical techniques, we have advances in immunosuppression, and we have better matching of donor and recipient factors. All these things allow us to have better outcomes.” 

    Study coauthors are Malcolm MacConmara, MBBCh, FACS; Madhukar S. Patel, MD; Jigesh A. Shah, DO; Steven I. Hanish, MD, FACS; and Parsia A. Vagefi, MD, FACS. 

    Citation: Kadakia Y, et al. Centurion Livers — Making It to 100 with A Transplant, Scientific Forum, American College of Surgeons Clinical Congress 2022. 

    ________________________  

    * Data. Organ Procurement & Transplantation Network. Accessed September 23, 2022. Available at: https://optn.transplant.hrsa.gov/data/ (.)  

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    About the American College of Surgeons  

    The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. 

    American College of Surgeons (ACS)

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