COVID-19 in solid organ transplantation: an analysis of the impact on transplant activity and wait lists

The limited knowledge about COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), makes mortality figures hard to interpret in the undetermined prevalence of an asymptomatic infection. Treatments are currently being tested, but without proof of an effective vaccination, the fear of further detrimental outcomes, as a result of a second wave, persists. One of the main differences in the death toll among the various countries seems related to the different response to the outbreak: early measures of containment as lockdown, revealed their effectiveness in mitigating the virus spread, with the earliest the lockdown, the lower the death toll

Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment

Biliary lithiasis is a global disorder affecting nearly 20% of the world’s population, although most cases occur without symptoms. Gallbladder stones could move into the common bile duct after gallbladder contraction, causing acute cholecystitis. The progression of the acute disease can take different forms, from mild inflammation, treatable with oral antibiotics, to the most severe forms with septic shock or biliary peritonitis, requiring specific treatment. Liver function tests and abdominal ultrasound are generally sufficient for diagnostic purposes. The most commonly used antibiotic is penicillin, with piperacillin achieving the best results; alternatively, fluoroquinolones could also be used, although there is no univocal consensus and surgery remains the only definitive treatment. A prolonged antibiotic therapy after cholecystectomy seems inadvisable, except in severe cases and/or in the immuno-compromised patient, where it should be periodically evaluated to avoid antibiotic resistance and unnecessary use. This review presents an evidence-based analysis to describe the advantages and disadvantages of the available options for the treatment of biliary lithiasis and cholecystitis, from the pathophysiological mechanisms behind lithiasis formation and also covering the main diagnostic findings for biliary stones, recommending an approach tailored to the patient’s characteristics and to the team’s expertise

Obesity and bariatric intervention in patients with chronic renal disease

Obesity is associated with chronic metabolic conditions that directly and indirectly cause kidney parenchymal damage. A review of the literature was conducted to explore existing evidence of the relationship between obesity and chronic kidney disease as well as the role of bariatric surgery in improving access to kidney transplantation for patients with a high body mass index. The review showed no definitive evidence to support the use of a transplant eligibility cut-off parameter based solely on the body mass index. Moreover, in the pre-transplant scenario, the obesity paradox is associated with better patient survival among obese than non-obese patients, although promising results of bariatric surgery are emerging. However, until more information regarding improvement in outcomes for obese kidney transplant candidates is avail-able, clinicians should focus on screening of the overall frailty condition of transplant candidates to ensure their eligibility and addition to the wait list

Assessing kidney graft viability and its cells metabolism during machine perfusion

 Kidney transplantation is the golden treatment for end‐stage renal disease. Static cold  storage is currently considered the standard method of preservation, but dynamic techniques, such  as machine perfusion (MP), have been shown to improve graft function, especially in kidneys donated by extended criteria donors and donation after circulatory death. With poor organ quality  being a major reason for kidneys not being transplanted, an accurate, objective and reliable quality  assessment during preservation could add value and support to clinicians’ decisions. MPs are  emerging technologies with the potential to assess kidney graft viability and quality, both in the  hypothermic and normothermic scenarios. The aim of this review is to summarize current tools for  graft viability assessment using MP prior to implantation in relation to the ischemic damage.&nbsp

Living kidney donation: practical considerations on setting up a program

Living kidney donation represents the best treatment for end stage renal disease patients, with the potentiality to pre-emptively address kidney failure and significantly expand the organ pool. Unfortunately, there is still limited knowledge about this underutilized resource. The present review aims to describe the general principles for the establishment, organization, and oversight of a successful living kidney transplantation program, highlighting recommendation for good practice and the work up of donor selection, in view of potential short- and long-terms risks, as well as the additional value of kidney paired exchange programs. The need for donor registries is also discussed, as well as the importance of lifelong follow up

It is not only extending donor criteria: it is extending the donor pool. A cross-sectional survey from the European Society of Organ Transplantation

As part of the TLJ2.0 organised by the European Society of Organ Transplantation (ESOT), our working group surveyed transplant professionals’ attitudes towards expanding the donor pool, barriers and interventions to overcome these. The survey was posted for three weeks in July–August, 2020, via the ESOT’s social media platforms. A total of 135 participants, consisting mainly of surgeons (34%), transplant coordinators (30%), physicians (15%) and intensivists (4%) completed the survey (Table 1). Most respondents worked in the field for >20 years (34%), 6–10 years (20%) or 11–15 years (19%). The main European countries of practice were the Netherlands (16%), the United Kingdom (10%), Italy (8%), Sweden (7%) and Spain (4%) (Q1–3). History of cancer (Q4). The 88% felt that the history of leukaemia was not a contraindication to donate, although 15% suggested a multi-disciplinary team decision. Some stressed the need for explicit recipient consent (4%) or clearly stating the risks to the recipient (3%). Two respondents considered the history of leukaemia as a contraindication

Postoperative delirium in kidney transplant patients

Delirium, also known as acute brain failure, is a medical condition characterized by recent onset of confusion, fluctuating awareness, disorganized thought, with memory and attention impairment. Post-operative delirium (POD) generally arises 1 to 3 days after surgery, in 25-37% of the hospitalized patients and in > 65% of those admitted to intensive care unit [1]

Weight Loss and Sleep, Current Evidence in Animal Models and Humans

Sleep is a vital process essential for survival. The trend of reduction in the time dedicated to sleep has increased in industrialized countries, together with the dramatic increase in the prevalence of obesity and diabetes. Short sleep may increase the risk of obesity, diabetes and cardiovascular disease, and on the other hand, obesity is associated with sleep disorders, such as obstructive apnea disease, insomnia and excessive daytime sleepiness. Sleep and metabolic disorders are linked; therefore, identifying the physiological and molecular pathways involved in sleep regulation and metabolic homeostasis can play a major role in ameliorating the metabolic health of the individual. Approaches aimed at reducing body weight could provide benefits for both cardiometabolic risk and sleep quality, which indirectly, in turn, may determine an amelioration of the cardiometabolic phenotype of individuals. We revised the literature on weight loss and sleep, focusing on the mechanisms and the molecules that may subtend this relationship in humans as in animal models