Current Considerations for Multi-Organ Transplantation

The condition of chronic multi-organ disease is increasing with a significant number of patients reaching end-stage disease of more than one organ simultaneously. It is often difficult to ascertain which organ is the most critically in need of replacement or whether replacement of one organ would result in improvement of other organ function and whether a patient can survive or thrive with only one of the failing organs transplanted. Transplant centers having the capability of performing and managing multi-organ transplant surgeries are increasingly faced with the task of discerning how to address this scenario and balance the patient's needs with the availability of donor organs. Recent legislation, in fact, has attempted to control the use of simultaneous liver-kidney transplantation by changing allocation policy to require demonstration of certain kidney function parameters for a period after the liver transplant before a kidney can be allocated. Multi-organ transplantation also presents immunological and therapeutic challenges. The immunological response of the multi-organ recipient, receiving multiple organs from the same donor, differs (the acute and chronic rejection are usually milder) than that in single organ transplantation. This necessitates the modification of conventional immunotherapies. The immune mechanisms responsible for the modified response in multi-organ recipients are still very vague and require additional studies.

Mentioned above issues are exacerbated during the current Covid-19 pandemic, creating novel challenges in Covid-19 prevention, immunization, and adjusting or modifying the existing immunosuppression regimens in the multi-organ transplant recipients.

This Research Topic focuses on advancing the science of combined solid-organ transplants, including combined abdominal transplants, combined thoracic transplants, and the combination of transplanting thoracic and abdominal organs. Whilst addressing the topic of multi-organ transplants to provide insight on the current incidence and prevalence of multi-organ chronic disease and how transplant centers are addressing the needs of these very sick patients.

We welcome original research and review articles that examine:
• The incidence and prevalence of multi-organ end-stage disease
• Clinical indications and outcomes of multi-organ transplantation
• Deceased donor allocation and quality
• Multi-organ living donation
• Surgical procedures for multi-organ transplant to decrease complications and improve outcomes
• Immunology of multi-organ transplants and identification and prevention of rejection when multiple organs are transplanted
• Genetic factors influencing the success of multi-organ transplants and biomarkers that predict surgical and transplant outcomes

We invite the research and review papers on the basic, preclinical, and clinical studies in the multi-organ transplantation field. We believe that this Research Topic within Frontiers in Transplantation will be very timely, scientifically, and clinically innovative, and exciting.