6. Summary Hepatitis B or C infection is not an absolute contraindication for orthotopic heart transplantation. The National Health Service Blood and Transplant (NHSBT) organ donation statistics (2012-2013) clearly delineate the modest size of heart transplant program in UK compared to other organ transplantation processes: kidneys (n = 1750), liver (n = 775), lungs (n = 187), and heart (n = 142). Given the scarcity of donor organs and only limited evidence available on long-term survival outcome in this cohort, no clear recommendations can be made to list these patients for heart transplantation. The introduction of newer antiviral treatments in the treatment of hepatitis B and hepatitis C infection before and after transplantation seems promising but again their long-term effect is yet to be established. The hepatitis B drugs entecavir and tenofovir both have a high genetic barrier to the development of drug resistance but there is limited data available on their use in the cardiac transplant setting. There is currently no data available on the use of the new protease inhibitors for genotype I hepatitis C infection. Large multicentre randomised controlled trials with different antiviral therapies and immunosuppressive treatments are needed to resolve this issue and investigate the potential drug-drug interactions that may occur. Until then each case should be discussed on an individual basis. Author Contribution Dr. Baskar Sekar did the concept/design, data analysis/interpretation, and drafting of the paper; Dr. Pippa J. Newton did the data analysis/interpretation and critical revision and approved the paper; Dr. Simon G. Williams did the data analysis/interpretation and critical revision and approved the paper; Dr. Steven M. Shaw did the data analysis/interpretation and critical revision and approved the paper.
Delayed graft function (DGF) is an important complication of kidney transplantation (KTx) that adversely affects allograft survival. Despite substantial improvements in the field of KTx, the incidence of DGF is rising with the growing practice of accepting expanded criteria donors to increase transplantation rates [1�C6]. Delayed graft function predisposes kidney graft to acute and chronic rejection, contributes to progressive allograft dysfunction, and increases the risk of premature graft loss [7�C11]. Reliable biomarkers enabling early discrimination of DGF in KTx are lacking, which impairs timely therapeutic interventions. Traditionally, acute graft dysfunction is diagnosed by measuring serum creatinine, but this parameter is an unreliable indicator of kidney function during an episode of acute injury [12]. One of the most promising biomarkers of acute kidney injury is neutrophil gelatinase-associated lipocalin (NGAL), which is released to blood from activated neutrophils during inflammatory processes. In steady situations, this lipocalin is found in urine only in trace.