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CEDIT |
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Centro de Documentación e Información en Trasplantes (CEDIT)
El Centro de Documentación e Información en Trasplantes (CEDIT) del CUCAIBA se crea por una disposición ministerial, en agosto de 1999, cuando la Comisión de Educación Permanente y Apoyo a la Investigación planteó entre sus objetivos la creación de un Centro de Documentación en Trasplantología.
El CEDIT está especializado en temas de donación, procuración y trasplante de órganos y tejidos, y abarca también otras temáticas del área de la medicina, bioética y social.
El CEDIT surge con el objetivo de dar respuesta a los requerimientos de capacitación y actualización de información científica por parte de los equipos de salud de la Institución. La complejidad de esta disciplina necesita de una educación permanente en el área, para estar actualizados con la documentación producida por los adelantos científicos. Por tal motivo es importante resaltar la colaboración con los investigadores y estudiosos en la actualización científica y en la producción y diseminación de trabajos sobre esta temática, como asimismo a las distintas áreas del CUCAIBA.
El CEDIT recibe revistas especializadas en donación, procuración y trasplante de órganos y tejidos, documentación sobre aspectos ético-sociales, memorias institucionales, etc., como asimismo las publicaciones internas del CUCAIBA.
El CEDIT participa de la Red Nacional de Información en Ciencias de la Salud (RENICS/Argentina), Red de la Asociación de Bibliotecas Biomédicas Argentinas (Bibliomed) y de la Red Latinoamericano y del Caribe de Información en Ciencias de la Salud (BIREME/OPS/OMS, San Pablo, Brasil).
Resumen de actividades 2010
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El Centro de Documentación e Información en Trasplantes (CEDIT) del CUCAIBA, está especializado en temas de donación, procuración y trasplante de órganos y tejidos, y abarca también otras temáticas del área de la medicina, bioética y social.
Brinda servicios a las distintas áreas del Cucaiba, el INCUCAI y sus Jurisdicciones, la comunidad y a estudiosos e investigadores de Instituciones que lo requieran, servicios que están reseñados en la web institucional del Cucaiba.
La documentación e información de fuentes de información confiables, que en distintos soportes se recibe, difunde y administra, conforma la colección bibliográfica. El Cedit apoya los objetivos y actividades que cumple el Cucaiba, colaborando permanentemente con las necesidades de información y documentación, especialmente en tareas de apoyo en el estudio e investigación de su personal y directivos, facilitando su acceso y recuperación, como así también su diseminación selectiva, debido al carácter multidisciplinario de los temas que trata la trasplantología.
El Cedit obtuvo en el año 2005, el Código Internacional otorgado por BIREME/OPS/OMS, San Pablo, Brasil, organismo coordinador de la Red Latinoamericana y del Caribe de Ciencias de la Salud, iniciando sus actividades en la redes de información en salud. Actualmente participa en carácter de centro cooperante, en la Red Nacional de Información en Ciencias de la Salud (RENICS/Argentina), Red de la Asociación de Bibliotecas Biomédicas Argentinas (Bibliomed) y en la Red Latinoamericano y del Caribe de Información en Ciencias de la Salud (BIREME/OPS/OMS, San Pablo, Brasil).
Se elabora anualmente el “Informe Anual de Gestión”. En el año 2010 se brindaron entre otros servicios: 198 consultas y se cumplieron 591 pedidos de artículos científicos. Las consultas fueron de Capital Federal, La Plata y localidades de las provincias de Buenos Aires, Córdoba, San Juan, Santa Fe, Tierra del Fuego, Chaco, Misiones, Tucumán, Formosa y Jujuy. .
**La comunicación con los usuarios virtuales de trasplantología, se realizó por intermedio del sitio Profesional en la Web Institucional, colaborando en su actualización y al mismo tiempo, llegando a cada usuario en forma periódica, con los servicios de Alerta Bibliografica y Alerta Informativa, realizando al mismo tiempo una Diseminación Selectiva de la Información.
* *Colaboró en apoyo a la tarea docente, recibiendo en cuatro visitas de estudio, un total de 74 alumnos de la carrera de Bibliotecología, procedentes de distintas localidades del país, acompañados por profesores del Instituto Superior de Formación Técnica y Docente N° 8, dependiente de la Dirección de Cultura y Educación de la Provincia de Buenos Aires. Estas visitas tuvieron un efecto multiplicador, porque fueron propicias para que el personal de área prensa y difusión, realizara charlas, evacuara consultas y entregara material didáctico sobre las actividades del CUCAIBA. *Se recibieron 223 fascículos en carácter de donación, enviados por el INCUCAI y el Laboratorio de Trasplante de Organos y Tejidos de la Facultad de Ciencias Médicas de la Universidad Nacional de La Plata, lo que permitió completar colecciones existentes.
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Los servicios que presta en la actualidad son:
- Consultas
- Alerta Bibliográfica:
Se remite periódicamente por correo electrónico, las Tablas de Contenido de las revistas de trasplante que se reciben periódicamente, por gentileza del INCUCAI y al mismo tiempo se envían copia de los trabajos solicitados.
- Alerta Informativa:
Se envía periódicamente información especializada en trasplante e información general identificada por el Cedit, como asimismo se colabora con las distintas áreas del CUCAIBA en la difusión de la información y documentación producida por el mismo.
-Búsquedas bibliográficas:
Se efectúan búsquedas bibliografías a solicitud, localización de documentos seleccionados y entrega de los mismos, sobre la temática trasplantológíca.
- Actualización periódica de la Web Institucional:
Se actualiza periódicamente la página profesional de la web institucional.
- Visitas de Estudio
Visitas de estudio de alumnos y profesores del Instituto Superior de Formación Docente y Técnica N° 8, dependiente de la Dirección General de Cultura y Educación de la Provincia de Buenos Aires, para conocer la organización y funcionamiento del Cedit. Estas visitas tienen un efecto multiplicador, porque son propicias, para que el personal del área de difusión, realice charlas, evacue consultas y entregue folletos sobre la actividad trasplantológica del CUCAIBA.
- Fotocopias
- Prestamos.
Toda esta información se encuentra a disposición en la pagina web institucional.
Los servicios pueden solicitarse por correo, teléfono, fax o e-mail al:
Centro de Documentación e Información en Trasplantes (CEDIT) del CUCAIBA
Calle 129 e/ 51 y 53 (El Dique)
Ensenada (CP 1925)
Provincia de Buenos Aires
Argentina
E-mail: cedit@cucaiba.gba.gov.ar
Visite nuestra web: www.cucaiba.gba.gov.ar
Tel (0221) 427 6070 Interno 211
Fax (0221) 425 0400
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A todos los interesados:
El CEDIT. CUCAIBA recibió y pone a su disposición, los trabajos contenidos en la revista "Transplantation Proceedings", 43(5), June 2011. Parte 1. Este contenido se presenta en dos formas: con citas bibliográficas y a continuación en el mismo orden con citas bibliográficas y resumenes. Agradeceremos que cuando seleccionen los artículos de su interes, en el pedido incluyan la dirección postal y lugar de trabajo. Gracias.
cedit@cucaiba.gba.gov.ar
Transplantation Proceedings
43(5), June 2011. Parte 1
Original Contribution
NEW PATHWAYS IN TRANSPLANTATION RESEARCH AND CLINICAL PRACTICE
1
Successful long-term use of sitagliptin for the treatment of new-onset diabetes mellitus after solid organ transplantation: a case report.
Pinelli NR, Nemerovski CW, Koelling TM.
Transplant Proc. 2011 Jun;43(5):2113-5
2.
Extracorporeal shockwave lithotripsy of ureteral stone in a patient with en bloc kidney transplantation: a case report.
Markic D, Valencic M, Grskovic A, Spanjol J, Sotosek S, Fuckar Z, Maricic A,
Pavlovic I, Budiselic B.
Transplant Proc. 2011 Jun;43(5):2110-2.
3.
Single transplanted kidneys from a 90-year-old deceased donor perform acceptably at 1 year.
Midtvedt K, Namtvedt T, Scott H, Abedini S, Rocke JC, Dørje C, Foss S, Christen
U, Hagness M, Hartmann A.
Transplant Proc. 2011 Jun;43(5):2107-9.
4.
A case report: hepatic posttransplant lymphoproliferative disorder in a non-liver transplant patient.
Koyun M, Hazar V, Akkaya B, Comak E, Gökçeoğlu AU, Doğan CS, Çubuk SM, Akman S.
Transplant Proc. 2011 Jun;43(5):2102-6.
5.
Eculizumab for the treatment of de novo thrombotic microangiopathy post simultaneous pancreas-kidney transplantation--a case report.
Chandran S, Baxter-Lowe L, Olson JL, Tomlanovich SJ, Webber A.
Transplant Proc. 2011 Jun;43(5):2097-101.
6.
Supradiaphragmatic approach for Budd-Chiari syndrome with transjugular intrahepatic portosystemic shunt stent in combination with inferior vena cava reconstruction during living donor liver transplantation: a case report.
Ogura Y, Kanazawa H, Yoshizawa A, Nitta T, Ikeda T, Uemoto S.
Transplant Proc. 2011 Jun;43(5):2093-6.
7.
Neo-suprahepatic cava: a case report of a modified technique for domino liver transplantation.
Padín JM, Pfaffen G, Pérez Fernández I, Sandi M, Ramisch D, Barros Schelotto P,
Gondolesi GE.
Transplant Proc. 2011 Jun;43(5):2090-2.
8.
End-stage liver cirrhosis with severe autoimmune hemolytic anemia, treated by blood type-incompatible living donor liver transplantation: a case report.
Sanefuji K, Ikegami T, Nagata S, Sugimachi K, Gion T, Uchiyama H, Soejima Y,
Taketomi A, Shirabe K, Maehara Y.
Transplant Proc. 2011 Jun;43(5):2087-9.
9.
Hepatic artery thrombosis after liver transplantation: three case reports.
Yang N, Zhang HB, Lu JH, Zhao J, Si-Ma H, Zhu N, Yang GS.
Transplant Proc. 2011 Jun;43(5):2082-6.
10.
Neutrophilic reversible airways dysfunction after liver transplantation: a case report.
Verleden GM, Vos R, De Vleeschauwer S, Verleden S, Dupont L, Nevens F, Verbeken
E, Vanaudenaerde BM.
Transplant Proc. 2011 Jun;43(5):2078-81.
11.
The use of terlipressin for management of dynamic left ventricular outflow tract obstruction complicating othotropic liver transplantation: a case report.
Mukhtar A, Aboulfetouh F, Salah M, Hamza A, Elmeteini M.
Transplant Proc. 2011 Jun;43(5):2075-7.
12.
Liver transplantation is possible in some patients with liver metastasis of colon cancer.
Uskudar O, Raja K, Schiano TD, Fiel MI, del Rio Martin J, Chang C.
Transplant Proc. 2011 Jun;43(5):2070-4.
13.
Liver transplantation to treat suspected hepatocellular carcinoma in iron-free foci in congenital hemochromatosis: case report.
Quante M, Benckert C, Thelen A, Uhlmann D, Bartels M, Moche M, Dollinger M,
Wittekind C, Jonas S.
Transplant Proc. 2011 Jun;43(5):2066-9.
14.
Successful lung retransplantation after extended use of extracorporeal membrane oxygenation as a bridge.
Shigemura N, Bermudez C, Bhama J, Bonde P, Thacker J, Toyoda Y.
Transplant Proc. 2011 Jun;43(5):2063-5.
15.
Minimally invasive resection of a right atrial mass in a cardiac transplant recipient: a case report.
Conradi L, Deuse T, Treede H, Seiffert M, Adam M, Koelble K, Costard-Jaeckle A,
Wagner FM, Reichenspurner H.
Transplant Proc. 2011 Jun;43(5):2059-62.
16.
Mycotic pseudoaneurysm of the ascending aorta after heart transplantation: case report.
Yamane K, Hirose H, Mather PJ, Silvestry SC.
Transplant Proc. 2011 Jun;43(5):2055-8.
17.
Transforming growth factor-β1 modulates lipopolysaccharide-induced cytokine/chemokine production and inhibits nuclear factor-κB, extracellular
signal-regulated kinases and p38 activation in dendritic cells in mice.
Mou HB, Lin MF, Huang H, Cai Z.
Transplant Proc. 2011 Jun;43(5):2049-52.
18.
Recipient type-sepcific engineered regulatory T cells prevent graft-vs-host disease after allogeneic bone marrow transplantation in mice.
Chen C, Cao J, Zeng L, Li Y, Wang D, Xu K.
Transplant Proc. 2011 Jun;43(5):2041-8.
19.
Antigen-specific T-regulatory cells can extend skin graft survival time in mice.
Yu S, Fu B, He X, Peng X, Hu A, Ma Y.
Transplant Proc. 2011 Jun;43(5):2033-40.
20.
Treatment of early avascular necrosis of femoral head by small intestinal submucosal matrix with peripheral blood stem cells.
Song HJ, Lan BS, Cheng B, Zhang KF, Yan HW, Wang WZ, Gao ZQ.
Transplant Proc. 2011 Jun;43(5):2027-32.
21.
Thalidomide attenuates graft arteriosclerosis of aortic transplant in a rat model.
Zhang Y, Yang M, Yang Y, Zheng SL, Cai Y, Xia P, Chen WW, Chen BC, Yang YR.
Transplant Proc. 2011 Jun;43(5):2022-6.
22.
Local application of rapamycin inhibits vein graft restenosis in rabbits.
Chen HL, Liu K, Meng XY, Wen XD, You QS.
Transplant Proc. 2011 Jun;43(5):2017-21.
23.
Nonsurgical periodontal therapy combined with laser and photodynamic therapies for periodontal disease in immunosuppressed rats.
Bottura PE, Milanezi J, Fernandes LA, Caldas HC, Abbud-Filho M, Garcia VG,
Baptista MA.
Transplant Proc. 2011 Jun;43(5):2009-16.
24.
The effect of human fetal liver-derived mesenchymal stem cells on CD34+ hematopoietic stem cell repopulation in NOD/Shi-scid/IL-2Rã(null) mice.
Yang HM, Cho MR, Sung JH, Yang SJ, Nam MH, Roh CR, Kim JM, Shin M, Song SH, Kwon CH, Joh JW, Kim SJ.
Transplant Proc. 2011 Jun;43(5):2004-8.
25.
The use of a prostacyclin analog, iloprost, as an adjunct to uterus preservation with histidine-tryptophan-ketoglutarate solution.
Barun S, Özat M, Güngor T, Demiroğullari B, Sökmensüer LK, Aksakal FN, Erçin U,
Gülbahai Ö, Müftüoğlu S.
Transplant Proc. 2011 Jun;43(5):1998-2003.
26.
Immunoregulation effect by overexpression of heme oxygenase-1 on cardiac xenotransplantation.
Shen Z, Teng X, Qian X, He M, Hu Y, Ye W, Huang H, Yu Y, Chen Y.
Transplant Proc. 2011 Jun;43(5):1994-7.
27.
Effect of CD4+ memory T cells on rejection response of ectopic heart transplantation in mice.
Zhao Y, Shan Z, Li Q, Zhou Y, Zeng X, Fan Q, Liao C, Zhu Y, Zhao Y, Lu X, Liu J.
Transplant Proc. 2011 Jun;43(5):1989-93.
28.
Tranilast prevents the progression of chronic cyclosporine nephrotoxicity through
regulation of transforming growth factor β/Smad pathways.
Tao Y, Hu L, Li S, Liu Q, Wu X, Li D, Fu P, Wei D, Luo Z.
Transplant Proc. 2011 Jun;43(5):1985-8.
29.
Heme oxygenase-1 expression and its significance for acute rejection following kidney transplantation in rats.
Li SD, Wang L, Wang KY, Liang P, Wu G, Zhang KQ, Li QS, Jin FS.
Transplant Proc. 2011 Jun;43(5):1980-4.
30.
Antibody-mediated response in rat liver chronic rejection.
Wan R, Ying W, Zeng L, Deng X, Chen H, Gao L.
Transplant Proc. 2011 Jun;43(5):1976-9.
31.
Expression of glucocorticoid-induced tumor necrosis factor receptor ligand in rat graft after liver transplantation.
Wei S, Li J, Lian Z, Chen Y, Liu Z, You H, Gong J.
Transplant Proc. 2011 Jun;43(5):1971-5.
32.
CXCR1 deficiency does not alter liver regeneration after partial hepatectomy in mice.
Sakai N, Kuboki S, Van Sweringen HL, Tevar AD, Schuster R, Blanchard J, Edwards
MJ, Lentsch AB.
Transplant Proc. 2011 Jun;43(5):1967-70.
33.
Interleukin-23 promotes natural killer T-cell production of IL-17 during rat liver transplantation.
Liu XC, Zhai A, Li JQ, Qi HZ.
Transplant Proc. 2011 Jun;43(5):1962-6.
34.
Porcine partial liver transplantation without veno-venous bypass: an effective model for small-for-size liver graft injury.
Fu Y, Zhang HB, Yang N, Zhu N, Si-Ma H, Chen W, Zhao WC, Yang GS.
Transplant Proc. 2011 Jun;43(5):1953-61.
35.
Cytomegalovirus infection in mesenchymal stem cells and their activation could be enhanced by nuclear factor-κB inhibitor pyrrolidinedithiocarbamate in vitro.
Wei G, Lin M, Cai Z, Huang H.
Transplant Proc. 2011 Jun;43(5):1944-9.
36.
Early posttransplantation hemoglobin level corresponds with chronic renal dysfunction in heart transplant recipients.
Zhang R, Georgiou M, Gwinner W, Zardo P, Haverich A, Bara C.
Transplant Proc. 2011 Jun;43(5):1939-43.
37.
Dry eye disease in chronic graft-versus-host disease: results from a Spanish retrospective cohort study.
de la Parra-Colín P, Agahan AL, Pérez-Simón JA, López A, Caballero D, Hernández
E, Barrientos-Gutierrez T, Calonge M.
Transplant Proc. 2011 Jun;43(5):1934-8.
38.
Basiliximab for the treatment of steroid-refractory acute graft-versus-host disease after unmanipulated HLA-mismatched/haploidentical hematopoietic stem cell
transplantation.
Wang JZ, Liu KY, Xu LP, Liu DH, Han W, Chen H, Chen YH, Zhang XH, Zhao T, Wang Y,
Huang XJ.
Transplant Proc. 2011 Jun;43(5):1928-33.
39.
Autologous stem cell transplantation for systemic lupus erythematosus: report of efficacy and safety at 7 years of follow-up in 17 patients.
Song XN, Lv HY, Sun LX, Meng JB, Wang JK, Zhang JQ, Chang YJ.
Transplant Proc. 2011 Jun;43(5):1924-7
40.
Correlation between the kinetics of CD3+ chimerism and the incidence of graft-versus-host disease in patients undergoing allogeneic hematopoietic stem
cell transplantation.
Rupa-Matysek J, Lewandowski K, Nowak W, Sawiński K, Gil L, Komarnicki M.
Transplant Proc. 2011 Jun;43(5):1915-23.
41.
Complications of endomyocardial biopsy in heart transplant patients: a retrospective study of 2117 consecutive procedures.
Saraiva F, Matos V, Gonçalves L, Antunes M, Providência LA.
Transplant Proc. 2011 Jun;43(5):1908-12.
42.
Rapid decline in glomerular filtration rate during the first weeks following heart transplantation.
Hornum M, Andersen M, Gustafsson F, Oturai P, Sander K, Mortensen SA,
Feldt-Rasmussen B.
Transplant Proc. 2011 Jun;43(5):1904-7.
43.
Soluble tumor necrosis factor-like weak inducer of apoptosis plasma levels as a novel biomarker of endothelial function in prevalent orthotopic heart transplant recipients.
Przybylowski P, Malyszko JS, Malyszko J.
Transplant Proc. 2011 Jun;43(5):1900-3.
44.
Long-term maintenance therapy for post-cardiac transplant monoclonal lymphoproliferative disorder: caveat mammalian target of rapamycin.
Khalpey Z, Miller DV, Schmitto JD, Kushwaha SS.
Transplant Proc. 2011 Jun;43(5):1893-9.
45.
Prophylaxis of cytomegalovirus disease in mismatched patients after heart transplantation using combined antiviral and immunoglobulin therapy.
Czer LS, Ruzza A, Vespignani R, Rafiei M, Pixton JR, Awad M, De Robertis M, Wong
AV, Trento A.
Transplant Proc. 2011 Jun;43(5):1887-92.
46.
Effect of pulmonary hypertension in patients with end-stage lung disease on posttransplantation outcomes.
Omari MK, Smith SA, Jacobsen G, Kaza V.
Transplant Proc. 2011 Jun;43(5):1881-6.
47.
Tumor necrosis factor-related apoptosis-inducing ligand is a marker of kidney function and inflammation in heart and kidney transplant recipients.
Malyszko J, Przybylowski P, Malyszko J, Koc-Zorawska E, Mysliwiec M.
Transplant Proc. 2011 Jun;43(5):1877-80.
48.
Combined heart and kidney transplantation provides an excellent survival and decreases risk of cardiac cellular rejection and coronary allograft vasculopathy.
Raichlin E, Kushwaha SS, Daly RC, Kremers WK, Frantz RP, Clavell AL, Rodeheffer
RJ, Larson TS, Stegall MD, McGregor C, Pereira NL, Edwards BS.
Transplant Proc. 2011 Jun;43(5):1871-6.
49.
Treatment of intractable interstitial lung injury with alemtuzumab after lung transplantation.
Kohno M, Perch M, Andersen E, Carlsen J, Andersen CB, Iversen M.
Transplant Proc. 2011 Jun;43(5):1868-70.
50.
Increased incidence of acute graft rejection on calcineurin inhibitor-free immunosuppression after heart transplantation.
Celik S, Doesch AO, Konstandin MH, Kristen AV, Ammon K, Sack FU, Schnabel P,
Katus HA, Dengler TJ.
Transplant Proc. 2011 Jun;43(5):1862-7.
51.
Efficacy and safety of sirolimus and everolimus in heart transplant patients: a retrospective analysis.
Baur B, Oroszlan M, Hess O, Carrel T, Mohacsi P.
Transplant Proc. 2011 Jun;43(5):1853-61.
52.
Calcineurin inhibitor-free immunosuppression using everolimus (Certican) after heart transplantation: 2 years' follow-up from the University Hospital Münster.
Stypmann J, Engelen MA, Eckernkemper S, Amler S, Gunia S, Sindermann JR,
Rothenburger M, Rukosujew A, Drees G, Welp HA.
Transplant Proc. 2011 Jun;43(5):1847-52.
53.
Everolimus plus dosage reduction of cyclosporine in cardiac transplant recipients with chronic kidney disease: a two-year follow-up study.
Fuchs U, Zittermann A, Hakim-Meibodi K, Börgermann J, Schulz U, Gummert JF.
Transplant Proc. 2011 Jun;43(5):1839-46.
54.
Quantification of intraepithelial lymphocytes in normal pediatric small intestinal allograft and native ilea.
Liu L, Talmon G.
Transplant Proc. 2011 Jun;43(5):1831-5.
55.
Application of the paraboloidal model to assess mucosal changes following segmental intestinal transplantation in children.
Setty S, Wu SJ, Bogard A, Chejfec G, Carroll R, Benedetti E, John E, Setty A.
Transplant Proc. 2011 Jun;43(5):1823-30.
56.
Endothelin-1 markedly decreases the blood perfusion of transplanted pancreatic islets in rats.
Pettersson US, Henriksnäs J, Carlsson PO.
Transplant Proc. 2011 Jun;43(5):1815-20.
57.
Pretreatment with bilirubin protects islet against oxidative injury during isolation and purification.
Zhu HQ, Gao Y, Guo HR, Kong QZ, Ma Y, Wang JZ, Pan SH, Jiang HC, Dai WJ.
Transplant Proc. 2011 Jun;43(5):1810-4.
58.
31-Phosphorus magnetic resonance spectroscopy for dynamic assessment of adenosine triphosphate levels in pancreas preserved by the two-layer method.
Agrawal A, Bainbridge A, Powis S, Fuller B, Cady EB, Davidson BR.
Transplant Proc. 2011 Jun;43(5):1801-9.
59.
Myocardial perfusion is a useful screening test for the evaluation of cardiovascular risk in patients undergoing simultaneous pancreas kidney transplantation.
Ruparelia N, Bhindi R, Sabharwal N, Mason P, Klucniks A, Sinha S, Friend P,
Ormerod OJ.
Transplant Proc. 2011 Jun;43(5):1797-800.
60.
Effect of splenic artery embolization for splenic artery steal syndrome in liver transplant recipients: estimation at computed tomography based on changes in
caliber of related arteries.
Kim JH, Kim KW, Gwon DI, Ko GY, Sung KB, Lee J, Shin YM, Song GW, Hwang S, Lee
SG.
Transplant Proc. 2011 Jun;43(5):1790-3.
61.
Laparoscopic incisional hernia repair after solid-organ transplantation.
Scheuerlein H, Rauchfuss F, Gharbi A, Heise M, Settmacher U.
Transplant Proc. 2011 Jun;43(5):1783-9.
62.
Safety of ultra-rapid intravenous infusion of hepatitis B immunoglobulin in liver transplant recipients.
Hwang S, Yu YD, Park GC, Choi YI, Park PJ, Jung SW, Namgoong JM, Yoon SY, Ha HS, Hong JJ, Kim IO, Jeon MK, Ma JE, Choi SY, Yun JS, Jung DH, Song GW, Ha TY, Moon DB, Kimy KH, Ahn CS, Lee SG.
Transplant Proc. 2011 Jun;43(5):1780-2.
63.
Early diagnostic value of plasma PCT and BG assay for CRBSI after OLT.
Chen J, Wang Y, Shen Z, Zhu Z, Song Y, Han R.
Transplant Proc. 2011 Jun;43(5):1777-9.
64.
Chronic hepatic artery occlusion with collateral formation: imaging findings and outcomes.
Vaidya S, Dighe M, Bhargava P, Dick AA.
Transplant Proc. 2011 Jun;43(5):1770-6.
65.
Simultaneous surgical repair for combined biliary and arterial stenoses after liver transplantation.
Sommacale D, Rochas Dos Santos V, Dondero F, Francoz C, Durand F, Sibert A,
Paugam-Burtz C, Sauvanet A, Belghiti J.
Transplant Proc. 2011 Jun;43(5):1765-9.
66.
Update on biliary strictures in liver transplants.
Sibulesky L, Nguyen JH.
Transplant Proc. 2011 Jun;43(5):1760-4.
67.
Liver retransplantation in superobese patients: a single center experience.
Taner CB, Mughal D, Aranda-Michel J.
Transplant Proc. 2011 Jun;43(5):1757-9.
68.
Motivations and decision-making dilemmas of overseas liver transplantation: Taiwan recipients' perspectives.
Huang CH, Hu RH, Shih FJ, Chen HM, Shih FJ.
Transplant Proc. 2011 Jun;43(5):1754-6.
Citas bibliográficas y resúmenes:
1
Successful long-term use of sitagliptin for the treatment of new-onset diabetes mellitus after solid organ transplantation: a case report.
Pinelli NR, Nemerovski CW, Koelling TM.
Transplant Proc. 2011 Jun;43(5):2113-5
AIMS: To describe 2.5 years of exposure to sitagliptin on glycemic control,
immunosuppressive therapy, and adverse events following solid organ
transplantation.
CASE REPORT: A 63-year-old Caucasian male received an orthotopic heart
transplantation in June of 2006 secondary to idiopathic nonischemic
cardiomyopathy. He was diagnosed with new-onset diabetes mellitus after
transplantation (NODAT). Sitagliptin monotherapy was initiated in August 2007 and
continued for 2.5 years.
RESULTS: Hemoglobin A(1c) increased from 5.8% to 6.1%, but the recommended
glycemic target of <7% was maintained over time and improvements in fasting home
blood glucose monitoring values were achieved. Tacrolimus concentrations were not
altered. Only minor dose adjustments to tacrolimus and mycophenolate mofetil were
required. Maintenance corticosteroid dose remained unchanged and there was no
evidence of biopsy-proven acute rejection. No adverse events were reported.
DISCUSSION: This case report demonstrates that long-term sitagliptin treatment
for NODAT may be effective, safe, and well tolerated in solid organ transplant
recipients.
2.
Extracorporeal shockwave lithotripsy of ureteral stone in a patient with en bloc kidney transplantation: a case report.
Markic D, Valencic M, Grskovic A, Spanjol J, Sotosek S, Fuckar Z, Maricic A,
Pavlovic I, Budiselic B.
Transplant Proc. 2011 Jun;43(5):2110-2.
We report a case of ureterolithiasis in a patient with an en bloc kidney
transplantation, using extracorporeal shockwave lithotripsy (ESWL). The patient
presented with asymptomatic macrohematuria. Computed tomography revealed a
ureteral calculus just below the pyeloureteral junction with hydronephrosis of
the medially positioned kidney. Took two sessions of ESWL were required for
complete disintegration of the stone. At 3 years after successful treatment, the
patient has an excellent functioning and stone-free graft.
3.
Single transplanted kidneys from a 90-year-old deceased donor perform acceptably at 1 year.
Midtvedt K, Namtvedt T, Scott H, Abedini S, Rocke JC, Dørje C, Foss S, Christen
U, Hagness M, Hartmann A.
Transplant Proc. 2011 Jun;43(5):2107-9.
Most centers are reluctant to accept expanded criteria donors above 70 to 75
years of age. We accepted kidneys from a 90-year-old male and report the 1-year
outcome. The kidneys were used as single transplants and both had immediate graft
function. Recipient A was a 71-year-old male, with cold ischemia time of 4 hours
49 minutes. One rejection was successfully treated with intravenous
methylprednisolone. At 1 year, serum creatinine was 146 μmol/L with estimated
glomerular filtration rate (eGFR) 41 mL/min. Recipient B was a 79-year-old male
with known panel-reactive antibody positivity prior to transplantation. Cold
ischemia time was 10 hours 4 minutes. He experienced no rejections. At 1 year
serum-creatinine was 99 μmol/L with eGFR 63 mL/min. Both recipients performed a
surveillance biopsy at 1 year with identical findings: interstitial fibrosis and
tubular atrophy grade 1 with moderate to severe arteriolosclerosis. We conclude
that both kidneys performed acceptably 1 year after engraftment. The use of old
kidneys in old recipients gives them a properly functioning kidney and improves
quality of life. Longer observation is needed.
4.
A case report: hepatic posttransplant lymphoproliferative disorder in a non-liver transplant patient.
Koyun M, Hazar V, Akkaya B, Comak E, Gökçeoğlu AU, Doğan CS, Çubuk SM, Akman S.
Transplant Proc. 2011 Jun;43(5):2102-6.
Posttransplant lymphoproliferative disorder (PTLD) is the most common malignancy
in children after solid organ transplantation. We present a patient, who
developed Epstein-Barr virus (EBV)-related PTLD in the liver after renal
transplantation. A 10-year-old EBV-seronegative boy with cystinosis underwent a
living related preemptive renal transplantation. He received antiviral
prophylaxis with valacyclovir. At 5.5 months posttransplantation he displayed a
primary EBV infection with an high fever, hepatosplenomegaly, monocytosis, and
positive EBV DNA levels. Two months there after, a hypoechoic nodular 20-mm
lesion in the left lobe of liver was detected on abdominal ultrasonography,
performed because of anorexia and weight loss. EBV-DNA copy number was 7820
copies per milliliter. Liver biopsy showed a diffuse large B-cell lymphoma that
was compatible with PTLD. We stopped all immunosupressive agents other than
prednisolone. Chemotherapy consisting of two courses of cyclophosphamide,
vincristine, prednisolone, and adriamycin was followed by rituximab. Within 2
months, the lesion resolved and within 18 months, he was free of disease.
5.
Eculizumab for the treatment of de novo thrombotic microangiopathy post simultaneous pancreas-kidney transplantation--a case report.
Chandran S, Baxter-Lowe L, Olson JL, Tomlanovich SJ, Webber A.
Transplant Proc. 2011 Jun;43(5):2097-101.
A 34-year-old female recipient of a simultaneous pancreas-kidney transplant
presented 7 days posttransplant with acute renal allograft dysfunction,
thrombocytopenia, and microangiopathic hemolytic anemia. Renal biopsy revealed
acute antibody-mediated rejection (AMR) and acute thrombotic microangiopathy
(TMA). Clinical and laboratory manifestations, which had only partly responded to
treatment with daily plasma exchange and intravenous immunoglobulin, resolved
rapidly and completely to eculizumab (Soliris, Alexion Pharmaceuticals, Inc.,
Cheshire, Conn), a complement factor C5 antibody. De novo posttransplant TMA is a
rare and serious complication that can lead to graft loss in up to one third of
cases. This is the first report of successful treatment of de novo TMA with
eculizumab, which has previously shown benefit in recurrent atypical hemolytic
uremic syndrome as well as in refractory acute AMR. Targeted complement
inhibition offers the promise of a safe and effective therapeutic strategy in de
novo TMA, especially in light of recent evidence suggesting that genetic
mutations in complement regulatory proteins may predispose transplant recipients
to this serious disease.
6.
Supradiaphragmatic approach for Budd-Chiari syndrome with transjugular intrahepatic portosystemic shunt stent in combination with inferior vena cava reconstruction during living donor liver transplantation: a case report.
Ogura Y, Kanazawa H, Yoshizawa A, Nitta T, Ikeda T, Uemoto S.
Transplant Proc. 2011 Jun;43(5):2093-6.
Treatment of Budd-Chiari syndrome consists of medical management, surgical shunt,
transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation.
Liver transplantation is indicated only when other treatments have failed. A
36-year-old Japanese man underwent living-donor liver transplantation after
radiologic intervention procedures. Because of the position of the TIPS stent and
the damaged vascular lesion of Budd-Chiari syndrome, a supradiaphragmatic
approach was employed to achieve a safe total hepatectomy. Moreover, after
resection of damaged portion of the inferior vena cava (IVC), an artificial
vascular graft was utilized to fill the IVC gap. The postoperative course was
uneventful; no serious complications were experienced within 2 years after liver
transplantation. This supradiaphragmatic IVC approach and IVC reconstruction
technique emphasized the option of surgical techniques to decrease the operative
risk during liver transplantation for Budd-Chiari syndrome.
7.
Neo-suprahepatic cava: a case report of a modified technique for domino liver transplantation.
Padín JM, Pfaffen G, Pérez Fernández I, Sandi M, Ramisch D, Barros Schelotto P,
Gondolesi GE.
Transplant Proc. 2011 Jun;43(5):2090-2.
Domino liver transplantation, introduced in 1997, originally consisted of a graft
from a patient with familial amyloidotic polyneuropathy used as a donor for a
compatible recipient, thus increasing the pool of hepatic grafts for liver
transplantation. The aim of this report was to present a modification on the
technique for outflow reconstruction in domino liver transplantation first
proposed by Liu et al and Cescon et al. In this description we proposed a new
technique that differs from the one mentioned above by performing a
neo-suprahepatic cava, constructed using only an iliac vein graft, facilitating
the anastomosis as if it was a regular cadaveric liver transplant.
8.
End-stage liver cirrhosis with severe autoimmune hemolytic anemia, treated by blood type-incompatible living donor liver transplantation: a case report.
Sanefuji K, Ikegami T, Nagata S, Sugimachi K, Gion T, Uchiyama H, Soejima Y,
Taketomi A, Shirabe K, Maehara Y.
Transplant Proc. 2011 Jun;43(5):2087-9.
We present a case of successful living donor liver transplantation (LDLT) for
liver cirrhosis caused by hepatitis B virus with severe autoimmune hemolytic
anemia (AIHA) using an ABO-incompatible (ABOi) graft. The patient was a
47-year-old woman who had a history of ruptured esophageal varices, accumulation
of intractable ascites, frequent hepatic encephalopathy and severe anemia, with a
hemoglobin value of approximately 3 g/dL due to AIHA. We treated the patient by
LDLT using an ABOi liver graft. The treatment strategy included anti-CD20
antibody, plasma exchange and transfusion before LDLT. The patient's anemia
improved after surgery; she required only 2 units of irradiated red blood cell
concentrates-leukocytes reduced. The patient was discharged from the hospital on
postoperative day 35. Two years after surgery, the patient still shows normal
hepatic and hematological findings. The immunomodulation protocol for ABOi LDLT
was effective not only to avoid humoral reactions associated with ABOi LDLT, but
also those associated with AIHA.
9.
Hepatic artery thrombosis after liver transplantation: three case reports.
Yang N, Zhang HB, Lu JH, Zhao J, Si-Ma H, Zhu N, Yang GS.
Transplant Proc. 2011 Jun;43(5):2082-6.
OBJECTIVE: To explore the surgical techniques of hepatic artery reconstruction in
liver transplantation (OLT) and the choice of treatment for hepatic artery
thrombosis (HAT).
METHODS: We analyzed hepatic artery reconstructions based on 234 cadveric donor
liver transplantations and seven living related liver transplantations from April
2003 to February 2009. Anastomosis time was compared between the groups with
respect to vascular caliber. Interventional thrombolysis or early thrombectomy
and hepatic artery reconstruction was implemented in three HAT cases.
RESULTS: The hepatic artery anastomoses for vessels less than 3 mm in diameter (n
= 78) required 33.6 ± 21.3 minutes which were significantly greater compared with
those for vessels more than 3 mm in diameter (n = 163; 19.4 ± 7.4 minutes). Among
two patients (0.83%) who developed early HAT within the first week after the
operation, one was successfully treated by interventional thrombolysis, but the
other required an urgent conduit between the aorta and the graft after attempted
thrombolysis. Only one patient (0.41%) displayed a delayed HAT without special
management, but recovered liver function upon follow-up.
DISCUSSION: Early detection and proper revascularization measures can yield
satisfactory results after HAT.
10.
Neutrophilic reversible airways dysfunction after liver transplantation: a case report.
Verleden GM, Vos R, De Vleeschauwer S, Verleden S, Dupont L, Nevens F, Verbeken
E, Vanaudenaerde BM.
Transplant Proc. 2011 Jun;43(5):2078-81.
In the present case report we have described a 46-year-old female patient who
underwent a liver transplantation in 1998 for polycystic disease and developed a
syndrome of increasing dyspnea, with sputum production and a progressive decline
in pulmonary function [forced expiratory volume in one second (FEV(1)) (decreased
from 153% predicted to 87% predicted). Further examination revealed an impressive
tree in a bud pattern with diffuse peribronchiolar infiltrates on computed axial
tomographic scan of the thorax. Sputum cultures remained negative. Bronchoscopic
central airway biopsy specimens showed lymphocytic bronchitis; sputum induction
showed 92% neutrophils. This condition was similar to the bronchiolitis
obliterans syndrome after lung transplantation, although the specific
neutrophilic phenotype of bronchiolitis obliterans syndrome has recently been
renamed as neutrophilic reversible allograft/airway dysfunction, based on a
progressive decline in FEV(1), neutrophilic airway inflammation and its response
to neomacrolides. Additional azithromycin treatment resulted in complete recovery
in our patient, with normalization of FEV(1) and computed axial tomographic scan
of the thorax at 3 months after initiation. This case report suggests that
neutrophilic reversible allograft airway dysfunction can no longer be diagnosed
only after lung transplantation. Moreover, it demonstrates that this condition is
not always related to allograft rejection, but rather may be induced by
non-immunologic factors, which remain to be further investigated.
11.
The use of terlipressin for management of dynamic left ventricular outflow tract obstruction complicating othotropic liver transplantation: a case report.
Mukhtar A, Aboulfetouh F, Salah M, Hamza A, Elmeteini M.
Transplant Proc. 2011 Jun;43(5):2075-7.
We describe a patient with structurally normal heart who developed hemodynamic
instability during orthotropic liver transplantation caused by severe dynamic
left ventricular outflow tract obstruction. Successful management of this adverse
event was facilitated by the use of intravenous terlipressin. The case highlights
a role for terlipressin as a selective vasopressin receptor agonist with
subsequent effects on systemic vascular resistance.
12.
Liver transplantation is possible in some patients with liver metastasis of colon cancer.
Uskudar O, Raja K, Schiano TD, Fiel MI, del Rio Martin J, Chang C.
Transplant Proc. 2011 Jun;43(5):2070-4.
Liver metastases from colorectal cancer are an absolute contraindication for
liver transplantation. Aggressive therapy with liver resection and local
chemotherapy in selected patients may be able to provide long-term cure. Given
the risks of tumor recurrence, whether patients with post chemotherapy
complications leading to liver failure should be offered transplantation is a
challenging question in an era of limited organ availability. Herein we have
presented 2 cases of liver transplantation performed in patients with colorectal
cancer metastases treated with liver resection followed by hepatic artery
infusion chemotherapy leading to development of sclerosing cholangitis and
eventual liver failure. This report demonstrates that liver transplantation may
be an option in selected patients with colorectal cancer liver metastases that
have been well treated.
13.
Liver transplantation to treat suspected hepatocellular carcinoma in iron-free foci in congenital hemochromatosis: case report.
Quante M, Benckert C, Thelen A, Uhlmann D, Bartels M, Moche M, Dollinger M,
Wittekind C, Jonas S.
Transplant Proc. 2011 Jun;43(5):2066-9.
Hepatocellular carcinoma (HCC) commonly develops in cirrhotic or noncirrhotic
livers affected by congenital hemochromatosis. In patients with congenital
hemochromatosis and HCC, liver transplantation is a therapeutic option with a
5-year posttransplantation survival rate as high as 80%. Herein is reported
congenital hemochromatosis in a 37-year-old man. During a routine checkup, 2
liver nodules were detected. Signal characteristics at magnetic resonance imaging
indicated the presence of iron-free foci (IFF). The serum α-fetoprotein
concentration was within the range of normal, and repeated liver biopsy did not
show histomorphologic signs of malignancy but confirmed the presence of IFF in
surrounding siderosis. The patient was listed for liver transplantation with
match MELD (Model of End-Stage Liver Disease including exceptions) because of
suspected HCC. After 173 days on the waiting list, liver transplantation was
performed successfully. Histologic examination of the explanted liver confirmed 2
HCC lesions with a diameter of 0.9 cm in the exact projection as the IFF detected
at magnetic resonance imaging. At 20 months of rapamycin-based immunosuppression
therapy, there were no signs of HCC recurrence. This is, to our knowledge, the
first report of liver transplantation performed to treat suspected HCC based on
the finding of IFF in congenital hemochromatosis, with histopathologic
confirmation of the diagnosis of HCC after transplantation. According to this
case and the current literature, IFF in patients with congenital hemochromatosis
should be considered preneoplastic lesions vulnerable to possible development of
HCC.
14.
Successful lung retransplantation after extended use of extracorporeal membrane oxygenation as a bridge.
Shigemura N, Bermudez C, Bhama J, Bonde P, Thacker J, Toyoda Y.
Transplant Proc. 2011 Jun;43(5):2063-5.
Redo lung transplantation remains a major clinical challenge and its indication
for patients with early allograft dysfunction is difficult to determine. We
report a case of potentially fatal early allograft dysfunction owing to possible
acute cellular rejection after single lung transplantation in a patient who
underwent redo double lung transplantation after successful use of extracorporeal
membrane oxygenation as a bridge, which resulted in a successful outcome.
15.
Minimally invasive resection of a right atrial mass in a cardiac transplant recipient: a case report.
Conradi L, Deuse T, Treede H, Seiffert M, Adam M, Koelble K, Costard-Jaeckle A,
Wagner FM, Reichenspurner H.
Transplant Proc. 2011 Jun;43(5):2059-62.
Intracardiac thrombus formation usually occurs in the left-sided cavities of the
heart, most frequently in the presence of atrial fibrillation or cardiomyopathy.
We report the case of an initially unclear mass developing in the right atrium
(RA) of a heart transplant recipient, which was subsequently resected via a
minimally invasive surgical approach. Access via right anterior minithoracotomy
using videoscopic assistance allowed for uncomplicated RA thrombectomy in the
presented case, avoiding reentry sternotomy with the potential risk of cardiac
injury and without aortic cross-clamping or cardioplegic arrest. The patient is
doing fine with excellent graft function at the latest follow-up 4 months after
minimally invasive thrombectomy and 30 months after cardiac transplantation. To
the best of our knowledge, this is the first report describing minimally invasive
resection of a right atrial thrombus in a heart transplant recipient.
16.
Mycotic pseudoaneurysm of the ascending aorta after heart transplantation: case report.
Yamane K, Hirose H, Mather PJ, Silvestry SC.
Transplant Proc. 2011 Jun;43(5):2055-8.
Mycotic pseudoaneurysm of the ascending aorta is a rare but potentially
life-threatening complication after orthotopic heart transplantation. We present
a case of a 53-year-old man who developed a mycotic pseudoaneurysm of the
ascending aorta after orthotopic heart transplantation. The pseudoaneurysm was
surgically resected and the ascending aorta was replaced with allograft. The Gram
stain and multiple cultures of the pseudoaneurysm wall revealed that the
causative microorganism was coagulase-negative Staphylococcus. To the best of our
knowledge, this is the first case report that describes mycotic pseudoaneurysm
owing to coagulase-negative Staphylococcus infection after heart transplantation.
Although S aureus and Pseudomonas aeruginosa are common pathogens in previously
published literatures describing mycotic pseudoaneurysms in heart transplant
recipients, coagulase-negative Staphylococcus is aslo an important and virulent
pathogen that can cause mycotic aortic pseudoaneurysm in immunosuppressed
patients. Once diagnosed, aggressive surgical treatment with prudent operative
strategy, appropriate postoperative antibiotic therapy and close follow-up by
radiographic study are mandatory in managing patients with this potentially fatal
condition.
17.
Transforming growth factor-β1 modulates lipopolysaccharide-induced cytokine/chemokine production and inhibits nuclear factor-κB, extracellular
signal-regulated kinases and p38 activation in dendritic cells in mice.
Mou HB, Lin MF, Huang H, Cai Z.
Transplant Proc. 2011 Jun;43(5):2049-52.
Tolerogenic dendritic cells (DCs) are crucial for peripheral tolerance mediated
by a variety of cytokines, including transforming growth factor-β1 (TGF-β1). We
have observed that TGF-β1-treated DCs (TGFβ-DCs) were resistant to the maturation
stimulus of lipopolysaccharide (LPS) and that TGF-β1 down-regulated Toll-like
receptor 4 (TLR4) expression on DCs. The purpose of this study was to analyze
whether TGF-β1 affected the production of cytokines/chemokines and proteins in
the TLR4 signal transduction pathway following LPS stimulation. We observed that
TGF-β1 induced a significant increase in interleukin (IL)-10, impaired IL-12
secretion, and attenuated messenger RNA (mRNA) expression of chemokines CCL2,
CCL3, and CXCL10 in DCs following LPS administration. We also noted that TGF-β1
suppressed LPS-induced activation of nuclear factor (NF)-κB, extracellular
signal-related kinases (ERK)-1/2, and p38 in DCs. Taken together, our results
identified the suppressive effects of TGF-β1 on TLR4 signal transduction,
strengthening the notion that TGFβ-DCs are a unique type of tolerogenic DC
exhibiting distinct characteristics.
18.
Recipient type-sepcific engineered regulatory T cells prevent graft-vs-host disease after allogeneic bone marrow transplantation in mice.
Chen C, Cao J, Zeng L, Li Y, Wang D, Xu K.
Transplant Proc. 2011 Jun;43(5):2041-8.
Adoptive transfer of regulatory T cells (Tregs), in particular, recipient-type
specific Tregs (sTregs), represents a promising approach to prevent graft-vs-host
disease (GvHD) after allogeneic bone marrow transplantation. The objective of
this study was to investigate whether engineered sTregs could prevent GvHD after
bone marrow transplantation. Lentiviral vector forkhead box P3 (Foxp3)/pXZ9
containing Foxp3-IRES-GFP fragment and its mock control pXZ9 was constructed.
Lentiviruses were produced via transient 3-plasmid transfection. BALB/c
CD4+CD25-T cells were infected with lentiviruses and further stimulated using
anti-CD3ε and anti-CD28 antibody (engineered irrelevant-Tregs [irTregs]) or
C57BL/6 splenocytes (engineered sTregs). The expression of Tregs marks,
production of cytokines, cell proliferation rate, and suppression function of
Foxp3/pXZ9 infected cells were similar to natural Tregs. Irradiation BABL/c
recipient were injected with C57BL/6 donor T cell-depleted bone marrow (TCD-BM)
cells (1 × 10(7)) and C57BL/6 splenocytes (1 × 10(7)) together with engineered
sTregs, irTregs, or natural Tregs (5 × 10(6)). Irradiated BABL/c mice received
TCD-BM cells only, TCD-BM cells plus splenocytes, or splenocytes and
pXZ9-transduced cells (control). Recipient survival, short-term GvHD scores, and
the Th1 subpopulation were monitored. Recipients of a combination of TCD-BM cells
and splenocytes developed lethal GVHD. When engineered sTregs were added, 80% of
recipients survived at least 60 days after transplantation; this survival rate
was much higher than in any other group. The GvHD scores between the 3 Tregs
groups did not demonstrate significance. Compared with other sources of Tregs in
vivo, engineered sTregs strongly suppressed Th1 cell expansion. Therefore, a an
in vitro strategy was developed to generate engineered sTregs. These cells
demonstrated similar phenotypes and stable suppressive capacity as natural Tregs.
Like natural Tregs, co-injection of engineered Tregs protected recipients from
lethal GvHD in a murine model of GvHD. The engineered sTregs were superior to
irTregs in minimizing murine GvHD.
19.
Antigen-specific T-regulatory cells can extend skin graft survival time in mice.
Yu S, Fu B, He X, Peng X, Hu A, Ma Y.
Transplant Proc. 2011 Jun;43(5):2033-40.
This study investigated the effects of donor antigen-specific CD4(+)CD25(+)
T-regulatory cells (Tregs) on skin allografts in mice. An allogeneic skin
transplant model was established using donor C57BL/6 or DBA and recipient BALB/c
mice. Recipients were divided into 4 groups: control group without intervention
(CON; C57BL/6 to BALB/c), rapamycin gavage group (RAP; C57BL/6 to BALB/c),
CD4(+)CD25(+) Tregs-treated group (TRE; C57BL/6 to BALB/c), in which recipients
received transfusions of CD4(+)CD25(+) Tregs stimulated with C57BL/6-derived
immature dendritic cells, and the third-party donor group (DBA; DBA to BALB/c) in
which recipients received transfusions of BALB/c CD4(+)CD25(+) Tregs stimulated
with C57BL/6-derived immature dendritic cells. Mean (SD) survival time of the
skin allografts in the TRE group was 17.0 (3.4) days, significantly longer than
in the other groups: CON, 6.9 (1.9) days; RAP, 10.3 (3.0) days; and DBA, 10.8
(3.6) days. The TRE group demonstrated a significantly greater expression of
transforming growth factor-β and interleukin (IL)-10. Donor antigen-specific
CD4(+)CD25(+) Tregs effectively extend skin allograft survival in mice.
20.
Treatment of early avascular necrosis of femoral head by small intestinal submucosal matrix with peripheral blood stem cells.
Song HJ, Lan BS, Cheng B, Zhang KF, Yan HW, Wang WZ, Gao ZQ.
Transplant Proc. 2011 Jun;43(5):2027-32.
BACKGROUND: Avascular necrosis of the femoral head (ANFH) is a highly mutilating
disease. There are no effective ways to treat early femoral head ischemia.
Peripheral blood stem cell (PBSC) transplantation may be superior to conventional
bone marrow transplantation. Small intestinal submucosae matrix (SIS) is composed
of highly conserved collagens, glycoproteins, proteoglycans, and
glycoaminoglycans in their natural configuration and concentrations. When
implanted in a number of microenvironments in vivo, SIS has been used to induce
proliferation, remodeling, and regeneration of host tissues. This study was
designed to verify the curative effects of PBSC and SIS transplantation-induced
vascular regeneration to improve ischemic femoral head necrosis in rabbits.
METHODS: 32 New Zealand white rabbits underwent ischemic femoral head necrosis
modeling in both hindlimbs by liquid-nitrogen refrigeration. All rabbits were
intraperitoneally injected with grannlocytectomy-stimulating factor (250
μg/kg/d), except for normal control subjects injected with equivalent saline
solution. After separation of peripheral blood stem cells (PBSCs), 64 femoral
heads in 32 rabbits were randomly divided into 4 groups: group A, cancellous bone
and peripheral blood stem cells cultured with small intestinal submucosa; group
B, cancellous bone and PBSCs; group C, cancellous bone autografts; and group D,
no treatment. The specimens were harvested at 4 and 8 weeks after surgery. All
specimens were examined to observe angiogenesis and osteogenesis repairing the
avascular necrosis of the femoral head by using gross observation, x-ray,
histology, and immunohistochemical staining.
RESULTS: In 4 weeks after peripheral stem cell transplantation, the standing
ability and activity of the transplanted hindlimbs were improved remarkably, but
there were no obvious changes in the control limbs. X-rays showed a greater
density of grafts than the host bone in groups A,B, and group C was unchanged at
4 weeks. Histology revealed many osteoprogenitor cells and osteoblasts and no
inflammatory cell infiltration at 4 weeks with much new bone formed at 8 weeks in
group A and at 4 weeks in group B. The cancellous bone autograft was absorbed
completely at 8 weeks in group C. There was little osteoid tissue formed in group
D at 8 weeks. The zone of new bone formation in group A was greater than that in
group B (P < .05), but there was no significant difference between groups A and C
(P > .05). Immunohistochemical staining with CD31 mouse antibody showed greater
amounts and zones of new blood vessels in groups A and B at 4 and 8 weeks and
little evidence in group D. There was no significant difference between groups A
and B (P > .05) and significant differences between groups A and B versus C and D
(P < .05).
CONCLUSION: Transplantation of PBSCs cultured with SIS effectively improved
ischemic femoral head necrosis.
21.
Thalidomide attenuates graft arteriosclerosis of aortic transplant in a rat model.
Zhang Y, Yang M, Yang Y, Zheng SL, Cai Y, Xia P, Chen WW, Chen BC, Yang YR.
Transplant Proc. 2011 Jun;43(5):2022-6.
OBJECTIVE: The purpose of the current study was to evaluate the effects of
thalidomide on graft arteriosclerosis.
MATERIALS AND METHODS: Male Lewis rats received abdominal aorta grafts from male
Brown-Norway rats. The animals were divided into 4 groups: no treatment controls,
a low-dose group that received thalidomide (50 mg/kg per day), a middle dose
group that received thalidomide (100 mg/kg per day), and a high-dose group that
received thalidomide (200 mg/kg per day) by daily intragastric administration.
Rats were humanely killed at 60 days after surgery. The grafted aortas were
analyzed by histology, immunohistochemistry, and Western blot analysis. The serum
was analyzed by an enzyme-linked immunosorbent assay (ELISA).
RESULTS: The neointimal thickness of the thalidomide treated aortas was
significantly thinner compared with that of no treatment aortas (P < .05).
Vascular endothelial growth factor (VEGF), platelet-derived growth factor, and
intracellular adhesian molecule (ICAM-1) protein expression in the treatment
group were significantly lower than those in the control group (P < .05).
Moreover, thalidomide significantly inhibited the production of VEGF and ICAM-1
in serum (P < .05).
CONCLUSION: Our data suggested that thalidomide can attenuate graft
arteriosclerosis so as to protect aortic grafts.
22.
Local application of rapamycin inhibits vein graft restenosis in rabbits.
Chen HL, Liu K, Meng XY, Wen XD, You QS.
Transplant Proc. 2011 Jun;43(5):2017-21.
OBJECTIVE: The aim of this study was to investigate whether local application of
rapamycin reduced neointimal formation in a rabbit model of venous disease.
METHODS: Each rabbit (n = 30; 2.5-3.5 kg) received a treated and a control graft.
For the treated graft, 0.3 rapamycin mg was applied locally in Pluronic gel. The
control graft received only the Pluronic gel. Grafts were harvested at 28 days
for morphometric, immunohistochemical, and flow cytometry analysis.
RESULTS: In the control group, the intimal thickness was 63.72 ± 14.0 μm; in
treated group, it was 77.76 ± 14.9 μm (P < .05). Immunohistochemically,
proliferation cell nuclear antigen-positive cells were present in the control
group and in the treatment group but not in normal external jugular veins. The
control group showed much stronger expression than the treatment group (P < .05).
Flow cytometry showed, among the control group, decreased G(0)G(1)-stage cells
and increased S/G(2)M-stage cells. Among the treatment group, S/G(2)M stage cells
were decreased compared with the control. The progression indexes of the control
and treatment groups were 29.3 ± 7.15 and 20.1 ± 9.48, respectively, a remarkable
decrease (P < .05). Proliferating cells in the control group were apparently
inhibited by rapamycin. The treatment group showed positive staining for
P27(kip1), but neither the control group nor the normal external jugular veins
showed positive results (P < .05). The degree of reduction in intimal thickness
and inhibition of proliferating cells in the treatment group correlated with the
expression of P27(kip1).
CONCLUSIONS: We observed that perivascular application of rapamycin inhibited
neointimal hyperplasia of vein grafts in a rabbit model, an effect that appeared
to result from increased P27(kip1) expression.
23.
Nonsurgical periodontal therapy combined with laser and photodynamic therapies for periodontal disease in immunosuppressed rats.
Bottura PE, Milanezi J, Fernandes LA, Caldas HC, Abbud-Filho M, Garcia VG,
Baptista MA.
Transplant Proc. 2011 Jun;43(5):2009-16.
BACKGROUND: Periodontal disease is often associated with systemic diseases and is
characterized by destruction of the tissues supporting the teeth. Patients using
immunosuppressive drugs such as tacrolimus are among those who suffer from tissue
destruction.
OBJECTIVE: We sought to evaluate the effects of laser and photodynamic therapies
(PDT; nonsurgical) as an adjunct to scaling and rootplaning (SRP) in the
treatment of corona-induced periodontitis in rats immunosuppressed with
tacrolimus (Prograf).
MATERIALS AND METHODS: The animals were divided into 5 groups. Each groups had 6
rats. Group I, the control group, received only saline solution throughout the
study period of 42 days and did not receive periodontal treatment; group II
received saline solution and SRP; group III received tacrolimus (1 mg/kg per day)
and was treated with SRP; group IV animals were treated identically to group III
and then administered laser treatment; and in group V, the animals were treated
identically to group III and then administered PDT.
RESULTS: Statistical analysis indicated decreased bone loss with the progression
of time (P = .035). There was no difference between the bone loss associated with
the types of treatment administered to groups I, II, and III (P > .9) or groups
IV and V (P > .6). The analysis also indicated that immunosuppression was not a
bone loss-determining factor.
CONCLUSION: Laser and PDT therapies were effective as an adjunctive treatment to
SRP in reducing bone loss caused by experimental periodontitis induced in animals
being treated systemically with tacrolimus.
24.
The effect of human fetal liver-derived mesenchymal stem cells on CD34+ hematopoietic stem cell repopulation in NOD/Shi-scid/IL-2Rã(null) mice.
Yang HM, Cho MR, Sung JH, Yang SJ, Nam MH, Roh CR, Kim JM, Shin M, Song SH, Kwon CH, Joh JW, Kim SJ.
Transplant Proc. 2011 Jun;43(5):2004-8.
Mesenchymal stem cells (MSCs) are progenitors that are capable of differentiating
into mesenchymal tissues. They are known to support allogeneic hematopoietic stem
cell transplantation by facilitating engraftment without increasing the risk of
graft-versus-host disease. We optimized culture conditions for human fetal
liver-derived MSCs (hFL-MSCs) to investigate the role of hFL-MSCs on repopulation
of hematopoietic stem cells in NOD/Shi-scid/IL-2Rγ(null) (NOG) mice using CD34(+)
hematopoietic stem cells (HSCs) derived from umbilical cord blood (UCB). FL-MSCs
and CD34(+) HSCs were prepared from fetal liver and UCB, respectively.
Twenty-four hours after irradiation, CD34(+) HSCs and hFL-MSCs were injected
intravenously and intratibially into NOG mice. During 24 weeks
posttransplantation, engraftment levels of human cells were analyzed in bone
marrow, peripheral blood, and spleen of transplanted mice by flow cytometry.
hFL-MSCs showed a fibroblast-like morphology and immunophenotypic characteristics
appropriate for MSCs. hFL-MSCs prolonged the survival of NOG mice that had been
cotransplanted with UCB CD34(+) cells. Fluorescence-activated cell-sorting
analysis showed that engraftment of human cells was increased by
cotransplantation of hFL-MSCs. However, significant enhancement of human cell
engraftment was not detected in NOG mice regardless of the number of
cotransplanted MSCs. Although survival of repopulating NOG mice and engraftment
of human cells were prolonged by cotransplantation of hFL-MSCs, 8.0 × 10(6) MSCs
were not sufficient to increase HSC engraftment in irradiated NOG mice in vivo.
25.
The use of a prostacyclin analog, iloprost, as an adjunct to uterus preservation with histidine-tryptophan-ketoglutarate solution.
Barun S, Özat M, Güngor T, Demiroğullari B, Sökmensüer LK, Aksakal FN, Erçin U,
Gülbahai Ö, Müftüoğlu S.
Transplant Proc. 2011 Jun;43(5):1998-2003.
INTRODUCTION: Although assisted reproductive techniques have made most causes of
both male and female infertility treatable, uterine factor infertility is not
able to therapy. Therefore, transplantation of the uterus has been suggested as a
future possible cure. Organ preservation solutions seek to reduce reperfusion
injury. Since iloprost is an antioxidant with cytoprotective properties, we
investigated its potential positive effects in histidine-tryptophan-ketoglutarate
(HTK) solution after 4 or 24 h cold storage period of the rat uterus.
METHODS: We divided 24 female Wistar-albino rats into four groups: Group 1 had
the uterus tissue stored in HTK solution at 4 °C for 4h. Group 2, the tissue was
stored in HTK solution combined with iloprost (10(-8) M) for 4h at 4 °C. The same
procedures were repeated for 24 h for Groups 3 and 4 respectively. Tissue levels
of malondialdehyde (MDA) and nitric oxide (NO), as indicators of oxidative stress
were determined with histopathological evaluations.
RESULTS: MDA and NO levels were compared between the group 1 vs 3; and 2 vs 4. No
significant difference was observed between the groups. Cold storage for 24 h
produced alterations in histological appearences that were mitigated by the
addition of iloprost to HTK solution.
CONCLUSION: In conclusion, addition of iloprost to HTK solution reversed the
histological alterations after 24h-cold storage of the rat uterus.
26.
Immunoregulation effect by overexpression of heme oxygenase-1 on cardiac xenotransplantation.
Shen Z, Teng X, Qian X, He M, Hu Y, Ye W, Huang H, Yu Y, Chen Y.
Transplant Proc. 2011 Jun;43(5):1994-7.
OBJECTIVE: This study was designed to investigate the effect of the
overexpression of heme oxygenase-1 (HO-1) on the immunoregulation in the model of
abdominal cardiac xenotransplantation from the guinea pig to the rat.
MATERIALS AND METHODS: To increase the expression of HO-1, both donors and
recipients were injected with heme through the abdomen before the operation. The
donors (guniea pigs) and the recipients (Sprague-Dawley [SD] rats) were divided
randomly into three groups: group A, the heart from a guinea pig transplanted
into the abdomen of an SD rat; group B, the recipients were injected with Chinese
cobra venom factor (CVF) into the abdomen (40 μg/kg and 60 μg/kg 24 hours later)
prior to transplantation; group C, CVF + HO-1 high-expression group: donors and
recipients were abdominally injected with heme (75 μmol/kg for 2 days before
transplantation). The mean survival time (MST), pathological changes, the
positive area of HO-1 in the grafted hearts, as well as the expressions of C-C
chemokine receptor 5 (CCR5), intercellular adhesion molecule-1 (ICAM-1), and
natural killer (NK) cell activity in recipients.
RESULTS: 1. The MST was longest in group C treated with heme. 2. The pathologic
changes of hyperacute rejection were showed on the donor heart in group A, while
delayed xenograft rejection changes took place on donor heart in other groups. 3.
Compared with group B, The HO-1 positive area in the donor hearts of group C was
significantly higher. (P < .05). 4. The lever of ICAM-1 and CCR5 in the
peripheral blood of recipients (pg/mL) was attenuated in group C injected with
heme. 5. Compared with group B, the activity of NK cell in the peripheral blood
of recipients was much lower in group C (P < .05).
CONCLUSION: The MST was prolonged by increasing expressions of HO-1, but acute
vascular rejection was not completely overcome. Activation of vascular
endothelial cells could be decreased by strengthening the expression of HO-1. NK
cell activity was weakened by reinforced expression of HO-1.
27.
Effect of CD4+ memory T cells on rejection response of ectopic heart transplantation in mice.
Zhao Y, Shan Z, Li Q, Zhou Y, Zeng X, Fan Q, Liao C, Zhu Y, Zhao Y, Lu X, Liu J.
Transplant Proc. 2011 Jun;43(5):1989-93.
BACKGROUND: CD4(+) memory T cells mediate resistance of the body to infection by
exotic pathogens. This study investigated the effects of alloreactive CD4(+)
memory T cells on acute graft rejection responses toward ectopic hearts in the
abdominal cavities of mice.
METHODS: BALB/C mice were used as recipients and C57BL/6 mice as donors. The
animals in the CD4(+) memory T-cell group were infused with CD4(+) memory T
cells, those in the other group were infused with nonsensitized CD4(+) T cells,
and those in the control group received no CD4(+) T cells. Heart transplantation
was performed at 3 weeks after the cell infusion with cyclosporine administered
beginning 1 day before transplantation via intraperitoneal injection.
RESULTS: The survival among the CD4(+) memory T-cell group was significantly
shorter than that of the nonsensitized CD4(+) T-cell group or the control group
(P < .01; n = 10). There was no significant difference between the survival times
of the nonsensitized CD4(+) T-cell group and the control group (P > .05; n = 10).
On the 5th day after the transplantation of heart, the histologic grades of the
nonsensitized CD4(+) T-cell and the blank control group were lower than those of
the CD4(+) memory T-cell group. There was no significant difference in the
histologic grades between the nonsensitized CD4(+) T-cell and control groups.
CONCLUSION: The CD4(+) memory T cells that mediate acute rejection of allografted
hearts are insensitive to cyclosporine.
28.
Tranilast prevents the progression of chronic cyclosporine nephrotoxicity through
regulation of transforming growth factor β/Smad pathways.
Tao Y, Hu L, Li S, Liu Q, Wu X, Li D, Fu P, Wei D, Luo Z.
Transplant Proc. 2011 Jun;43(5):1985-8.
PURPOSE: Our aim was to investigate the role of tranilast in transforming growth
factor (TGF) β/Smad pathways using a rat model of chronic cyclosporine (CsA)
nephrotoxicity.
METHODS: Thirty Sprague-Dawley (SD) rats were equally randomized in to 5 groups
for gavage treatments daily for 4 weeks: normal control (N), olive oil; CsA (25
mg/kg), (M) CsA plus low-dose tranilast group (T1; CsA 25 mg/kg and tranilast 100
mg/kg); CsA plus medium-dose tranilast group (T2; CsA 25 mg/kg and tranilast 200
mg/kg); and CsA plus high-dose tranilast group (T4; CsA 25 mg/kg and tranilast
400 mg/kg). Kidneys were harvested at the end of the fourth week. TGF-β1 as well
as Smad3 and Smad7 were detected by reverse-transcription polymerase chain
reaction and immunohistochemistry.
RESULTS: The administration of tranilast decreased the expression of TGF-β1 and
Smad3 by CsA-treated rats, whereas it increased both mRNA and protein levels of
Smad7. Semiquantitative analysis of mRNA production revealed these treatments to
markedly reduce the amount of TGF-β1: T1: 0.8452 ± 0.0825 vs 0.8529 ± 0.0606 (P <
.05); T2: 0.8414 ± 0.0696 vs 0.8529 ± 0.0606 (P < .05); T4: 0.8336 ± 0.0592 vs
0.8529 ± 0.0606 (P < .05). For Smad3: T1: 0.8581 ± 0.0328 vs 0.8613 ± 0.0542 (P <
.05); T2: 0.8528 ± 0.0599 vs 0.8613 ± 0.0542 (P < .05); T4: 0.8436 ± 0.0185 vs
0.8613 ± 0.0542 (P < .05). The significantly elevated dose-dependent amounts of
Smad7 were: T1: 0.9026 ± 0.0522 vs 0.8678 ± 0.0246, (P < .05); T2: 0.9087 ±
0.0506 vs 0.8678 ± 0.0246 (P < .05); T4: 0.9151 ± 0.0793 vs 0.8678 ± 0.0246 (P <
.05).
CONCLUSION: Regulation of TGF-β/Smad pathways is one of the mechanisims by which
tranilast mitigates the progression of chronic CsA nephrotoxicity in rats.
29.
Heme oxygenase-1 expression and its significance for acute rejection following kidney transplantation in rats.
Li SD, Wang L, Wang KY, Liang P, Wu G, Zhang KQ, Li QS, Jin FS.
Transplant Proc. 2011 Jun;43(5):1980-4.
OBJECTIVE: To analyze rejection and antiapoptotic effects of heme oxygenase-1
(HO-1) in kidney transplantations, to investigate the protective effects of
endogenous HO-1 induced by hemin on acute rat kidney allograft rejection.
METHODS: We selected 27 Brown-Norway rats and 27 male Lewis rats as donors and
recipients, respectively, randomly dividing them into three groups: kidney
transplantation alone, hemin treatment group, and cyclosporine (CsA) group (n =
18). Six recipient rats were harvested on the first, fifth, or seventh days after
operation among each group to examine histopathologic changes in renal tissuse,
HO-1 protein expression, and acute rejection as well as to measure serum
creatinine values.
RESULTS: HO-1 expression in both the kidney transplantation model group and the
hemin-induced groups were higher compared with the CsA group (P < .05-.01). The
expression increased with the aggravation of rejection; the expression in the CsA
group also increased after transplantation but was obviously lower than that of
the hemin-induced group (P < .01). The rejection process was relatively mild as
indenset by histopathologic examination. The serum creatinine levels among the
hemin-induced group were lower compared to the kidney transplantation control
group (P < .05), but higher compared to the CsA group (P < .05).
CONCLUSION: HO-1 provided protection of allografts against rejection in rats, but
such effects were poorer than those achieved using potent immunosuppressive
agents like CsA.
30.
Antibody-mediated response in rat liver chronic rejection.
Wan R, Ying W, Zeng L, Deng X, Chen H, Gao L.
Transplant Proc. 2011 Jun;43(5):1976-9.
PURPOSE: The aim was to study the effect of an antibody-mediated response on rat
chronic liver rejection.
METHODS: Liver transplantation was performed in rats assigned to one of the 3
treatment groups: group A, Brown Norway (BN) to BN + CsA; group B, dark Agouti
(DA) to BN; and group C, DA to BN + CsA. In addition to survival and
histopathologic assessment, we examined donor-specific antibodies in sera and C4d
staining in the transplanted liver.
RESULTS: In rats with chronic rejection, high levels of IgG1 were detected from
day 7, reaching peak levels at postoperative days 60-90, showing significance
compared with the acute rejection (P < .05) and the syngeneic groups (P < .01).
There was more C4d deposition in vessels and portal stroma of the livers from
recipients displaying chronic rejection compared with recipients showing acute
rejection or of syngeneic origin (P < .05).
CONCLUSION: Antibody-mediated responses might play important roles in the
development of chronic liver allograft rejection.
31.
Expression of glucocorticoid-induced tumor necrosis factor receptor ligand in rat graft after liver transplantation.
Wei S, Li J, Lian Z, Chen Y, Liu Z, You H, Gong J.
Transplant Proc. 2011 Jun;43(5):1971-5.
BACKGROUND: Costimulation between the glucocorticoid-induced tumor necrosis
factor receptor and its ligand (GITRL) breaks immunologic tolerance induced by
regulatory T cells. The purpose of this research was to examine the involvement
of GITRL during rat liver transplantation, the survival of which depends on
interactions between regulatory T cells and Kupffer cells (KCs).
METHODS: Recipients were divided into 2 groups: The allograft group underwent
orthotopic liver transplantation from male Lewis to Brown Norway (BN) rats and
the isograft group, BN-to-BN liver transplantation. We evaluated 2-week survival
rates, histologic changes, as well as serum and supernatant levels of tumor
necrosis factor-α (TNF-α); GITRL, and TNF-α expressions in the graft, and GITRL
expression by graft-derived KCs.
RESULTS: TNF-α levels were increased in plasma and in the supernates of KCs
during allograft transplantation compared with isograft liver transplantation (P
<.05). The expressions of TNF-α and GITRL in liver grafts were increased during
acute rejection. Furthermore, the expression of GITRL on KCs derived from
allografts was increased compared with isografts (P < .05).
CONCLUSION: GITRL expression on KCs may mediate acute rejection in liver
transplantation.
32.
CXCR1 deficiency does not alter liver regeneration after partial hepatectomy in mice.
Sakai N, Kuboki S, Van Sweringen HL, Tevar AD, Schuster R, Blanchard J, Edwards
MJ, Lentsch AB.
Transplant Proc. 2011 Jun;43(5):1967-70.
Previous studies have shown that CXC chemokines containing Glu-Leu-Arg (ELR) in
their amino-terminus stimulate hepatocyte proliferation and liver regeneration
after partial hepatectomy. These ELR+CXC chemokines bind to two receptors, CXCR1
and CXCR2. Previous work has shown that CXCR2 is involved in the proliferative
effects of CXC chemokines. However, the function of CXCR1 during the regenerative
response has not been studied. The aim of the current study was to investigate
the role of CXCR1 in liver regeneration after partial hepatectomy. C57BL/6 (wild
type) or CXCR1-/- mice were subjected to 70% partial hepatectomy or sham surgery
and sacrificed on day 2 and 4 after operation. There were no significant
differences in liver-to-body weight ratio or hepatocyte proliferation. The data
suggest that CXCR1 does not mediate the proliferative effects of ELR+ CXC
chemokines during liver regeneration after partial hepatectomy.
33.
Interleukin-23 promotes natural killer T-cell production of IL-17 during rat liver transplantation.
Liu XC, Zhai A, Li JQ, Qi HZ.
Transplant Proc. 2011 Jun;43(5):1962-6.
INTRODUCTION: Cytokine interleukin-17 (IL-17) is a key proinflammatory mediator
promoting allograft cytokine and chemokine production. In addition to Th17 cells,
natural killer T (NKT) cells have also been shown to be capable of rapidly
producing IL-17 after activation.
METHODS: The levels of IL-17 and IL-23 of liver allografts were determined using
enzyme-linked immunosorbent assay (ELISA). IL-17-positive cells in CD1d CD4+
cells of grafts were detected using flow cytometry.
RESULTS: High expression of IL-17 and IL-23 was observed in liver allografts. The
ratios of NKT cells were dramatically increased in the allograft group compared
with that in the control group (P < .01). In vitro, blockage of IL-23 using
anti-IL-23 antibody can inhibit increasing expression of IL-17 (P < .01).
CONCLUSION: NKT cells contribute to production of IL-17 mediated by IL-23 on a
rat acute allograft rejection model of orthotopic liver transplantation (OLT).
34.
Porcine partial liver transplantation without veno-venous bypass: an effective model for small-for-size liver graft injury.
Fu Y, Zhang HB, Yang N, Zhu N, Si-Ma H, Chen W, Zhao WC, Yang GS.
Transplant Proc. 2011 Jun;43(5):1953-61.
OBJECTIVE: Partial liver transplantation is currently gaining wider acceptance,
which alleviates donor organ shortage, but also reveals the problem of
small-for-size (SFS) syndrome. The precise mechanism behind it remains unknown.
Large animal models for SFS syndrome are being developed using veno-venous bypass
(VVB), however, splenectomies have often become necessary making the models
useless for clinical situations. This study establishes a clinically
well-simulated and effective model of SFS graft injury without VVB.
METHODS: In this study, 30% and 100% of liver grafts were orthotopically
transplanted to pigs in groups A (n = 12) and B (n = 5), respectively, both
without VVB. Intraoperative hemodynamics and metabolic parameters were assessed
consecutively. The operative survival rates were evaluated during 7 days of
follow-up as well as the serum biochemical profiles, the kinesis of portal
pressure gradient, and the pathological findings.
RESULTS: All the recipients survived the anhepatic period except one in group A
who died of irretrievable acidosis. The tolerance rate for non-VVB were 91.7%
(11/12) in group A and 100% (5/5) in group B with no significant differences. The
7-day survival rate in group A was significantly less than that for group B (50%
versus 100%, P < .05) with more prolonged prothrombin times, increased bilirubin
and alanine aminotransferase levels, and persistantly higher values of portal
pressure gradient during almost the entire follow-up period. Accordingly, the
pathological findings clarified more severe microvascular impairments in group A
than group B.
CONCLUSION: These data suggest that the model of pigs transplanting with 30%
liver grafts without VVB is safe and reproducible. The good clinical simulation
on operative procedures and clinicopathological performance indicates it is a
more rational model for further research on SFS syndrome.
35.
Cytomegalovirus infection in mesenchymal stem cells and their activation could be enhanced by nuclear factor-κB inhibitor pyrrolidinedithiocarbamate in vitro.
Wei G, Lin M, Cai Z, Huang H.
Transplant Proc. 2011 Jun;43(5):1944-9.
Because of the central role of the transcription factor nuclear factor (NF)-κB in
cell survival and proliferation in many kinds of cancer cells, NF-κB inhibitors
may have a potential role in cancer therapy. Currently, many NF-κB inhibitors are
used for immunosuppression to treat hematologic malignancy patients after stem
cell transplantation (SCT). Human cytomegalovirus (HCMV) infection is one of the
most common complications following SCT. Some workers have reported that HCMV
infection has a close relationship to NF-κB activation; however, the specific
effects of NF-κB inhibitors, such as pyrrolidinedithiocarbamate (PDTC), on
infection with and activation of CMV in mesenchymal stem cells (MSCs) remain
unknown. In our study, we isolated MSCs from the bone marrows of healthy human
donors for infection with 1 tcid(50) of HCMV with or without 1 μmol/L PDTC. After
48 hours of culture in dmem supplemented with 10% (volume per volume) fetal calf
serum, we tested MSCs using reverse transcription-polymerase chain reaction
(RT-PCR) assays to detect messenger RNA (mRNA) expression of HCMV immediate early
(IE) gene and the GAPDH gene. Flow cytometry was used to detect HCMV pp65
antigen-positive cells and transmission electron microscopy (TEM) for intra
cellular HCMV particles. We observed that the shape of the MSCs changed in
response to infection by 1 TCID(50) of HCMV. MSCs infected by 1 TCID(50) of HCMV
in combination with 1 μmol/L of PDTC changed their shapes more profoundly; almost
all cells went from a thin elongated profile to a round, thick ball. In contrast,
the shape of cells treated with PDTC alone or the HCMV mock-infected elements did
not change. The RT-PCR assay showed that there was a bright band corresponding to
HCMV IE mRNA in MSCs infected with 1 TCID(50) of HCMV in combination with 1
μmol/L of PDTC, as compared with cells infected by only 1 TCID(50) of HCMV. The
HCMV mock-infected MSCs did not express HCMV IE mRNA. Using flow cytometry, we
detected more HCMV pp65 antigen-positive cells among MSCs infected with 1
TCID(50) of HCMV in combination with 1 μmol/L of PDTC. HCMV particles were
observed by TEM in the nucleus and cytoplasm of MSCs infected with HCMV. There
were more HCMV particles in cells infected by HCMV in combination with PDTC. In
conclusion, NF-κB activation may affect HCMV infection efficiency of MSCs. An
NF-κB inhibitor increased the infection by activation of HCMV in MSCs, thus we
should pay close attention to HCMV infection when we prescribe an NF-κB inhibitor
in clinical settings.
36.
Early posttransplantation hemoglobin level corresponds with chronic renal dysfunction in heart transplant recipients.
Zhang R, Georgiou M, Gwinner W, Zardo P, Haverich A, Bara C.
Transplant Proc. 2011 Jun;43(5):1939-43.
BACKGROUND: The risk factors for moderate or severe chronic renal dysfunction
(MSCRD) among heart transplant recipients may be distinct from those previously
recognized owing to recently improved clinical care.
METHODS: We examined the clinical records of 88 adult patients who underwent
first heart transplantations from 2000 to 2005 and survived 2 years. MSCRD was
defined as a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) at 2 years
after transplantation. Fifty patients were included in the MSCRD group and 38 in
the non-MSCRD group.
RESULTS: Loss of renal function was observed largely during the first 9 months
after transplantation in the MSCRD group. The pretransplantation GFR was lower in
the MSCRD group. Besides older age in the MSCRD group, there were no differences
in baseline characteristics, immunosuppressive regimens, incidences of acute
rejection episodes, cardiac allograft vasculopathy, or severe infections. The
MSCRD group showed permanent lower posttransplantation hemoglobin levels. In
multivariate logistic regression analysis, recipient age, pretransplantation GFR,
postoperative intensive care unit stay and hemoglobin level at 9 month were
unfavorable factors for posttransplantation MSCRD.
CONCLUSIONS: In addition to recipient age and pretransplantation GFR as well
established risk factors, our results suggest a prognostic value of a low early
hemoglobin level for the development of chronic renal dysfunction after heart
transplantation.
37.
Dry eye disease in chronic graft-versus-host disease: results from a Spanish retrospective cohort study.
de la Parra-Colín P, Agahan AL, Pérez-Simón JA, López A, Caballero D, Hernández
E, Barrientos-Gutierrez T, Calonge M.
Transplant Proc. 2011 Jun;43(5):1934-8.
We describe the incidence, clinical features, and final outcome of dry eye
disease (DED) associated with chronic graft-versus-host disease (GVHD) over a
5-year period. We reviewed 109 clinical charts from patients undergoing
hematopoietic stem cell transplantation (HSCT) between January 2000 and December
2005, abstracting data from the 57 patients who developed chronic GVHD and
survived at least 180 days after allogenic HSCT. DED occurred in 22 (40%)
patients at an average of 16.5 months after HSCT. Photophobia, irritation, and
foreign body sensation were the most frequent symptoms, while punctate keratitis
was the most common sign. DED tended to improve over time, with fewer than 5% of
patients requiring more than two topical medications at the end of follow-up. Our
study represented a formal evaluation of DED incidence among Spanish chronic GVHD
patients. It is of utmost importance to assure patients will undergo a
comprehensive ophthalmologic evaluation throughout their follow-up.
38.
Basiliximab for the treatment of steroid-refractory acute graft-versus-host disease after unmanipulated HLA-mismatched/haploidentical hematopoietic stem cell
transplantation.
Wang JZ, Liu KY, Xu LP, Liu DH, Han W, Chen H, Chen YH, Zhang XH, Zhao T, Wang Y,
Huang XJ.
Transplant Proc. 2011 Jun;43(5):1928-33.
BACKGROUND: Anti-CD(25) monoclonal antibodies (Mabs) have been evaluated for the
treatment of steroid-refractory acute graft-versus-host disease (GVHD) in
patients undergoing hematopoietic stem cell transplantation (HSCT) mainly with
matched donors for years, but there is little attention concerning patients with
unmanipulated human leukocyte antigen (HLA)-mismatched/haploidentical
transplantations. We investigated the efficacy and safety of the chimeric Mab,
basiliximab, to treat steroid-refractory acute GVHD after unmanipulated
mismatched/haploidentical HSCT.
METHODS: Fifty-three patients who developed steroid-refractory acute GVHD between
July 2005 and July 2009 were treated at our institute with basiliximab. No
prisoners were used in this study.
RESULTS: Forty-six among 53 patients responded, including 37 complete remissions
at a median response of 6 days from Mab initiation. There were 29 episodes of
viral reactivations, 25 bacterial infections, and 11 probable fungal infections.
Thirty-four out of 49 patients who could be evaluated developed chronic GVHD.
Twenty-eight of 53 subjects (52.8%) were alive at a median follow-up of 16 months
(range, 2-57) posttransplantation. The Kaplan-Meier probability of a 3-year
event-free survival was 47.7%. The causes of death were infection alone (n = 15),
progressive GVHD with infection (n = 3), relapse (n = 3), and other etiologies (n
= 4).
CONCLUSION: These data suggested that basiliximab was effective to treat
steroid-refractory acute GVHD after unmanipulated HLA-mismatched/haploidentical
stem cell transplantation.
39.
Autologous stem cell transplantation for systemic lupus erythematosus: report of efficacy and safety at 7 years of follow-up in 17 patients.
Song XN, Lv HY, Sun LX, Meng JB, Wang JK, Zhang JQ, Chang YJ.
Transplant Proc. 2011 Jun;43(5):1924-7
INTRODUCTION: We observed the efficacy and toxicity of autologous stem cell
transplantation (auto-SCT) for patients with systemic lupus erythematosus (SLE).
METHODS: Seventeen patients with SLE were treated with auto-SCT. No prisoners
were used in the study. Peripheral blood stem cells were mobilized with
cyclophosphamide (Cy) and granulocyte colony-stimulating factor. After a
conditioning regimen of Cy and antithymocyte globulin, we reinfused stem cells.
The probabilities of overall survival (OS) and progression-free survival (PFS)
were used to assess the efficacy and adverse experiences, to detect the
toxicities of the treatment.
RESULTS: The median follow-up time was 89 months (range 33-110). Probabilities of
7-year OS and PFS were 82.4% ± 9.2% and 64.7% ± 11.6%, respectively. The
principal adverse events included allergy, infection, elevation of liver enzymes,
bone pain, and heart failure. Two patients died due to severe pneumonia and heart
failure at 33 and 64 months after transplantation, respectively.
CONCLUSIONS: Our 7-year follow-up results suggested that auto-SCT seemed
beneficial for SLE patients.
40.
Correlation between the kinetics of CD3+ chimerism and the incidence of graft-versus-host disease in patients undergoing allogeneic hematopoietic stem
cell transplantation.
Rupa-Matysek J, Lewandowski K, Nowak W, Sawiński K, Gil L, Komarnicki M.
Transplant Proc. 2011 Jun;43(5):1915-23.
INTRODUCTION: Graft-versus-host disease (GvHD) remains a significant complication
after allogeneic hematopoietic stem cell transplantation (HSCT). Early diagnosis
and treatment may improve patient outcomes. A prospective study to investigate
the relationship between chimerism kinetics and the development of acute or
chronic GvHD was carried out. Split chimerism in association with the onset of
GvHD was also analyzed.
METHODS: Thirty-three patients with hematologic diseases treated with allogeneic
HSCT were analyzed. They were conditioned with myeloablative or reduced intensity
regimens and grafted with peripheral blood (PB) or bone marrow stem cells. GvHD
prophylaxis consisted of cyclosporine and methotrexate. Chimerism evaluation was
performed on PB mononuclear cells and purified cell subsets consisting of
separated CD3(+) T cells, monocytes (CD14(+)), and granulocytes (CD15(+)).
Chimerism analysis was performed at 30, 60, 120, and a median of 200 days after
HSCT.
RESULTS: Acute GvHD was diagnosed in 19 patients and chronic GvHD in 16. On day
30, no relation was found between the level of donor chimerism and aGvHD. Upon
univariate analysis, decreasing mixed chimerism among CD3(+) and infused CD34(+)
cell numbers was significantly correlated with acute GvHD development, while the
PB stem cell source, reduced-intensity conditioning regimen, and female donor sex
were associated with an increased risk of chronic GvHD. In multivariate analysis,
the risk of acute GvHD correlated only with the CD34(+) cell dose, while the risk
of extensive chronic GvHD was associated with high CD3(+) donor chimerism on day
30. Patients with versus without split chimerism (T cell vs myeloid lines) did
not differ statistically in their incidence of acute GvHD or chronic GvHD.
CONCLUSION: Our results supported the belief that chimerism kinetics or
longitudinal chimerism evaluation is of greater significance than isolated
absolute values of the percentage of chimerism at a single point after HSCT. The
observations suggest that longitudinal monitoring of chimerism in CD3(+) T-cell
subsets is an acceptable method to predict the development of GvHD among patients
undergoing HSCT.
41.
Complications of endomyocardial biopsy in heart transplant patients: a retrospective study of 2117 consecutive procedures.
Saraiva F, Matos V, Gonçalves L, Antunes M, Providência LA.
Transplant Proc. 2011 Jun;43(5):1908-12.
BACKGROUND: Endomyocardial biopsy (EMB) remains the gold standard for the
diagnosis of graft rejection after heart transplantation (HT). Our purpose was to
evaluate the rate of complications of this invasive procedure.
METHODS: This was a retrospective study of 175 patients, who were transplanted
between November 2003 and October 2010 and survived more than 1 month after
surgery. We evaluated the number of inconclusive EMB and described the incidence,
nature, and subsequent management of several complications associated with this
procedure.
RESULTS: Over a period of approximately 7 years, we performed 2217 EMB yielding
4972 specimens, namely, an average of 2.3 fragments per procedure. The majority
of EMBs (95.3%) were performed by the femoral approach. Only 12 EMB (0.57%) were
inconclusive. The overall complication rate was 0.71%. During puncture, one
patient experienced a vasovagal reaction and another one, a femoral artery false
aneurysm. During the biopsy, there was one case of cardiac perforation with
tamponade, two cases of supraventricular tachycardia, and three atrioventricular
conduction abnormalities. In 19 patients, histological analysis revealed chordal
tissue, but only two patients developed mild tricuspid regurgitation. We observed
five cases of coronary artery fistulae. The clinical outcomes were favorable in
all cases.
CONCLUSION: EMB proved to be a suitable, safe method to monitor rejection after
HT.
42.
Rapid decline in glomerular filtration rate during the first weeks following heart transplantation.
Hornum M, Andersen M, Gustafsson F, Oturai P, Sander K, Mortensen SA,
Feldt-Rasmussen B.
Transplant Proc. 2011 Jun;43(5):1904-7.
We hypothesized that a decrease in renal function is seen immediately after heart
transplantation (HTX) with little recovery over time. Twelve consecutive patients
had their glomerular filtration rate (GFR) measured using
(51)Cr-ethylenediaminetetraacetic acid (EDTA) measured GFR (mGFR) before
transplantation and at 1, 2, 3, and 26 weeks after transplantation. The mGFR
decreased by 28% and 24% during the first 3 and 26 weeks, respectively, with mean
blood cyclosporine concentration as an independent risk factor for the decrease
in mGFR. The identification of cyclosporine A (CsA) as the most important risk
factor for the rapid and sustained decrease in renal function supports the need
for more studies on renoprotective strategies immediately after HTX.
43.
Soluble tumor necrosis factor-like weak inducer of apoptosis plasma levels as a novel biomarker of endothelial function in prevalent orthotopic heart transplant recipients.
Przybylowski P, Malyszko JS, Malyszko J.
Transplant Proc. 2011 Jun;43(5):1900-3.
BACKGROUND: Nonrenal solid organ transplantation is now an established method of
therapy with significantly improved outcome over the last years; however, an
increasingly prevalent complication in this population is chronic kidney disease.
Endothelial dysfunction is highly prevalent in both cardiovascular disease and
chronic kidney disease. Tumor necrosis factor (TNF)-like weak inducer of
apoptosis (TWEAK) is a member of the TNF superfamily of cytokines.
MATERIALS AND METHODS: The aim of the study was to assess TWEAK concentration in
134 prevalent heart transplant recipients in relation to kidney function.
Complete blood count, urea, serum lipids, fasting glucose, creatinine, NT-proBNP
were studied. Soluble TWEAK was assayed using commercially available kits from
Bender MedSystems (VIenna, Austria). High-sensitivity C-reactive protein was
assayed using commercially available kits from American Diagnostica (Greenwich,
Conn, USA).
RESULTS: Heart transplant recipients had significantly higher serum creatinine,
urea, cholesterol, triglycerides, fasting glucose, white blood cell count, lower
TWEAK levels and lower estimated glomerular filtration rate (eGFR) than the
control group. Serum TWEAK levels fell together with New York Heart Association
(NYHA) class and rise in GFR. Serum TWEAK was related to kidney function, NYHA
class, NT-proBNP, and triglycerides. Kidney function and NYHA class turn out to
be predictors of TWEAK in heart transplant recipients.
CONCLUSION: TWEAK level is dependent on kidney and heart function. It might also
represent a surrogate marker of endothelial dysfunction and atherosclerosis.
44.
Long-term maintenance therapy for post-cardiac transplant monoclonal lymphoproliferative disorder: caveat mammalian target of rapamycin.
Khalpey Z, Miller DV, Schmitto JD, Kushwaha SS.
Transplant Proc. 2011 Jun;43(5):1893-9.
A 53-year-old Caucasian male suffering from idiopathic dilated cardiomyopathy
underwent cardiac transplantation. Fifty-seven days following transplant, he
developed posttransplant lymphoproliferative disorder (PTLD), which was
Epstein-Barr virus positive. The initial episode of PTLD was treated with a dose
reduction in cyclosporine (CsA) and a 4-week course of rituximab. Subsequent
biopsies showed resolution of PTLD. One year posttreatment, his evaluation
revealed severe cardiac allograft vasculopathy (CAV). The patient was switched to
sirolimus-based immunosuppression regimen with gradual up-titration of sirolimus
in combination with complete withdrawal of previously administered
Calcineurin-based immunosuppression approach. The switchover was carried out over
a 6-week period. In the following 3 years, there was CAV regression as well as
PTLD remission, without any significant episode of rejection. Despite frequent
relapses with this form of PTLD, the patient remains in remission, 8 years
posttransplantation. In summary, sirolimus has been demonstrated to attenuate the
progression of CAV, and this case report illustrates that regression of CAV is
possible. In addition to preventing rejection, mammalian target of rapamycin
inhibitors directly suppress signaling pathways leading to PTLD and may be
effective monotherapy for preventing rejection and suppressing PTLD.
45.
Prophylaxis of cytomegalovirus disease in mismatched patients after heart transplantation using combined antiviral and immunoglobulin therapy.
Czer LS, Ruzza A, Vespignani R, Rafiei M, Pixton JR, Awad M, De Robertis M, Wong
AV, Trento A.
Transplant Proc. 2011 Jun;43(5):1887-92.
BACKGROUND: Cytomegalovirus (CMV) is a common cause of infection and morbidity
after heart transplantation. Seronegative recipients (R-) of seropositive donor
hearts (D+) are at high risk for CMV disease. We compared three different CMV
prophylaxis regimens using combined antiviral and immunoglobulin therapy.
METHODS: In 99 patients who survived more than 30 days after heart transplant,
all received induction with antilymphocytic therapy and triple-drug therapy. In
group A, D+R- patients received one dose of intravenous immunoglobulin (IVIG)
followed by one dose of CMV-specific immunoglobulin (CMV-IVIG), and intravenous
ganciclovir (GCV) for 4 weeks followed by 11 months of oral acyclovir (ACV). In
group B, D+R- patients received one dose IVIG followed by five doses of CMV-IVIG
and intravenous GCV for 14 weeks followed by 9 months of oral ACV. In group C,
D+R- patients were treated with the same regimen as for group B, except oral ACV
was replaced with oral GCV.
RESULTS: The actuarial freedom from CMV disease for D+R- patients at 1 month, 1
year, and 2 years after transplantation in group A was 100%, 25% ± 15%, and 25% ±
15%, respectively; group B was 100%, 67% ± 27%, and 67% ± 27%; group C was 100%,
83% ± 15%, and 83% ± 15% (P < .01, groups B and C vs group A). By comparison, the
actuarial freedom from CMV disease for seropositive recipients (D-R+ or D+R+) at
1 month, 1 year, and 2 years in group A was 100%, 87% ± 7%, and 82% ± 8%,
respectively; group B was 100%, 88% ± 8%, and 75% ± 11%; group C was 100%, 72% ±
9%, and 72% ± 9% (P = NS among groups). Rejection rates did not differ among the
three groups.
CONCLUSIONS: A longer course of intravenous GCV with multiple doses of CMV-IVIG
was a more effective prophylaxis regimen against CMV disease for the high-risk
group of seronegative recipients of seropositive donor hearts.
46.
Effect of pulmonary hypertension in patients with end-stage lung disease on posttransplantation outcomes.
Omari MK, Smith SA, Jacobsen G, Kaza V.
Transplant Proc. 2011 Jun;43(5):1881-6.
A subgroup of patients with end-stage lung disease develop secondary pulmonary
hypertension (PH). PH results in worse prognosis in these patients. However, it
is unclear if this effect prevails in the immediate- and long-term outcomes of
these patients after lung transplantation (LT). The objective of this study was
to evaluate the effect of pretransplantation PH on immediate- or long-term
posttransplantation outcomes. A retrospective chart review of post-LT patients at
Henry Ford Hospital from January 1995 through January 2008 was done. Patients
were grouped by presence or absence of PH and were compared using chi-square or
Fisher exact tests for categorical variables and t tests or Wilcoxon rank sum
tests for continuous variables. Kaplan-Meier estimation was used to evaluate
primary and secondary outcomes. Among the patients included in the study, 25 had
PH. This group consisted mostly of females (68%). There was no difference in the
indication or type of LT in the 2 groups. There was no statistically significant
difference in freedom from bronchiolitis obliterans syndrome (BOS; P = .42), time
to onset of BOS (P = .82), grade of BOS (P = .21), or cummulative acute rejection
(CAR) score (P = .66). There was no difference in overall mortality at 3 and 5
years (P = .57) or time to death (P = .25). Number of A1 rejection episodes was
the only significant predictor for BOS (P = .001). In conclusion, PH due to
end-stage lung disease does not have any effect on early or late
posttransplantation outcomes. There is predisposition for females with end-stage
lung disease to develop secondary PH more so than males. The number of A1
rejections increases the likelihood of development of BOS. A larger multicenter
study is needed to confirm the results of this pilot study.
47.
Tumor necrosis factor-related apoptosis-inducing ligand is a marker of kidney function and inflammation in heart and kidney transplant recipients.
Malyszko J, Przybylowski P, Malyszko J, Koc-Zorawska E, Mysliwiec M.
Transplant Proc. 2011 Jun;43(5):1877-80.
BACKGROUND: Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL)
was originally identified as the third member of the TNF superfamily to induce
apoptosis. TRAIL is normally expressed in many human tissues including kidney.
Circulating soluble TRAIL is a negative marker for inflammation and is inversely
associated with the mortality risk in chronic kidney disease patients. One
increasingly prevalent complication in heart transplant recipients appears to be
chronic kidney disease.
MATERIALS AND METHODS: The aim of the study was to assess TRAIL concentration in
136 heart transplant recipients and 80 prevalent kidney allograft recipients in
relation to kidney function. Complete blood count, urea, serum lipids, fasting
glucose, creatinine, NT-proBNP were studied. Soluble TRAIL, hsCR P, interleukin-6
(IL-6), von willebrand factor (vWF) were assayed using commercially available
kits.
RESULTS: Heart transplant recipients had significantly higher serum creatinine,
urea, cholesterol, triglycerides, fasting glucose, white blood cell count, serum
TRAIL and lower estimated glomerular filtration rate than the control group.
Similar results were obtained for kidney allograft recipients. Serum TRAIL levels
fell, together with decline in glomerular filtration rate in heart transplant
patients. Serum TRAIL was related to age, kidney function, erythrocyte count,
hemoglobin, NT-proBNP, New York Heart Association class, presence of diabetes,
high-density lipoprotein (HDL), IL-6, and ejection fraction. Age and HDL turn out
to be predictors of TRAIL in heart transplant recipients. In kidney transplant
recipients, TRAIL was related, in univariate analysis, to age, NT-proBNP, time
after transplantation, kidney function, and vWF. In multiple regression analysis,
predictors of TRAIL were vWF and time after transplantation.
CONCLUSION: TRAIL may represent a surrogate marker of endothelial dysfunction and
atherosclerosis as these processes are accelerated in heart and kidney
dysfunction.
48.
Combined heart and kidney transplantation provides an excellent survival and decreases risk of cardiac cellular rejection and coronary allograft vasculopathy.
Raichlin E, Kushwaha SS, Daly RC, Kremers WK, Frantz RP, Clavell AL, Rodeheffer
RJ, Larson TS, Stegall MD, McGregor C, Pereira NL, Edwards BS.
Transplant Proc. 2011 Jun;43(5):1871-6.
BACKGROUND: We analyzed the results of combined heart-kidney transplantation
(CHKTx) over a 10-year period.
METHODS: Between September 1996 and May 2007 at Mayo Clinic, 12 patients (age 52
± 12.2 years) underwent CHKTx as a simultaneous procedure in 10 recipients and as
a staged procedure in two recipients with unstable hemodynamics after heart
transplantation.
RESULTS: There was no operative mortality. Patient survival rates for the CHKTx
recipients at 1 and 3 months and 6 years were 91%, 83%, and 83% and did not
differ from isolated heart transplantation (IHTx) recipients (97%, 95%, and 79%,
P = 0.61). The freedom from cardiac allograft rejection (≥ grade 2) at 3 months
was 73% for CHKTx and had not changed during further follow-up; for IHTx, freedom
from rejection at 3 months and 1 and 6 years was 61%, 56%, and 42% (P = .08).
Heart and renal allograft survival was 100% with and left ventricular ejection
fraction 66% ± 8.4% and glomerular filtration rate 61 ± 25 at last follow-up.
There were no signs of cardiac allograft vasculopathy in the CHKTx recipients.
CONCLUSION: CHKTx yields favorable long-term outcome, with a low incidence of
cardiac rejection and vasculopathy. Simultaneous CHKTx appears feasible, if
hemodynamics is satisfactory. This approach expands the selection criteria for
transplantation in patients with coexisting end-stage cardiac and renal disease.
49.
Treatment of intractable interstitial lung injury with alemtuzumab after lung transplantation.
Kohno M, Perch M, Andersen E, Carlsen J, Andersen CB, Iversen M.
Transplant Proc. 2011 Jun;43(5):1868-70.
A 44-year-old woman underwent left single-lung transplantation for end-stage
emphysema due to α1-antitrypsin deficiency in January 2010. Cyclosporine,
azathioprine, and prednisolone were administered for immunosuppression and
antithymocyte globulin for induction therapy at the time of transplantation.
Routine examination of a lung biopsy, 4 months after transplantation, showed
nonspecific, diffuse interstitial inflammation with alveolar septal fibrosis. The
patient's clinical status and imaging studies, consistent with nonspecific
interstitial pneumonitis, which was considered as signs of acute rejection,
worsened within 2 weeks, despite high-dose steroids, change of calcineurin
inhibitor, and plasmapheresis. Within a few days after a single, 10-mg,
intravenous dose of alemtuzumab, the patient's health improved markedly. She has
remained stable for 4 months on a standard, ambulatory, posttransplant
antirejection drug regimen. We have since successfully treated with alemtuzumab
three additional patients who developed interstitial lung injury after lung
transplantation, who are also summarized in this report.
50.
Increased incidence of acute graft rejection on calcineurin inhibitor-free immunosuppression after heart transplantation.
Celik S, Doesch AO, Konstandin MH, Kristen AV, Ammon K, Sack FU, Schnabel P,
Katus HA, Dengler TJ.
Transplant Proc. 2011 Jun;43(5):1862-7.
BACKGROUND: Calcineurin inhibitor (CNI)-free immunosuppression is used
increasingly after heart transplantation to avoid CNI toxicity, but in the
absence of a randomized trial, concerns remain over an increased rejection risk.
METHODS: We studied the incidence of graft rejection episodes among all cardiac
graft recipients, beginning with the first introduction of CNI-free protocols. We
compared events during CNI-free and CNI-containing immunosuppression among 231
transplant recipients of overall mean age 55.2 ± 11.8 years, from a mean 5.2 ±
5.4 years after transplantation through a mean follow-up of 3.1 ± 1.4 years. We
considered as acute rejection episodes requiring treatment those of International
Society for Heart and Lung Transplantation.
RESULTS: During the total follow-up of 685 patient years (CNI-containing, 563;
CNI-free, 122), we performed 1,374 biopsies which diagnosed 78 rejection
episodes. More biopsies were performed in CNI-free patients:
biopsies/patient-month of CNI-containing, 0.13 versus CNI-free, 0.22 (P < .05).
The incidence of rejection episodes per patient-month was significantly higher on
CNI-free compared with CNI therapy, among patients switched both early and later
after heart transplantation, namely, within 1 year, 0.119 versus 0.035 (P = .02);
beyond 1 year, 0.011 versus 0.004 (P = .007); beyond 2 years, 0.007 versus 0.003
(P = .04); and beyond 5 years: 0.00578 versus 0.00173 (P = .04).
CONCLUSIONS: Rejection incidence during CNI-free immunosuppression protocols
after heart transplantation was significantly increased in both early and later
postoperative periods. Given the potentially long delay to rejection occurrence,
patients should be monitored closely for several months after a switch to
CNI-free immunosuppressive protocols.
51.
Efficacy and safety of sirolimus and everolimus in heart transplant patients: a retrospective analysis.
Baur B, Oroszlan M, Hess O, Carrel T, Mohacsi P.
Transplant Proc. 2011 Jun;43(5):1853-61.
BACKGROUND: Since its introduction as an immunosuppressant in the late 1990s,
sirolimus (SRL) has been used to prevent rejections after heart transplantation
(HTx) in the United States. An analogue, everolimus (ERL) has been mainly used in
Europe. We performed a retrospective longitudinal single-center study to evaluate
efficacy and side effects of SRL and ERL.
PATIENTS AND METHODS: We analyzed 71 patients, 39 in the SRL and 32 in the ERL
group. The following data were collected: Trough levels of SRL and ERL,
biopsy-proven rejections, renal function, blood lipids, hematology, blood
pressure, pulse rate, and side effects (via an anonymous questionnaire).
Follow-up time was 6 months. No prisoners or organs from prisoners were used in
the study.
RESULTS: Introduction of SRL or ERL into therapy took place 44 or 42 months
(average) after HTx. SRL and ERL were equally effective in preventing rejection
(8/39 versus 6/32). Hemoglobin levels decreased slightly in the SRL group
(nonsignificant). Leucocytes and thrombocyte levels decreased in both groups (P <
.05 only in the ERL group). Creatinine levels remained unchanged. Cholesterol and
triglyceride levels increased significantly in the SRL group. High-density
lipoprotein levels increased significantly in the ERL group. Vital signs remained
stable in both groups. Side effects (mainly edema, gastrointestinal symptoms and
infections) were considerable and prompted discontinuation in 39% of all patients
in both groups. Infections were more frequent in SRL (18/39 versus 12/32,
nonsignificant). Calcineurin therapy could be reduced by 25% in SRL and 45% in
ERL.
CONCLUSION: The impact of SRL and ERL on laboratory values and rejection rates,
as well as on clinical parameters, is similar with a slight advantage to ERL
regarding lipids and rate of infections (not significant). Both SRL and ERL allow
an important reduction of calcineurin-therapy; however, both drugs have
considerable side effects, which often require discontinuation of therapy.
52.
Calcineurin inhibitor-free immunosuppression using everolimus (Certican) after heart transplantation: 2 years' follow-up from the University Hospital Münster.
Stypmann J, Engelen MA, Eckernkemper S, Amler S, Gunia S, Sindermann JR,
Rothenburger M, Rukosujew A, Drees G, Welp HA.
Transplant Proc. 2011 Jun;43(5):1847-52.
BACKGROUND: Everolimus is a proliferation-signal inhibitor which was introduced
for heart transplant recipients in 2004. To date, there are only sparse data
about long-term calcineurin inhibitor (CNI)-free immunosuppression using
everolimus.
METHODS: After heart transplantation, patients receiving everolimus were
consecutively enrolled. Reasons for switching to everolimus were side effects of
CNI immunosuppression, such as deterioration of kidney function and recurrent
rejection episodes. All 60 patients underwent standardized switching protocols,
42 patients completed 24-month follow-up. Blood was sampled for lipid status,
renal function, routine controls, and levels of immunosuppressive agents. On days
0, 14, and 28, and then every 3 months, echocardiography and physical examination
were performed.
RESULTS: After switching to everolimus, most patients recovered from the side
effects. Renal function improved significantly after 24 months (creatinine, 2.1 ±
0.6 vs 1.8 ± 1 mg/dL; P < .001; creatinine clearance, 41.8 ± 22 vs 48.6 ± 21.8
mL/min; P < .001). Median blood pressure increased from 120.0/75.0 mm Hg at
baseline to 123.8/80.0 mm Hg at month 24 (P values .008 and .003 for systolic and
diastolic pressures, respectively). Tremor, peripheral edema, hirsutism, and
gingival hyperplasia markedly improved. Levels of interleukin-6 were stable
between baseline and 24-month levels. Temporary adverse events occurred in 8
patients [13.3%: interstitial pneumonia (n = 2), skin disorders (n = 2);
reactivated hepatitis B (n = 1), and fever of unknown origin (n = 3)].
CONCLUSION: CNI-free immunosuppression using everolimus is safe, with excellent
efficacy in maintenance of heart transplant recipients. Arterial hypertension and
renal function significantly improved. CNI-induced side effects, such as tremor,
peripheral edema, hirsutism, and gingival hyperplasia, markedly improved in most
patients.
53.
Everolimus plus dosage reduction of cyclosporine in cardiac transplant recipients with chronic kidney disease: a two-year follow-up study.
Fuchs U, Zittermann A, Hakim-Meibodi K, Börgermann J, Schulz U, Gummert JF.
Transplant Proc. 2011 Jun;43(5):1839-46.
The calcineurin inhibitor cyclosporine (CSA) displays nephrotoxic side effects.
We switched 95 maintenance heart transplant recipients with chronic kidney
disease (CKD) stages 3-4 from CSA to everolimus (EVL). The CSA dosage was reduced
by 50%. Kidney function, lipid metabolism, and cardiac function investigated
during a 2-year follow-up were compared with heart transplant recipients with CKD
stages 2-3 who continued to receive CSA (CSA group; n = 84). Whereas 64/95
patients received reduced CSA plus EVL during the entire follow-up period (EVL
continued subgroup, ECN), 31 discontinued EVL (EVL discontinued subgroup, EDS)
after 4.3 months (median) because of various clinically relevant adverse events.
Glomerular filtration rates (estimated using the modification of diet in renal
disease formula) increased by 4.0 mL/min/1.73 m(2) in the ECN subgroup but
decreased by 2.4 mL/min/1.73 m(2) and 9.0 mL/min/1.73 m(2) in the EDS subgroup
and the CSA group, respectively (P < .001). Triglyceride and total cholesterol
concentrations increased significantly among the ECN group, but remained constant
in the EDS subgroup and the CSA group. Statin use was increased by 15% in the ECN
group (P < .01). Mortality and cardiac rejection rates did not differ
significantly among the 3 groups. In summary, EVL combined with low-dose CSA had
modest beneficial effects on kidney function in heart transplant recipients with
CKD stages 3-4. A significant percentage of patients had to stop EVL because of
various adverse events.
54.
Quantification of intraepithelial lymphocytes in normal pediatric small intestinal allograft and native ilea.
Liu L, Talmon G.
Transplant Proc. 2011 Jun;43(5):1831-5.
BACKGROUND: The small bowel acts as one of the first lines of defense against
intraluminal infections and antigenic stimuli. Pediatric small bowel transplant
patients are at particular risk from such agents, especially viral enteridities.
Quantification of intraepithelial lymphocytes (IEL) in architecturally normal
small intestinal mucosal biopsies plays an important role in the diagnosis of
conditions such as celiac disease and some viral infections. No studies to date
have been done to quantify IEL numbers in pediatric small bowel allografts and in
native pediatric ilea. Our study investigated the IEL:enterocyte (EC) ratio in
pediatric allograft and native ilea.
METHODS: Hematoxylin and eosin slides from 50 surveillance endoscopic biopsies of
small bowel allografts taken from patients <8 years of age and 50 terminal ileal
biopsies from aged-matched control populations were reviewed. IEL:EC ratios were
averaged from five well-oriented villi in each case. IEC numbers were compared
between biopsies from proximal (afferent) and distal (efferent) limbs of
double-barrel allograft stomas, as well as native terminal ilea.
RESULTS: Within small bowel allografts, the average number of villus tip IELs was
1.3/20 ECs (standard deviation [SD] 0.6) in the proximal limb and 1.0/20 ECs in
the distal (SD 0.6 P < .01). This value was significantly lower than in the
control ilea (2.1/20 EC [SD 0.6]; P < .01, each). The overall distribution of
lymphocytes was in a similar pattern throughout the villus with IEL:EC ratios on
villus sides from proximal allografts, distal allografts, and native ilea being
1:20, 0.8:20, and 2:20, respectively.
CONCLUSIONS: The results suggest that approximately one to two IEL per 20 ECs at
villus tips may represent a "normal" intraepithelial inflammatory cell population
in small bowel allografts. The value is lower than that seen in age-matched
native ileal biopsies. IEL numbers are significantly higher in the proximal limb
compared to the distal limb of double-barrel stomas.
55.
Application of the paraboloidal model to assess mucosal changes following segmental intestinal transplantation in children.
Setty S, Wu SJ, Bogard A, Chejfec G, Carroll R, Benedetti E, John E, Setty A.
Transplant Proc. 2011 Jun;43(5):1823-30.
Segmental living related small intestinal transplantation (LRSITx) is a
therapeutic option for conditions that present with short gut syndromes. Recovery
of small intestinal mucosa after transplantation is critical to function. We
examined the posttransplant mucosal changes to understand the absorptive
capabilities of transplanted small intestine. The study of human subjects is
constrained by limited biopsy material; therefore, we developed a technique of
villus area measurement by extrapolation from two-dimensional surgical biopsy
images. Using a detailed model of the villus as the gold standard, two simpler
models (cylindrical and paraboloid) were tested. Comparisons with the accurate
measurement revealed that the cylinder model does not compare well in early
posttransplant biopsies. The paraboloid function developed in this article worked
very well under all conditions. The simplicity of the paraboloid model and its
robustness made high-quality estimates of the absorptive surface area from
abundant data relatively easy. The remodeling expected in the initial stages of
growth was also captured by this model. Time-dependent villus growth curves were
obtained for transplanted bowel. Serial biopsies showed an initial
"reconstruction" dip around 2 weeks after transplant, followed by continuous
growth of villus surface area. An eventual plateau resulted at an average of 6
months after transplant. This growth of villi was shown to parallel the improved
absorption of electrolytes, amino acids, and water.
56.
Endothelin-1 markedly decreases the blood perfusion of transplanted pancreatic islets in rats.
Pettersson US, Henriksnäs J, Carlsson PO.
Transplant Proc. 2011 Jun;43(5):1815-20.
BACKGROUND: Transplantation of insulin-producing β-cells is the only available
curative treatment for type 1 diabetes. However, graft function declines within
the first years after transplantation, which may reflect inadequate vascular
engraftment. Endothelin-1 (ET-1) is a potent vasoconstrictor whose production is
regulated by both hypoxia and inflammation. Moreover, the plasma concentration of
ET-1 is elevated in patients with type 1 diabetes. The aim of this study was to
investigate the gene expression and effects of ET-1 and its 2 receptor
antagonists, BQ123 and BQ788, on blood flow in syngeneic rat islet transplants.
METHODS: Pancreatic islets from Wistar Furth rats were isolated and transplanted
syngeneically under the kidney capsule. Transplant and kidney cortex blood flow
was measured using laser Doppler flowmetry after administration of ET-1 via
topical application, or after administration of BQ123 and BQ788 intravenously.
The grafts and isolated islets were analyzed for mRNA expression of ET-1, ET(A)
receptor, ET(B) receptor, and endothelin-converting enzyme 1 using by
reverse-transcription polymerase chain reaction.
RESULTS: ET-1 markedly decreased transplant blood flow (77.5 ± 4.4% 1 minute
after administration; n = 6), whereas neither BQ123 nor BQ788 had vascular
effects. No differences in relative gene expression between the grafts and
freshly isolated control islets were seen for ET-1 (0.65 ± 0.14 [n = 8] vs 0.79 ±
0.24 [n = 5]), ET(A) receptor (0.37 ± 0.14 [n = 8] vs 0.25 ± 0.04 [n =5]), ET(B)
receptor (4.78 ± 1.43 [n = 8] vs 1.94 ± 0.32 [n = 5]), or endothelin converting
enzyme 1 (7.25 ± 1.88 [n = 8] vs 11.83 ± 0.95 [n = 5]) when expressed as 2(-ΔCt).
CONCLUSION: Exogenous ET-1 strongly affects the blood perfusion of transplanted
islets, and endogenous levels can, if up-regulated, contribute to graft failure.
57.
Pretreatment with bilirubin protects islet against oxidative injury during isolation and purification.
Zhu HQ, Gao Y, Guo HR, Kong QZ, Ma Y, Wang JZ, Pan SH, Jiang HC, Dai WJ.
Transplant Proc. 2011 Jun;43(5):1810-4.
BACKGROUND: A high yield of pure, viable islets is one of the most important
prerequisites for successful islet transplantation. However, during isolation and
purification, many factors may cause oxidative stress, impacting islet viability.
Accumulating evidence indicates that bilirubin (BR) not only has antioxidative
but also has cytoprotective activities. In this study, we investigated whether
pretreatment with bilirubin would protect islets against oxidative damage during
isolation and purification.
METHODS: Wistar rats were randomly divided into control and BR groups. The latter
rats received an injection of BR 2 hours before islet isolation, whereas the
controls received vehicle. Islet purity was determined using a dithizone stain.
Survival rate and viability were determined using acridine orange and propidium
iodide staining and the Cell Counting Kit-8 Kit. Islet function was quantified by
testing glucose-stimulated insulin secretion. Islet damage caused by oxidative
stress was quantified by measuring the malondialdehyde (MDA) in freshly isolated
islets.
RESULTS: Pretreatment with bilirubin did not enhance the purity, but
significantly enhanced the survival rate and viability of the islets. Islet
function in the BR group was significantly better than that in the control
cohort. The MDA level was 0.62 ± 0.23 nmol/L/μg protein in the BR group, which
was significantly lower (P < .05) than that in controls (1.31 ± 0.34 nmol/L/μg
protein).
CONCLUSIONS: We concluded that oxidative stress during islet isolation and
purification can be mitigated by BR pretreatment. BR exerts antioxidant and
cytoprotective properties by reducing lipid peroxidation (MDA) and enhancing
islet viability and function. Pretreatment with BR may become a simple, clinical
applicable means to improve human islet isolation and transplantation outcomes.
58.
31-Phosphorus magnetic resonance spectroscopy for dynamic assessment of adenosine triphosphate levels in pancreas preserved by the two-layer method.
Agrawal A, Bainbridge A, Powis S, Fuller B, Cady EB, Davidson BR.
Transplant Proc. 2011 Jun;43(5):1801-9.
Cold preservation injury influences islet graft function. Reliable tools for
real-time assessment of pancreas viability before islet isolation are lacking.
Phosphorus magnetic resonance spectroscopy ((31)P-MRS) was used immediately after
organ harvest to study rat pancreases at 4 °C to 6 °C in five randomized
preservation groups: Marshall's solution, static two-layer method (TLM),
continuous TLM with oxygen perfused at 0.5 L/min, and static TLM or continuous
TLM both the latter following 30 minutes of warm ischemia (WI). (31)P spectra
were analyzed for phosphomonoesters, inorganic phosphate (Pi) and α-, β-and
γ-nucleotide triphosphate. Intergroup rates of change of [γ-adenosine
triphosphate (ATP)]/[Pi] and [β-ATP]/[Pi] throughout preservation period were
significantly different. For continuous TLM there was an increase relative to
baseline (0.043 (SD0.033) h(-1) and 0.029 (0.029) h(-1), respectively) but a
decrease for both static TLM (-0.023 (0.016) h(-1) and 0.015 (0.026), P < .001
and < .05, respectively) and Marshall's (-0.049 (0.025) h(-1) and -0.036 (0.019)
h(-1), respectively, both P < .001) with respect to continuous TLM. Rate of
decrease was similar for the Marshall's and static TLM groups. [γ-ATP]/[Pi] and
[β-ATP]/[Pi] increased with WI continuous TLM (0.008 [0.009] h(-1) and 0.007
[0.008] hr(-1), respectively) but decreased for WI static TLM (-0.018 (0.008)
h(-1) and -0.014 (0.004) hr(-1), respectively, P < .001). (31)P-MRS is an
effective tool for noninvasive assessment of pancreas bioenergetics. Continuous
TLM preserves cellular bioenergetics and is superior to current non-perfluorocar
bone based solutions for pancreas preservation.
59.
Myocardial perfusion is a useful screening test for the evaluation of cardiovascular risk in patients undergoing simultaneous pancreas kidney transplantation.
Ruparelia N, Bhindi R, Sabharwal N, Mason P, Klucniks A, Sinha S, Friend P,
Ormerod OJ.
Transplant Proc. 2011 Jun;43(5):1797-800.
Cardiovascular disease is the leading cause of death in simultaneous pancreas
kidney transplantation (SPKT) patients. SPKT is increasingly being undertaken to
manage patients with advanced diabetic nephropathy and type 1 diabetes mellitus.
Traditionally, invasive angiography has been used as a tool to diagnose
significant coronary disease and inform decision making with regard to coronary
revascularization prior to transplantation. In our retrospective analysis of 167
consecutive patients who underwent SPKT in our center, we show that using
myocardial perfusion scintigraphy (MPS) as the first-line screening tool is
highly sensitive without exposing the patient to undue investigative procedural
risks (or an unacceptably high false-negative rate) and it provides 1-year
cardiovascular outcomes that are comparable with those of patients managed via
the more traditional but riskier invasive route.
60.
Effect of splenic artery embolization for splenic artery steal syndrome in liver transplant recipients: estimation at computed tomography based on changes in
caliber of related arteries.
Kim JH, Kim KW, Gwon DI, Ko GY, Sung KB, Lee J, Shin YM, Song GW, Hwang S, Lee
SG.
Transplant Proc. 2011 Jun;43(5):1790-3.
PURPOSE: To estimate the effect of splenic artery embolization (SAE) on blood
flow in orthotopic liver transplantation (OLT) recipients with splenic artery
steal syndrome (SASS) based on changes in caliber of related arteries upon serial
computed tomography (CT) scans.
METHODS: Between 2004 and 2007, nine OLT recipients with SASS underwent SAE. They
had CT scans before and after SAE: short-, mid-, and long-term, ie, approximately
1 week, 1 month, and 1 year, respectively. The diameters of the celiac axis (CA),
common hepatic artery (CHA), and splenic artery (SA) were measured with arterial
phase of each CT scan and the ratios of SA to CHA diameter (SA/CHA) calculated to
analyze their changes during the follow-up period.
RESULTS: The diameters of celiac axis, CHA, and SA and SA/CHA changed most
rapidly during the short-term period. The CHA diameter significantly increased
short-term post-SAE by CT and slightly decreased thereafter. However, the
mid-term and long-term post-SAE CT values were still significantly greater than
those on the pre-SAE CT. The SA diameter steadily decreased throughout the
follow-up. The SA/CHA decreased until the mid-term. The SA diameter and SA/CHA
were significantly smaller upon mid-term and long-term post-SAE CT compared with
those at pre-SAE CT.
CONCLUSIONS: The effect of SAE to improve hepatic arterial flow in OLT recipients
with SASS might be expected for at least approximately one year. The effect
maximally occurred during the short-term after SAE on the basis of changes in the
caliber of related arteries upon CT.
61.
Laparoscopic incisional hernia repair after solid-organ transplantation.
Scheuerlein H, Rauchfuss F, Gharbi A, Heise M, Settmacher U.
Transplant Proc. 2011 Jun;43(5):1783-9.
BACKGROUND: Incisional hernias are a frequent problem after liver
transplantation. Mesh repair techniques including laparoscopic repair have been
employed in order to address this problem. We have introduced intraperitoneal
onlay mesh repair (IPOM) in 2008 because of advantages that had been reported in
the literature. To perform a structured comparison of methods and outcomes, we
compared patients who have been treated with IPOM and those who have been treated
conventionally.
METHODS: We included 29 consecutive patients (15 IPOM, 14 conventional hernia
repair [CHR] who have been analyzed and have been examined clinically and
sonographically during their follow-up.
RESULTS: Recurrence rate was 6% (IPOM) and 50% (CHR), complication rate was 33%
(IPOM) and 21% (CHR), mean hospital stay was 7.2 (IPOM) and 9.7 (CHR) days. None
of the 29 patients had an impaired wound healing or infectious complications. Of
the 29 patients, 10 received sirolimus for immunosuppression, which was switched
preoperatively to a calcineurin inhibitor.
CONCLUSION: IPOM results in a shorter hospital stay. The complication rate with
IPOM was higher compared with CHR, recurrence rate was considerably lower. The
role of perioperative sirolimus switch needs to be interpreted with caution, but
should be further investigated because of potential advantages with respect to
fewer wound healing complications.
62.
Safety of ultra-rapid intravenous infusion of hepatitis B immunoglobulin in liver transplant recipients.
Hwang S, Yu YD, Park GC, Choi YI, Park PJ, Jung SW, Namgoong JM, Yoon SY, Ha HS, Hong JJ, Kim IO, Jeon MK, Ma JE, Choi SY, Yun JS, Jung DH, Song GW, Ha TY, Moon DB, Kimy KH, Ahn CS, Lee SG.
Transplant Proc. 2011 Jun;43(5):1780-2.
PURPOSE: To evaluate the safety of institutional protocol for ultra-rapid
hepatitis B immunoglobulin (HBIG) infusion (10,000 IU in 30 minutes) for
hepatitis B virus prophylaxis in adult liver transplant recipients.
METHODS: In this case-controlled study, prospectively recruited liver transplant
recipients received ultra-rapid infusions of HBIG (10,000 units in 30 minutes)
for 6 months. The historical control group consisted of patients who had received
1-hour HBIG infusions (conventional rapid infusion) for the precedent 6 months.
RESULTS: We found that 1472 patients had received 5744 ultra-rapid HBIG
infusions, whereas 1343 patients had received 5200 conventional rapid HBIG
infusions. Adverse side-effects were observed after 7 (0.13%) and 9 (0.16%)
infusions, respectively (P = .763). The number of infusions per month increased
significantly, from 878 ± 34 before the introduction of ultra-rapid infusion to
957 ± 29 afterwards (P < .001), an increase of 10.5%. The maximal capacity of
HBIG infusions per day in the outpatient clinic increased from 53 for
conventional rapid infusion to 65 for ultra-rapid infusion, without expansion of
the outpatient facility or equipment.
CONCLUSIONS: Nearly all adult liver recipients able to tolerate 1-hour infusions
of HBIG can also tolerate ultra-rapid infusions well. Thus, it seems to be
reasonable to perform ultra-rapid infusion protocol widely for patient
convenience.
63.
Early diagnostic value of plasma PCT and BG assay for CRBSI after OLT.
Chen J, Wang Y, Shen Z, Zhu Z, Song Y, Han R.
Transplant Proc. 2011 Jun;43(5):1777-9.
AIM: The aim was to evaluate the role of procalcitonin (PCT) and (1-3)-β-D-glucan
(BG) tests for early detection or exclusion of central venous catheter-related
bloodstream infections (CRBSI) in patients after orthotopic liver transplantation
(OLT).
METHODS: Fifty-five patients with clinically suspected CRBSI were assessed after
OLT in this prospective study. On the day of clinical suspicion of CRBSI, blood
samples were obtained from central venous catheters and a peripheral vein for
blood cultures and from a peripheral vein for PCT and BG tests. Plasma PCT and BG
values were measured by using an immunoluminometric assay and Fungitell BG assay,
respectively. No prisoners or organs from prisoners were used in this study.
RESULTS: Twenty-five patients (45%) were diagnosed with CRBIS. Among them, 13
(52%) displayed gram-positive bacteriemia, 11 (44%) gram-negative bacteriemia,
and 1 (4%) fungemia. The PCT values were higher in CRBSI than in non-CRBSI
patients (P = .003). CRBSI patients did not show significant increases in plasma
BG values compared with non-CRBSI subjects (P = .051). PCT and BG area under
receiver operating characteristic curves were 0.840 and 0.486, respectively.
Sensitivity, specificity, and positive and negative predictive values of a PCT of
≥ 3.1 ng/mL for the diagnosis of CRBSI were 0.72, 0.87, 0.82, and 0.79,
respectively. The figures for a BG of ≥ 83 pg/mL were 0.32, 0.90, 0.73, and 0.61,
respectively. Among the 24 patients with bacteria infections, PCT was higher in
patients with gram-negative than those with gram-positive bacterial infections (P
= .022).
CONCLUSION: We concluded that the PCT assay may be a useful rapid diagnostic
adjunct for the diagnosis of suspected CRBSI in OLT patients.
64.
Chronic hepatic artery occlusion with collateral formation: imaging findings and outcomes.
Vaidya S, Dighe M, Bhargava P, Dick AA.
Transplant Proc. 2011 Jun;43(5):1770-6.
OBJECTIVE: The imaging findings, clinical presentation, and outcome in post liver
transplantation patients with hepatic arterial collaterals are reviewed.
MATERIALS AND METHODS: Adult post orthotopic liver transplantation patients who
underwent an angiography at our institution for suspected hepatic arterial
abnormality during an approximately 10-year period were included in our study. A
retrospective review of all cases that had hepatic arterial collaterals detected
on angiography was then performed. Angiographic findings were correlated with the
findings on ultrasound and other imaging studies. Liver function at the time of
angiography was recorded. Clinical outcomes were reviewed.
RESULTS: Of the 129 angiographies performed in the approximately 10-year period,
24 (19.4%) were found to have collaterals on angiography. Maximum size of the
collaterals seen on angiography was 3 mm. Twenty patients (83%) with collaterals
are currently alive. Twelve patients (50%) had a normal outcome and did not
develop any complications on follow-up; however, the rest developed
complications. Eleven patients (41.7%) had complication related to the liver
ischemia and 2 patients (8.3%) developed malignancy (posttransplant
lymphoproliferative disease).
CONCLUSION: Collaterals seen in patients with chronic hepatic artery occlusion
are usually small in caliber and their significance is unclear. Recognition and
understanding of this phenomenon is important as this subset of patients may not
need urgent surgical re-exploration/vascular intervention.
65.
Simultaneous surgical repair for combined biliary and arterial stenoses after liver transplantation.
Sommacale D, Rochas Dos Santos V, Dondero F, Francoz C, Durand F, Sibert A,
Paugam-Burtz C, Sauvanet A, Belghiti J.
Transplant Proc. 2011 Jun;43(5):1765-9.
After orthotopic liver transplantation (OLT), hepatic artery stenoses (HAS) and
biliary strictures (BS) are frequent. These complications remain a significant
cause of graft loss and patient death. The present study reported a group of 7
patients in whom both HAS and BS were identified and treated surgically in the
same surgical session. The median times to diagnosis were 42 (range, 5-120) and
84 (range, 15-280) days after OLT for biliary and arterial stenosis,
respectively. The mortality was nil. Two patients (28%) developed postoperative
complications. The median hospital stay was 16 days (range, 10-42). All patients
are alive; there was no graft loss. With a median of 76 months' follow-up (range,
38-132), only 1 patient (14%) developed recurrence of both BS and HAS. In
patients with coincident biliary and artery stenosis, concomitant surgical repair
is feasible, offering good long-term results.
66.
Update on biliary strictures in liver transplants.
Sibulesky L, Nguyen JH.
Transplant Proc. 2011 Jun;43(5):1760-4.
Biliary complications continue to be the Achilles heel of orthotopic liver
transplantation. These include ischemic-type biliary lesions that mostly affect
liver allografts donated after cardiac and lead to increased morbidity and
retransplantation in patients undergoing liver transplantation. Although this
entity has been recognized for >20 years, the true mechanism of injury remains
unknown. Identification of the pathogenesis will likely lead to the increased use
of grafts donated after cardiac death and thus increase the organ pool. This
update reviews the risk factors that have been implicated in ischemic-type
biliary lesion formation, potential therapies, and mechanisms that might lead to
their formation.
67.
Liver retransplantation in superobese patients: a single center experience.
Taner CB, Mughal D, Aranda-Michel J.
Transplant Proc. 2011 Jun;43(5):1757-9.
A retrospective review of patients who had body mass indeces greater than 40
kg/m(2) who underwent liver retransplantation (LR) from February 1998 to December
2008 at our institution. There were 73 patients who had body mass indeces greater
than 40 kg/m(2) and had orthotopic liver transplantation. Six of 73 patients
required retransplantation. Median time between orthotopic liver transplantation
and LR was 131 days (range, 2 to 2812 days). Indications for LR were ischemic
cholangiopathy, hepatic necrosis, recurrent hepatitis C, and primary
non-function. Four patients are still alive with median survival of 37 months
after LR. Two patients had perioperative death.
68.
Motivations and decision-making dilemmas of overseas liver transplantation: Taiwan recipients' perspectives.
Huang CH, Hu RH, Shih FJ, Chen HM, Shih FJ.
Transplant Proc. 2011 Jun;43(5):1754-6.
PURPOSE: This study sought to explore the motivation and dilemmas in the
decision-making process encountered by Taiwan overseas orthotopic liver
transplant (OLT) recipients.
PATIENTS AND METHODS: We used an exploratory qualitative research method on a
sample of transplant recipients. Face-to-face in-depth interviews were performed
with a semistructured interview guide. Data were evaluated by qualitative content
analysis.
RESULTS: We interviewed 15 patients including 11 males and 4 females aged between
41 and 68 years (mean = 57.3) including 14 who received OLT in China and one in
the United States. The most important motivations were saving lives from
end-stage liver disease and avoiding a hopeless sense of their residual lives
with the psychological torture of a waiting death. Their decision-making process
leading to overseas OLT could be divided into several phases among which the
phase of transplant data evaluation and decision was the most critical one.
Nevertheless, every stage and phase had its unique contents, factors, and
dilemmas.
CONCLUSION: This study demonstrated that patients encountered various dilemmas at
different phases in the decision-making process of considering overseas OLT. This
information is important for care providers and policy makers in dealing with
patients who consider overseas OLT.