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Clinical Transplantation

D Larson, C Jacobs, D Berglund, J Wiseman, C Garvey, K Gillingham, H N Ibrahim, A J Matas
Transplant programs inform potential donors that they should be able to return to normal activities within ~2 weeks and to work by 6 weeks after laparoscopic nephrectomy. We studied actual time. Between 10/2004 - 9/2014, 911 donors having laparoscopic nephrectomy were surveyed 6 months post-donation. Surveys asked questions specific to their recovery experience, including time to return to normal activities and work; and a description of their recovery time relative to pre-donation expectations. Of the 911, 646 (71%) responded: mean age at donation was 43...
October 14, 2016: Clinical Transplantation
Simon R Knight, Samia Hussain
Early measures of graft function are increasingly used to assess efficacy in clinical trials of kidney transplant immunosuppression. This study aimed to assess the variability and quality of reporting of these endpoints in contemporary trials. Data regarding renal function endpoints were extracted from 213 reports from randomised controlled trials comparing immunosuppressive interventions in renal transplant recipients published between 2010 and 2014. 174 (81.7%) reports included a measure of renal function; in 44 (20...
October 14, 2016: Clinical Transplantation
Maria Stepanova, Trevor Locklear, Nila Rafiq, Alita Mishra, Chapy Venkatesan, Zobair M Younossi
BACKGROUND: Chronic HCV infection is often considered a contraindication for receiving a heart transplantation. METHODS: From the Scientific Registry of Transplant Recipients, we selected all adults with and without HCV infection who underwent a single organ heart transplantation in 1995-2013; the mortality status was updated in September 2015. RESULTS: A total of 32,812 heart transplant recipients were included; N=756 (2.30%) HCV-positive...
October 14, 2016: Clinical Transplantation
Lauren B Cooper, Carmelo A Milano, Melissa Williams, Wendy Swafford, Donna Croezen, Adrian B Van Bakel, Joseph Rogers, Chetan B Patel
BACKGROUND: Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can halt that process and lead to increased utilization of donor organs, but prolonged used of thyroid replacement has not been well studied. METHODS: We developed a 15 question survey regarding policies, procedures, and reporting of thyroid hormone use by OPOs. The survey was posted for five weeks on the Association of OPOs Portal...
October 11, 2016: Clinical Transplantation
Elias David-Neto, Ana Heloisa Kamada Triboni, Fernanda Ramos, Fabiana Agena, Nelson Zocoler Galante, Marcelo Altona, Francine Brambate Carvalhinho Lemos, Marcelo Tatit Sapienza, William Carlos Nahas
Equations to estimate glomerular filtration rate (eGFR) were developed in patients using the variables: age, body weight and serum creatinine which may be different in the elderly. Elderly renal transplant patients (EG; n=70; mean age 65±4y) who measured plasma (51) Cr-EDTA-Clearance (mGFR) had mGFR compared to eGFR obtained by the Cockcroft-Gault corrected by body surface area (CG-BSA), the Modification of Diet in Renal Disease (MDRD-4), the Berlin Initiative Study (BIS-1) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)...
October 11, 2016: Clinical Transplantation
Giovanni Battista Levi Sandri, Edoardo De Werra, Gianluca Mascianà, Francesco Guerra, Gabriele Spoletini, Quirino Lai
Minimally invasive surgical approaches in transplantation are gaining increasing interest, and many centers are reporting their, mainly laparoscopic, experiences. Robotic surgery (RS) has some hypothetical advantages over traditional laparoscopy, and has been successfully applied, although infrequently to organ transplantation. Our goal was to review and critique the publications reporting RS use in organ transplantation. Most of the RS experience has been with living renal donor organ procurement and, to a lesser extent, with RS procedures in the transplant recipient...
October 11, 2016: Clinical Transplantation
Thomas Hugh Feeley, Brian L Quick, Seyoung Lee
BACKGROUND: Two direct mail campaigns were undertaken in Rochester and Buffalo, New York with the goal of enrolling adults' ages 50-64 years into the state organ and tissue donation electronic registry. Meta-analytic methods were used to summarize the body of research on the effects of direct mail marketing to promote organ donation registration. METHODS: In the first study, 40,000 mailers were sent to targeted adults in Rochester, New York and varied by brochure-only, letter-only, and letter plus brochure mailing conditions...
October 11, 2016: Clinical Transplantation
Pearlie P Chong, David van Duin, Jessica L Sonderup, Wendy J Grant, Andre C Kalil, Diana F Florescu
Solid organ transplant (SOT) recipients may develop protracted diarrheal illness from norovirus. We performed a retrospective chart review between January 2010 and April 2014 to identify predictors of persistent diarrhea in transplant recipients with norovirus enteritis. A total of 152 SOT recipients with mean age of 31.5 years (SD 23.1) were included: 43.4% male, 34.2% pediatric patients. Allograft types were abdominal 136 (89.5%) (kidney [39.5%], liver-small bowel [23%], other [27%]) and thoracic 16 (10...
October 6, 2016: Clinical Transplantation
Shun Huang, Worapot Apinyachon, Vatche G Agopian, Christopher L Wray, Ronald W Busuttil, Randolph H Steadman, Victor W Xia
Myocardial injury, defined as an elevation of cardiac troponin (cTn) resulting from ischemia, is associated with substantial mortality in surgical patients, and its incidence, risk factors, and impact on patients undergoing liver transplantation (LT) are poorly understood. In this study, adult patients who experienced perioperative hemodynamic derangements and had cTn measurements within 30 days after LT between 2006 and 2013 were studied. Of 502 patients, 203 (40.4%) met the diagnostic criteria (cTn I ≥0...
September 21, 2016: Clinical Transplantation
Kevin Pilarczyk, Nils Haake, Jens Heckmann, Henning Carstens, Assad Haneya, Jochen Cremer, Heinz Jakob, Nikolaus Pizanis, Markus Kamler
BACKGROUND: Lung transplant (LTX) recipients are at high risk of invasive aspergillus infections (IAI). However, no randomized controlled trials (RCT) or international guidelines on antifungal prophylaxis (AFP) in the LTX population exist. METHODS: A meta-analysis was performed to determine whether AFP reduces the rate of IAI after LTX. A total of six eligible observational studies (five with no prophylaxis, one with targeted prophylaxis, three studies including heart(lung)transplantation) with a total of 748 patients were included...
September 21, 2016: Clinical Transplantation
Don Hayes, Dmitry Tumin, Andrew R Yates, Heidi M Mansour, Kathleen K Nicol, Joseph D Tobias, Andre F Palmer
BACKGROUND: The effect of pre-transplant transfusion of red blood cells on survival after lung transplantation (LTx) has not been studied. METHODS: The UNOS database was queried from 2005 to 2013 to compare survival in recipients receiving a transfusion while on the LTx waitlist. RESULTS: Of 12,283 adult patients undergoing single or bilateral LTx from May 2005 onwards, 11,801 met inclusion criteria, among whom 512 required transfusion while on the LTx waitlist...
September 21, 2016: Clinical Transplantation
Soo-Ho Lee, Jun-Suh Lee, Gun-Hyung Na, Young-Kyoung You, Dong-Goo Kim
AIM: There were differences in progression and prognosis of hepatocellular carcinoma (HCC) after surgery between liver resection (LR) and liver transplantation (LT). In this study, immunohistochemical (IHC) markers associated with the prognosis of HCC were assessed. METHODS: Data were collected from 167 patients who underwent LT (n = 41) or LR (n = 126) for HCC. IHC markers including alpha fetoprotein (AFP), p53, Ki-67, cytokeratin 7 (CK7), and cytokeratin 19 (CK19) were compared between the treatment methods in tumor tissue...
September 21, 2016: Clinical Transplantation
Jennifer A McCaughan, Victoria Robertson, Stuart J Falconer, Claire Cryer, David M Turner, Gabriel C Oniscu
There is limited evidence for a negative impact of preformed, donor specific HLA antibodies (DSA) identified by cross matching on outcomes after liver transplantation. Three recent studies have suggested an association between preformed DSA detected by Luminex and reduced graft or recipient survival in liver transplant cohorts with a high prevalence of hepatitis C. This study investigated the impact of preformed DSA identified by Luminex in the Scottish liver transplant population. All recipients of liver transplants in Scotland between 2007 and 2015 with samples available for day of transplant antibody testing and donor HLA typing were included (n=459); 96% of the cohort were White and 19% had a primary diagnosis of hepatitis C...
September 21, 2016: Clinical Transplantation
Toru Ikegami, Norifumi Harimoto, Masahiro Shimokawa, Tomoharu Yoshizumi, Hideaki Uchiyama, Shinji Itoh, Norihisa Okabe, Kazuhito Sakata, Akihisa Nagatsu, Yuji Soejima, Yoshihiko Maehara
The learning curve for performing living donor hemi-liver procurement (LDHP) via small upper midline incision (UMI) has not been determined. Living donors (n=101) who underwent LDHP via UMI were included to investigate the learning curve using cumulative sum analysis. The cumulative sum analysis showed that 9 cases for right lobe (case # 23) and 19 cases for left lobe (case # 32 in the whole series) are needed for stable and acceptable surgical outcomes in LDHP via UMI. The established phase (n=69, since case #33) had a significantly shorter operative time, a smaller incision size and less blood loss than the previous learning phase (n=32, serial case number up to the last 19(th) left lobe case)...
September 21, 2016: Clinical Transplantation
Hannah Lee, Chan Woo Cho, Susie Yoon, Kyung-Suk Suh, Ho Geol Ryu
Postoperative ileus (POI) is a common complication after major abdominal surgery. Gum chewing has been shown to stimulate bowel motility and decrease duration of POI after abdominal surgery. We evaluated the effect of gum chewing in reducing the time to first flatus and on oral calorie intake in patients undergoing living or deceased donor liver transplantation. Patients were randomized into the sham feeding group or the control group. The sham feeding group chewed two pieces of xylitol flavored gum for 15 minutes, three times a day after extubation until oral nutrition was tolerated...
September 21, 2016: Clinical Transplantation
R M Nygaard, A M Sirany, E A Wyman, J Bodner, C J Richardson, A L Ney, M D Odland, M J Hill
Preoperative risk assessment of potential kidney transplant recipients often fails to adequately balance risk related to underlying comorbidities with the beneficial impact of kidney transplantation. We sought to develop a simple scoring system based on factors known at the time of patient assessment for placement on the waitlist to predict likelihood of severe adverse events one year post-transplant. The tool includes four components: age, cardiopulmonary factors, functional status, and metabolic factors. Pre-transplant factors strongly associated with severe adverse events include: diabetic (OR 3...
September 20, 2016: Clinical Transplantation
Edward J Filippone, John L Farber
Membranous nephropathy (MN) may occur in a kidney transplant as recurrence of the original disease (rMN) or as a de novo MN (dnMN). rMN often occurs early, within the first year, and often in a mild or subclinical fashion. Recurrence cannot be predicted by clinical features at the time of transplantation. The natural history is increasing proteinuria over time, with less chance for spontaneous remission compared to primary MN (pMN). Antiphospholipase A2 receptor (PLA2R) antibodies should be evaluated in all patients with pMN at the time of transplantation and serially...
September 20, 2016: Clinical Transplantation
Minoru Murakami, Shingo Fukuma, Masaya Ikezoe, Chizuko Iizuka, Satoshi Izawa, Yosuke Yamamoto, Shin Yamazaki, Shunichi Fukuhara
INTRODUCTION: Little is known about the effect of education programs on changing attitudes and behaviors of participants and their families toward deceased organ donation. METHODS: The subjects of this randomized trial were Japanese nursing students who were not previously designated organ donors. They were randomly assigned to either the education program or information booklet group. The program comprised a lecture followed by group discussion and information booklet...
September 13, 2016: Clinical Transplantation
Nahid Tabibzadeh, François Glowacki, Marie Frimat, Vincent Elsermans, François Provôt, Arnaud Lionet, Viviane Gnemmi, Alexandre Hertig, Christian Noël, Marc Hazzan
BACKGROUND: Despite long-term side effects, calcineurin inhibitors (CNI) remain a cornerstone of immunosuppression in renal transplantation. Few trials assessed the long-term outcome after early CNI withdrawal. METHODS: This intention-to-treat study assessed the 10-year outcome of 108 patients randomly converted from a cyclosporine (CsA)-mycophenolate mofetil (MMF)-prednisone regimen to a dual therapy (CsA-prednisone or MMF-prednisone) at 3 months postgraft. RESULTS: At 10 years, 3...
September 13, 2016: Clinical Transplantation
Joshua S Jolissaint, Linda W Langman, Claire L DeBolt, Jacob A Tatum, Allison N Martin, Andrew Y Wang, Daniel S Strand, Victor M Zaydfudim, Reid B Adams, Kenneth L Brayman
OBJECTIVE: The purpose of this study was to determine whether bacterial contamination of islets affects graft success after total pancreatectomy with islet autotransplantation (TPIAT). BACKGROUND: Factors associated with insulin independence after TPIAT are inconclusive. Although bacterial contamination does not preclude transplantation, the impact of bacterial contamination on graft success is unknown. METHODS: Patients who received TPIAT at the University of Virginia between January 2007 and January 2016 were reviewed...
September 13, 2016: Clinical Transplantation
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