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Clinical Transplantation

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https://www.readbyqxmd.com/read/28636211/resolution-of-donor-non-alcoholic-fatty-liver-disease-following-liver-transplantation
#1
Andrew D Posner, Samuel T Sultan, Norann A Zaghloul, William S Twaddell, David A Bruno, Steven I Hanish, William R Hutson, Laci Hebert, Rolf N Barth, John C LaMattina
INTRODUCTION: Transplant surgeons conventionally select against livers displaying high degrees (>30%) of macrosteatosis (MaS), out of concern for primary non-function or severe graft dysfunction. As such, there is relatively limited experience with such livers, and the natural history remains incompletely characterized. We present our experience of transplanted livers with high degrees of MaS and microsteatosis (MiS), with a focus on the histopathologic and clinical outcomes. METHODS: 29 cases were identified with liver biopsies available from both the donor and the corresponding liver transplant recipient...
June 21, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28636074/optimizing-outcomes-in-pancreas-transplantation-impact-of-organ-preservation-time
#2
Ehren N Rudolph, Ty B Dunn, David E R Sutherland, Raja Kandaswamy, Erik B Finger
Recent changes to pancreas graft allocation policy have increased the number of organs available for regional and distant sharing, which results in a corresponding increase in preservation time. We sought to systematically assess the impact of cold ischemia time (CIT) on outcomes posttransplant. A retrospective review of 1,253 pancreas transplants performed at a single transplant center was performed to correlate CIT to transplant outcomes. The rate of technical failure (TF) increased with 20+ hours of CIT, with a 2...
June 21, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28627046/donor-specific-antibodies-are-associated-with-micro-and-macrovascular-coronary-disease-restrictive-myocardial-damage-and-poor-outcome-in-heart-transplanted-patients
#3
Tor Skibsted Clemmensen, Pernille Koefoed-Nielsen, Lis-Ann Jensen, Steen Hvitfeldt Poulsen, Niels Ramsing Holm, Brian Bridal Løgstrup, Evald Høj Christiansen, Jouke Dijkstra, Kamilla Pernille Bjerre Valen, Hans Eiskjaer
AIMS: We examined the relationship between donor-specific HLA antibody (DSA) presence and graft function, hemodynamics, cardiac allograft vasculopathy (CAV), and major adverse cardiac events (MACE) in stable long-term heart-transplanted (HTx) patients. METHODS: Sera from 79 patients (median 7.5 years after HTx) were analyzed for DSA presence. Graft function was evaluated by echocardiography and right heart catheterization. CAV-burden was determined by coronary angiography, optical coherence tomography (OCT), and coronary flow velocity reserve (CFVR)...
June 19, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28621877/autoimmune-hemolytic-anemia-in-solid-organ-transplantation-the-role-of-immunosuppression
#4
REVIEW
Theoni Kanellopoulou
Hemolysis after solid organ transplantation can be caused by both immune and non-immune mediated mechanisms and the evaluation must take into account issues distinctive to the post-transplant period. Autoimmune hemolytic anemia usually occurs within the first year and has been attributed to immunosuppressive treatment, infections or underlying post-transplant lymphoproliferative disorder. Review of the literature revealed 59 cases with autoimmune hemolytic anemia mostly in children after liver transplantation...
June 16, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28612360/analysis-of-local-versus-imported-expanded-criteria-donor-ecd-kidneys-a-single-center-experience-with-497-ecd-kidney-transplants
#5
Muhammad Arsalan Khan, Hany El-Hennawy, Alan C Farney, Jeffrey Rogers, Giuseppe Orlando, Amber Reeves-Daniel, Amudha Palanisamy, Michael Gautreaux, Samy Iskandar, William Doares, Scott Kaczmorski, Robert J Stratta
The value of importing expanded criteria donor (ECD) kidneys is uncertain. METHODS: We retrospectively reviewed our single center experience with ECD kidney transplants (KT). RESULTS: Over 12.8 years, we performed 497 ECD KTs including 247 local and 250 imported from other donor service areas. The import ECD group had more donors (16% vs 9%) ≥ age 70, more zero HLA-mismatches (14% vs 2%), more KTs with a cold ischemia time >30 hours (46% vs 19%), and fewer kidneys managed with pump preservation (78% vs 92%, all p ≤ 0...
June 14, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28609813/trajectories-of-self-care-agency-and-associated-factors-in-lung-transplant-recipients-over-the-first-12-months-following-transplantation
#6
L Hu, J H Lingler, A DeVito Dabbs, M A Dew, S M Sereika
Self-care agency (SCA), defined as one's ability and willingness to engage in self-care behaviors, can influence actual performance of self-care behaviors in lung transplant recipients (LTRs). Understanding patterns of SCA over time may inform the design of interventions to promote self-care in LTRs. Using group-based trajectory modeling, we sought to identify patterns and correlates of SCA among 94 LTRs over the first 12-months post-transplant. Baseline measures of sociodemographic, clinical, and psychosocial factors, and longitudinally assessed psychological distress were examined for their associations with predicted trajectory group membership...
June 13, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28582797/the-detrimental-impact-of-persistent-versus-an-isolated-occurrence-of-de-novo-donor-specific-antibodies-on-intermediate-term-renal-transplant-outcomes
#7
Jennifer M Loucks-DeVos, Todd N Eagar, A Osama Gaber, Samir J Patel, Larry D Teeter, Edward A Graviss, Richard J Knight
BACKGROUND: De novo donor specific antibodies (dnDSA) after renal transplant are associated with acute rejection (AR) and graft loss, yet most recipients with dnDSA have stable function and no AR. We assessed whether the persistence of dnDSA increased the risk of a detrimental outcome. METHODS: A single-center review of renal transplant recipients monitored for dnDSA at multiple time points post-transplant. An Isolated dnDSA was defined as one positive dnDSA and no additional positive tests, whereas ≥2 positive dnDSA was defined as persistent dnDSA...
June 5, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28581202/switch-to-an-everolimus-facilitated-cyclosporine-a-sparing-immunosuppression-improves-glycemic-control-in-selected-kidney-transplant-recipients
#8
Florian Kälble, Jörg Seckinger, Matthias Schaier, Christian Morath, Vedat Schwenger, Martin Zeier, Claudia Sommerer
BACKGROUND: Mammalian target of rapamycin inhibitors (mToRi) allow calcineurin inhibitor (CNI) sparing therapy in renal transplant recipients with possible beneficial effects on the long-term allograft function and cardiovascular risk. The influence of mToRi on glucose metabolism is still under discussion. METHODS: In a retrospective analysis, renal allograft recipients switched from a cyclosporine A (CsA) to an everolimus (EVR) based immunosuppression in the first year after transplantation were compared with patients on continued CsA treatment...
June 5, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28580753/reporting-functional-status-in-unos-the-weakness-of-the-karnofsky-performance-status-scale
#9
LETTER
Connie W Wang, Jennifer C Lai
No abstract text is available yet for this article.
June 5, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28580616/deceased-organ-donors-with-central-nervous-system-neoplasm
#10
LETTER
Olivier Detry
No abstract text is available yet for this article.
June 5, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28573685/epidemiology-risk-factors-and-outcomes-of-infections-in-patients-undergoing-liver-transplantation-for-hilar-cholangiocarcinoma
#11
Poornima Ramanan, Nathan W Cummins, Mark P Wilhelm, Julie K Heimbach, Ross Dierkhising, Walter K Kremers, Charles B Rosen, Gregory J Gores, Raymund R Razonable
The epidemiology of infection after liver transplantation for hilar cholangiocarcinoma has not been systematically investigated. In this study of 124 patients, 255 infections occurred in 105 patients during the median follow-up of 4.2 years. The median time to first infection was 15.1 weeks (IQR 1.6 - 62.6). The most common sites were the abdomen, bloodstream and musculoskeletal system. Risk factors for any post-transplant infection were pre-transplant VRE colonization (Hazard Ratio [HR] 1.9, p=0.002), living donor transplantation (HR 6...
June 2, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28564273/kidney-transplantation-from-donors-with-rhabdomyolysis-and-acute-renal-failure
#12
Chuan-Bao Chen, Yi-Tao Zheng, Jian Zhou, Ming Han, Xiao-Ping Wang, Xiao-Peng Yuan, Chang-Xi Wang, Xiao-Shun He
Rhabdomyolysis in deceased donors usually causes acute renal failure (ARF), which may be considered a contraindication for kidney transplantation. From January 2012 to December 2016, 30 kidneys from 15 deceased donors with severe rhabdomyolysis and ARF were accepted for transplantation at our center. The peak serum creatinine kinase, myoglobin, and serum creatinine of the these donors was 15569 ± 8597 U/L, 37092 ± 42100 μg/L, and 422 ± 167 μmol/L, respectively. Two donors received continuous renal replacement therapy due to anuria...
May 31, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28564127/impact-of-terlipressin-infusion-during-and-after-live-donor-liver-transplantation-on-incidence-of-acute-kidney-injury-and-neutrophil-gelatinase-associated-lipocalin-serum-levels-a-randomized-controlled-trial
#13
Mohamed Abdelrauf Kandil, Khalid Mousa Abouelenain, Ayman Alsebaey, Hanaa Said Rashed, Mohamed Helmi Afifi, Mohamed Abdelmoneem Mahmoud, Khaled Ahmed Yassen
Acute kidney injury (AKI) with liver transplantation is not uncommon. Impact of Terlipressin infusion on AKI, haemodynamics and plasma concentration of Neutrophil Gelatinase Associated Lipocalin (NGAL) was studied METHODS: Patients (n=50) were randomized (NCT02059460, USA) into 2 equal groups; Terlipressin vs Controls. Terlipressin (1-4 μg/kg/h) was administrated for 5 days. Intraoperative Transoesophageal Doppler for haemodynamic management. Renal functions, peak portal vein blood flow velocity (PPV) and hepatic artery resistive index (HARI) were recorded...
May 31, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28564126/prehabilitation-for-kidney-transplant-candidates-is-it-time
#14
REVIEW
Xingxing S Cheng, Jonathan N Myers, Glenn M Chertow, Ralph Rabkin, Khin N Chan, Yu Chen, Jane C Tan
Many patients become frail with diminished cardiorespiratory fitness while awaiting kidney transplantation. Frailty and poor fitness powerfully predict mortality, transplant graft survival, and health care utilization after kidney transplantation. Efforts to intervene with post-transplant physical therapy have been met with limited success, in large part due to high study drop-out. We reviewed the literature on chronic kidney disease and exercise to propose a clinical framework for physical therapy interventions to improve fitness, scheduled for before the transplant...
May 31, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28544075/dual-kidney-transplant-techniques-a-systematic-review
#15
Annelise Cocco, Sara Shahrestani, Nicholas Cocco, Ahmer Hameed, Lawrence Yuen, Brendan Ryan, Wayne Hawthorne, Vincent Lam, Henry Pleass
BACKGROUND: Dual kidney transplantation (DKT) was developed in order to improve outcomes from transplantation of extended criteria donors (ECD). This paper examined which surgical techniques have been reported for DKT, and whether any technique had superior patient and graft survival. METHOD: Electronic databases were searched for published studies mapping to MESH terms: ''kidney or renal" AND "transplan*" AND "dual or double". Single case reports; studies of patients less than 18 years old; studies which did not describe the surgical technique; and studies that did not report patient or graft survival were excluded...
May 23, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28523792/the-impact-of-calcineurin-inhibitors-on-neutrophil-gelatinase-associated-lipocalin-and-fibroblast-growth-factor-23-in-long-term-kidney-transplant-patients
#16
Inger Hjørdis Bleskestad, Inga Strand Thorsen, Grete Jonsson, Øyvind Skadberg, Lasse Gunnar Gøransson
BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL), a protein with bacteriostatic functions rapidly excreted from stimulated or damaged epithelial cells, is elevated in acute and chronic kidney disease. A calcineurin dependent signaling pathway for fibroblast growth factor 23 (FGF23) has been revealed, but the effect of calcineurin inhibitors (CNIs) on the levels of NGAL and markers of mineral metabolism in long-term kidney transplant patients has not been explored. METHODS: In a cross-sectional study, 39 patients who received a first kidney transplant more than 10 years ago were split into two groups based on whether (n=28) or not (n=11) they used CNIs...
May 19, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28523715/dual-en-bloc-technique-for-adult-renal-transplantation
#17
Kim Chi Tran, David Li, Ali Taqi, Alp Sener, Vivian C McAlister, Patrick P Luke
INTRODUCTION: We describe and provide follow-up for a novel simplified technique permitting dual en-bloc (DEB) transplantation of adult organs using single in situ arterial and venous anastomoses. METHODS: Twenty-two adult DEB transplants were performed at our centre between 2001 and 2012, utilizing 44 kidneys en bloc. Results were compared with 20 solitary transplants from expanded criteria donors (ECD) associated with lower terminal serum creatinines and Remuzzi biopsy scores vs...
May 19, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28517493/accuracy-of-computed-tomography-for-detecting-hepatic-steatosis-in-donors-for-liver-transplantation-a-meta-analysis
#18
Danping Zheng, Wenshuo Tian, Zhouying Zheng, Jincui Gu, Zhiyong Guo, Xiaoshun He
BACKGROUND: The accuracy of computed tomography (CT) for detecting donor hepatic steatosis (HS) before liver transplantation is not well established. METHODS: A meta-analysis was performed to determine the accuracy of CT for HS detection in liver donor candidates. Pooled sensitivity, specificity, positive and negative likelihood ratios, hierarchical summary receiver operating characteristic (HSROC) curves, and the area under the curve (AUC) were estimated using HSROC and bivariate random-effects models...
May 18, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28517242/race-ethnicity-is-associated-with-abo-non-identical-liver-transplantation-in-the-united-states
#19
Jin Ge, John P Roberts, Jennifer C Lai
United Network for Organ Sharing (UNOS) policies allows for ABO non-identical liver transplantation (LT) in candidates with Model for End-Stage Liver Disease (MELD) scores greater than 30. Previous studies showed ABO non-identical LT resulted in an 18% and 55% net gain in livers for B and AB candidates. These results suggested that the current liver ABO allocation policies may need refinement. There are, however, strong associations between ABO blood groups and race/ethnicity. We hypothesized that race/ethnicity is associated with ABO non-identical LT and that this is primarily influenced by recipient ABO status...
May 18, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28517112/patterns-and-correlates-of-adherence-to-self-monitoring-in-lung-transplant-recipients-during-the-first-12-months-after-discharge-from-transplant
#20
Lu Hu, Annette DeVito Dabbs, Mary Amanda Dew, Susan M Sereika, Jennifer H Lingler
Self-monitoring of lung function, vital signs, and symptoms is crucial for lung transplant recipients (LTRs) to ensure early detection of complications and prompt intervention. This study sought to identify patterns and correlates of adherence to self-monitoring among LTRs over the first 12-months post-discharge from transplant. This study analyzed existing data from the usual care arm participants of a randomized clinical trial who tracked self-monitoring activities using paper-and-pencil logs. Adherence was calculated as the percent of days LTRs recorded any self-monitoring data per interval: hospital discharge-2 months, 3-6 months, and 7-12 months...
May 18, 2017: Clinical Transplantation
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