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Journal of Transplantation

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https://www.readbyqxmd.com/read/29862061/renal-transplants-from-older-deceased-donors-use-of-preimplantation-biopsy-and-differential-allocation-to-dual-or-single-kidney-transplant-according-to-histological-score-has-no-advantages-over-allocation-to-single-kidney-transplant-by-simple-clinical-indication
#1
Costanza Casati, Valeriana Giuseppina Colombo, Marialuisa Perrino, Ornella Marina Rossetti, Marialuisa Querques, Alessandro Giacomoni, Agnese Binaggia, Giacomo Colussi
Background: Grafts from elderly donors (ECD) are increasingly allocated to single (SKT) or dual (DKT) kidney transplantation according to biopsy score. Indications and benefits of either procedure lack universal agreement. Methods: A total of 302 ECD-transplants in period from Jan 1, 2000, to Dec 31, 2015, were allocated to SKT (SKTpre ) on clinical grounds alone (before Dec 2010, pre-DKT era, n = 170) or according to a clinical-histological protocol (after Dec 2010, DKT era, n = 132) to DKT ( n = 48), SKT biopsy-based protocol ("high-risk", SKThr , n = 51), or SKT clinically based protocol ("low-risk", SKTlr , n = 33)...
2018: Journal of Transplantation
https://www.readbyqxmd.com/read/29854421/pilot-analysis-of-late-conversion-to-belatacept-in-kidney-transplant-recipients-for-biopsy-proven-chronic-tacrolimus-toxicity
#2
Shruti Gupta, Ivy Rosales, David Wojciechowski
Background: Calcineurin inhibitors are associated with chronic nephrotoxicity, manifesting as interstitial fibrosis/tubular atrophy (IF/TA) and arteriolar hyalinosis. Conversion from tacrolimus to belatacept may be one strategy to preserve renal function. Methods: We conducted a retrospective review of renal transplant patients followed at our institution who were converted to belatacept and found to have chronic tacrolimus toxicity on biopsy. The primary outcome was eGFR at conversion as compared to eGFR at 3, 6, 12, and 24 months after conversion...
2018: Journal of Transplantation
https://www.readbyqxmd.com/read/29850195/the-kinetics-of-anti-hla-antibodies-in-the-first-year-after-kidney-transplantation-in-whom-and-when-should-they-be-monitored
#3
Maria Cristina Ribeiro de Castro, Erick A Barbosa, Renata P Souza, Fabiana Agena, Patrícia S de Souza, Gabriella Maciel, Hélcio Rodrigues, Nicolas Panajotopoulos, Daísa S David, Flávio J de Paula, Elias David-Neto
The impact of the kinetics of the anti-HLA antibodies after KTx on the occurrence of acute rejection as well as the better time-point to monitor anti-HLA Abs after transplantation is not completely defined. This prospective study followed 150 patients over 12 months after transplantation. Serum IgG anti-HLA Abs were detected by single antigen beads after typing donors and recipients for loci A, B, C, DR, and DQ. Before KTx, 89 patients did not present anti-HLA Abs and 2% developed "de novo" Abs during the 1st year, 39 patients were sensitized without DSAs, and 13% developed DSA after surgery; all of them presented ABMR...
2018: Journal of Transplantation
https://www.readbyqxmd.com/read/29808114/preoperative-low-density-lipoprotein-apheresis-for-preventing-recurrence-of-focal-segmental-glomerulosclerosis-after-kidney-transplantation
#4
Akihito Sannomiya, Toru Murakami, Ichiro Koyama, Kosaku Nitta, Ichiro Nakajima, Shohei Fuchinoue
Background: Focal segmental glomerulosclerosis (FSGS) often develops rapidly and frequently progresses to renal failure, while the recurrence rate after kidney transplantation is 20-50%. We performed low-density lipoprotein (LDL) apheresis before kidney transplantation in FSGS patients to prevent recurrence. Methods: Five adult patients with chronic renal failure due to FSGS undergoing living related donor kidney transplantation were investigated retrospectively...
2018: Journal of Transplantation
https://www.readbyqxmd.com/read/29796311/role-of-direct-antiviral-agents-in-treatment-of-chronic-hepatitis-c-infection-in-renal-transplant-recipients
#5
Sourabh Sharma, Debabrata Mukherjee, Ranjith K Nair, Bhaskar Datt, Ananth Rao
Background: Since the introduction of direct antiviral agents (DAAs), morbidity of HCV has considerably decreased but still no guidelines have been formulated in renal transplant recipients (RTRs). We studied efficacy and tolerability of direct antiviral agents in RTRs. Methods: This prospective observational study was conducted at Army Hospital Research & Referral, Delhi, from June 2016 to May 2017. Forty-five HCV infected RTRs with stable graft function were included...
2018: Journal of Transplantation
https://www.readbyqxmd.com/read/29670765/mending-a-broken-heart-treatment-of-stress-induced-heart-failure-after-solid-organ-transplantation
#6
REVIEW
N Thao Galván, Kayla Kumm, Michael Kueht, Cindy P Ha, Dor Yoeli, Ronald T Cotton, Abbas Rana, Christine A O'Mahony, Glenn Halff, John A Goss
Stress-induced heart failure, also known as Broken Heart Syndrome or Takotsubo Syndrome, is a phenomenon characterized as rare but well described in the literature, with increasing incidence. While more commonly associated with postmenopausal women with psychiatric disorders, this entity is found in the postoperative patient. The nonischemic cardiogenic shock manifests as biventricular failure with significant decreases in ejection fraction and cardiac function. In a review of over 3000 kidney and liver transplantations over the course of 17 years within two transplant centers, we describe a series of 7 patients with Takotsubo Syndrome after solid organ transplantation...
2018: Journal of Transplantation
https://www.readbyqxmd.com/read/29670764/corticosteroid-weaning-in-stable-heart-transplant-patients-guidance-by-serum-cortisol-level
#7
David A Baran, Cheryl Rosenfeld, Mark J Zucker
Background: Despite earlier studies describing the feasibility of steroid weaning in heart transplant patients, the majority of patients are maintained on steroid therapy for life. We examined a strategy based on a single morning serum cortisol measurement. Methods: We assigned stable posttransplant patients, who were maintained on tacrolimus, mycophenolate mofetil, and corticosteroids, into one of two groups based on a screening morning cortisol level. Patients with a cortisol < 8 micrograms/deciliter were assigned to a "maintenance" group and the others were assigned to the weaning group and steroids were tapered off over 4-6 weeks...
2018: Journal of Transplantation
https://www.readbyqxmd.com/read/29623219/management-strategies-for-posttransplant-diabetes-mellitus-after-heart-transplantation-a-review
#8
REVIEW
Matthew G Cehic, Nishant Nundall, Jerry R Greenfield, Peter S Macdonald
Posttransplant diabetes mellitus (PTDM) is a well-recognized complication of heart transplantation and is associated with increased morbidity and mortality. Previous studies have yielded wide ranging estimates in the incidence of PTDM due in part to variable definitions applied. In addition, there is a limited published data on the management of PTDM after heart transplantation and a paucity of studies examining the effects of newer classes of hypoglycaemic drug therapies. In this review, we discuss the role of established glucose-lowering therapies and the rationale and emerging clinical evidence that supports the role of incretin-based therapies (glucagon like peptide- (GLP-) 1 agonists and dipeptidyl peptidase- (DPP-) 4 inhibitors) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of PTDM after heart transplantation...
2018: Journal of Transplantation
https://www.readbyqxmd.com/read/29593894/validation-of-a-survey-questionnaire-on-organ-donation-an-arabic-world-scenario
#9
Rajvir Singh, Tulika Mehta Agarwal, Hassan Al-Thani, Yousuf Al Maslamani, Ayman El-Menyar
Objective: To validate a questionnaire for measuring factors influencing organ donation and transplant. Methods: The constructed questionnaire was based on the theory of planned behavior by Ajzen Icek and had 45 questions including general inquiry and demographic information. Four experts on the topic, Arabic culture, and the Arabic and English languages established content validity through review. It was quantified by content validity index (CVI). Construct validity was established by principal component analysis (PCA), whereas internal consistency was checked by Cronbach's Alpha and intraclass correlation coefficient (ICC)...
2018: Journal of Transplantation
https://www.readbyqxmd.com/read/29312783/analysis-of-risk-factors-for-kidney-retransplant-outcomes-associated-with-common-induction-regimens-a-study-of-over-twelve-thousand-cases-in-the-united-states
#10
Alfonso H Santos, Michael J Casey, Karl L Womer
We studied registry data of 12,944 adult kidney retransplant recipients categorized by induction regimen received into antithymocyte globulin (ATG) ( N = 9120), alemtuzumab ( N = 1687), and basiliximab ( N = 2137) cohorts. We analyzed risk factors for 1-year acute rejection (AR) and 5-year death-censored graft loss (DCGL) and patient death. Compared with the reference, basiliximab: (1) one-year AR risk was lower with ATG in retransplant recipients of expanded criteria deceased-donor kidneys (HR = 0.56, 95% CI = 0...
2017: Journal of Transplantation
https://www.readbyqxmd.com/read/28386475/retrospective-study-looking-at-cinacalcet-in-the-management-of-hyperparathyroidism-after-kidney-transplantation
#11
Habib Mawad, Hugues Bouchard, Duy Tran, Denis Ouimet, Jean-Philippe Lafrance, Robert Zoël Bell, Sarah Bezzaoucha, Anne Boucher, Suzon Collette, Vincent Pichette, Lynne Senécal, Michel Vallée
Objectives. The primary objective of this study is to evaluate the use of cinacalcet in the management of hyperparathyroidism in kidney transplant recipients. The secondary objective is to identify baseline factors that predict cinacalcet use after transplantation. Methods. In this single-center retrospective study, we conducted a chart review of all patients having been transplanted from 2003 to 2012 and having received cinacalcet up to kidney transplantation and/or thereafter. Results. Twenty-seven patients were included with a mean follow-up of 2...
2017: Journal of Transplantation
https://www.readbyqxmd.com/read/28316834/the-cecari-study-everolimus-certican%C3%A2-initiation-and-calcineurin-inhibitor-withdrawal-in-maintenance-heart-transplant-recipients-with-renal-insufficiency-a-multicenter-randomized-trial
#12
Jan Van Keer, David Derthoo, Olivier Van Caenegem, Michel De Pauw, Eric Nellessen, Nathalie Duerinckx, Walter Droogne, Gábor Vörös, Bart Meyns, Ann Belmans, Stefan Janssens, Johan Van Cleemput, Johan Vanhaecke
In this 3-year, open-label, multicenter study, 57 maintenance heart transplant recipients (>1 year after transplant) with renal insufficiency (eGFR 30-60 mL/min/1.73 m2 ) were randomized to start everolimus with CNI withdrawal ( N = 29) or continue their current CNI-based immunosuppression ( N = 28). The primary endpoint, change in measured glomerular filtration rate (mGFR) from baseline to year 3, did not differ significantly between both groups (+7.0 mL/min in the everolimus group versus +1.9 mL/min in the CNI group, p = 0...
2017: Journal of Transplantation
https://www.readbyqxmd.com/read/28246556/switching-stable-kidney-transplant-recipients-to-a-generic-tacrolimus-is-feasible-and-safe-but-it-must-be-monitored
#13
Fernando González, René López, Elizabeth Arriagada, René Carrasco, Natalia Gallardo, Eduardo Lorca
Background. Tacrolimus is the primary immunosuppressive drug used in kidney transplant patients. Replacing brand name products with generics is a controversial issue that we studied after a Chilean Ministry of Health mandate to implement such a switch. Methods. Forty-one stable Prograf (Astellas) receiving kidney transplant patients were switched to a generic tacrolimus (Sandoz) in a 1 : 1 dose ratio and were followed up for up to 8 months. All other drugs were maintained as per normal practice. Results...
2017: Journal of Transplantation
https://www.readbyqxmd.com/read/28210502/a-single-perioperative-injection-of-dexamethasone-decreases-nausea-vomiting-and-pain-after-laparoscopic-donor-nephrectomy
#14
Shigeyoshi Yamanaga, Andrew Mark Posselt, Chris Earl Freise, Takaaki Kobayashi, Mehdi Tavakol, Sang-Mo Kang
Background. A single dose of perioperative dexamethasone (8-10 mg) reportedly decreases postoperative nausea, vomiting, and pain but has not been widely used in laparoscopic donor nephrectomy (LDN). Methods. We performed a retrospective cohort study of living donors who underwent LDN between 2013 and 2015. Donors who received a lower dose (4-6 mg)  ( n = 70) or a higher dose (8-14 mg) of dexamethasone ( n = 100) were compared with 111 donors who did not receive dexamethasone (control). Outcomes and incidence of postoperative nausea, vomiting, and pain within 24 h after LDN were compared before and after propensity-score matching...
2017: Journal of Transplantation
https://www.readbyqxmd.com/read/28203455/risk-balancing-of-cold-ischemic-time-against-night-shift-surgery-possibly-reduces-rates-of-reoperation-and-perioperative-graft-loss
#15
Nikos Emmanouilidis, Julius Boeckler, Bastian P Ringe, Alexander Kaltenborn, Frank Lehner, Hans Friedrich Koch, Jürgen Klempnauer, Harald Schrem
Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperation, graft loss, delayed graft function (DGF), and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1 h />1 h,  ≤2 h />2 h,  ≤3 h />3 h, …, ≤ nh /> nh ...
2017: Journal of Transplantation
https://www.readbyqxmd.com/read/28154760/blood-transfusions-and-tumor-biopsy-may-increase-hcc-recurrence-rates-after-liver-transplantation
#16
Daniel Seehofer, Robert Öllinger, Timm Denecke, Moritz Schmelzle, Andreas Andreou, Eckart Schott, Johann Pratschke
Introduction. Beneath tumor grading and vascular invasion, nontumor related risk factors for HCC recurrence after liver transplantation (LT) have been postulated. Potential factors were analyzed in a large single center experience. Material and Methods. This retrospective analysis included 336 consecutive patients transplanted for HCC. The following factors were analyzed stratified for vascular invasion: immunosuppression, rejection therapy, underlying liver disease, age, gender, blood transfusions, tumor biopsy, caval replacement, waiting time, Child Pugh status, and postoperative complications...
2017: Journal of Transplantation
https://www.readbyqxmd.com/read/27980860/pretransplant-factors-and-associations-with-postoperative-respiratory-failure-icu-length-of-stay-and-short-term-survival-after-liver-transplantation-in-a-high-meld-population
#17
Mark R Pedersen, Myunghan Choi, Jeffrey A Brink, Anil B Seetharam
Changes in distribution policies have increased median MELD at transplant with recipients requiring increasing intensive care perioperatively. We aimed to evaluate association of preoperative variables with postoperative respiratory failure (PRF)/increased intensive care unit length of stay (ICU LOS)/short-term survival in a high MELD cohort undergoing liver transplant (LT). Retrospective analysis identified cases of PRF and increased ICU LOS with recipient, donor, and surgical variables examined. Variables were entered into regression with end points of PRF and ICU LOS > 3 days...
2016: Journal of Transplantation
https://www.readbyqxmd.com/read/27822384/immunomodulatory-role-of-mesenchymal-stem-cell-therapy-in-vascularized-composite-allotransplantation
#18
REVIEW
Richard Heyes, Andrew Iarocci, Yourka Tchoukalova, David G Lott
This review aims to summarize contemporary evidence of the in vitro and in vivo immunomodulatory effects of mesenchymal stem cells (MSCs) in promoting vascularized composite allotransplant (VCA) tolerance. An extensive literature review was performed to identify pertinent articles of merit. Prospective preclinical trials in mammal subjects receiving VCA (or skin allograft) with administration of MSCs were reviewed. Prospective clinical trials with intravascular delivery of MSCs in human populations undergoing solid organ transplant were also identified and reviewed...
2016: Journal of Transplantation
https://www.readbyqxmd.com/read/27807479/everolimus-and-malignancy-after-solid-organ-transplantation-a-clinical-update
#19
REVIEW
Hallvard Holdaas, Paolo De Simone, Andreas Zuckermann
Malignancy after solid organ transplantation remains a major cause of posttransplant mortality. The mammalian target of rapamycin (mTOR) inhibitor class of immunosuppressants exerts various antioncogenic effects, and the mTOR inhibitor everolimus is licensed for the treatment of several solid cancers. In kidney transplantation, evidence from registry studies indicates a lower rate of de novo malignancy under mTOR inhibition, with some potentially supportive data from randomized trials of everolimus. Case reports and small single-center series have suggested that switch to everolimus may be beneficial following diagnosis of posttransplant malignancy, particularly for Kaposi's sarcoma and nonmelanoma skin cancer, but prospective studies are lacking...
2016: Journal of Transplantation
https://www.readbyqxmd.com/read/27777790/utilization-of-public-health-service-increased-risk-donors-yields-equivalent-outcomes-in-liver-transplantation
#20
V A Fleetwood, J Lusciks, J Poirier, M Hertl, E Y Chan
Background. The PHS increased risk donor (IRD) is underutilized in liver transplantation. We aimed to examine the posttransplant outcomes in recipients of increased-risk organs. Methods. We analyzed 228,040 transplants in the Organ Procurement and Transplantation Network database from 2004 to 2013. Endpoints were graft failure and death. Results were controlled for demographics and comorbidities. Statistical analysis utilized Fisher's test and logistic regression. Results. 58,816 patients were identified (5,534 IRD, 53,282 non-IRD)...
2016: Journal of Transplantation
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