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Transplantation Direct

Chetan Naik, Cody Moore, Matthew Pipeling, Jonathan D'Cunha, Kristine Ruppert, Christopher Ensor, Matthew Morrell
Background: Acute cellular rejection (ACR) is a major risk factor for chronic lung allograft dysfunction after lung transplantation. Acute cellular rejection can persist or recur despite augmentation of immunosuppression by conventional methods. There are limited therapeutic options in treating these recurrent and refractory ACRs. We describe our experience with cyclophosphamide therapy for recurrent and refractory ACR in lung transplant recipients. Methods: Six consecutive patients who were treated with cyclophosphamide for recurrent or refractory ACR were included in the series...
May 2018: Transplantation Direct
Kyle William Freischlag, Julia Messina, Brian Ezekian, Michael S Mulvihill, Andrew Barbas, Carl Berg, Debra Sudan, John Reynolds, Matthew Hartwig, Stuart Knechtle
Background: Combined lung-liver transplantation (LLT) applies 2 technically challenging transplants in 1 patient with severe 2-organ failure. Methods: Institutional medical records and United Network for Organ Sharing database were queried for patients at our institution that underwent LLT from 2000 to 2016. Results: Twelve LLTs were performed from 2000 to 2016 including 9 male and 3 female recipients with a median age of 28.36 years. Indications for lung transplantation were cystic fibrosis (8), idiopathic pulmonary fibrosis (3), and pulmonary fibrosis secondary to hepatopulmonary syndrome (1)...
May 2018: Transplantation Direct
Andrew S Barbas, Jordan Levy, Michael S Mulvihill, Nicolas Goldaracena, Martin J Dib, David P Al-Adra, Mark S Cattral, Anand Ghanekar, Paul D Greig, David R Grant, Gonzalo Sapisochin, Markus Selzner, Stuart A McCluskey, Ian D McGilvray
Background: The use of venovenous bypass in liver transplantation has declined over time. Few studies have examined the impact of surgical approach in cases performed exclusively without venovenous bypass. We hypothesized that advances in liver transplant anesthesia and perioperative care have minimized the importance of surgical approach in the modern era. Methods: Deceased donor liver transplants at the University of Toronto from 2000 to 2015 were reviewed, all performed without venovenous bypass...
May 2018: Transplantation Direct
Ali Akbar, Quynh T Tran, Satheesh P Nair, Salil Parikh, Muhammad Bilal, Mohammed Ismail, Jason M Vanatta, James D Eason, Sanjaya K Satapathy
Background: Biliary strictures (BS) are common complication after liver transplantation. We aimed to determine the accuracy of magnetic resonance cholagiopancreatography (MRCP) in diagnosing BS in liver transplant recipients (LTRs) when compared to direct cholangiographic methods (endoscopic resonance cholagiopancreatography [ERCP] and/or percutaneous transhepatic cholangiography [PTC]). Methods: Retrospective chart review of 910 LTRs (July 2008 to April 2015) was performed, and a total of 39 patients with duct-to-duct anastomosis (22 males; 56...
May 2018: Transplantation Direct
Qi-Fang Huang, Sander Trenson, Zhen-Yu Zhang, Jan Van Keer, Lucas N L Van Aelst, Wen-Yi Yang, Esther Nkuipou-Kenfack, Lutgarde Thijs, Fang-Fei Wei, Blerim Mujaj, Agnieszka Ciarka, Walter Droogné, Johan Vanhaecke, Stefan Janssens, Johan Van Cleemput, Harald Mischak, Jan A Staessen
Background: This proof-of-concept study investigated the feasibility of using biomarkers to monitor right heart pressures (RHP) in heart transplanted (HTx) patients. Methods: In 298 patients, we measured 7.6 years post-HTx mean pressures in the right atrium (mRAP) and pulmonary artery (mPAP) and capillaries (mPCWP) along with plasma high-sensitivity troponin T (hsTnT), a marker of cardiomyocyte injury, and the multidimensional urinary classifiers HF1 and HF2, mainly consisting of dysregulated collagen fragments...
May 2018: Transplantation Direct
Irene Beijert, Safak Mert, Viola Huang, Negin Karimian, Sharon Geerts, Ehab O A Hafiz, James F Markmann, Heidi Yeh, Robert J Porte, Korkut Uygun
Background: Steatosis is a major risk factor for primary nonfunction in liver transplantations. Steatotic livers recover poorly from ischemia reperfusion injury, in part due to alterations in the microcirculation, although the exact mechanism is unclear. In this study, we tested if there were any alterations in the shear stress sensing Kruppel-like factor 2 (KLF2) and its likely downstream consequences in the ex vivo perfused human liver endothelium, which would imply perturbations in microcirculatory flow in macrosteatotic livers disrupts laminar flow to evaluate if this is a potential therapeutic target for steatotic livers...
May 2018: Transplantation Direct
Samuel J Kesseli, Andrew S Barbas, Deepak Vikraman
Accessory gallbladder in a donor liver allograft is an uncommon anatomical finding that can complicate liver transplantation if unrecognized. This case describes a patient who underwent liver transplantation with a donor graft containing an accessory gallbladder that was obscured during transplantation; as a result, the patient experienced a prolonged postoperative course complicated by multiple readmissions for suspected biloma and intra-abdominal infection. The diagnosis of accessory gallbladder was not made until operative exploration several months after the initial transplant...
May 2018: Transplantation Direct
Sarah Tonkin-Crine, Rishi Pruthi, Dominic M Taylor, Geraldine M Leydon, Melania Calestani, Gabriel C Oniscu, J Andrew Bradley, Charles R Tomson, Clare Bradley, Christopher Dudley, Christopher J E Watson, Heather Draper, Rachel J Johnson, Wendy Metcalfe, Damian G Fogarty, Rommel Ravanan, Paul Roderick
Background: It is well recognized that there is significant variation between centers in access to kidney transplantation. In the absence of high-grade evidence, it is unclear whether variation is due to patient case mix, other center factors, or individual clinician decisions. This study sought consensus between UK clinicians on factors that should influence access to kidney transplantation. Methods: As part of the Access to Transplantation and Transplant Outcome Measures project, consultant nephrologists and transplant surgeons in 71 centers were invited to participate in a Delphi study involving 2 rounds...
May 2018: Transplantation Direct
Amanda J Vinson, Caren Rose, Bryce A Kiberd, Ayodele Odutayo, S Joseph Kim, Ian Alwayn, Karthik K Tennankore
Background: Prolonged warm ischemia time (WIT) is associated with graft failure and mortality, however less is known about factors associated with prolonged WIT. Methods: In a cohort of United States deceased donor kidney transplant recipients identified using the Scientific Registry of Transplant Recipients (Jan 2005-Dec 2013), we identified factors associated with prolonged WIT (defined as ≥ 30 minutes versus 10-30 minutes) using hierarchical multilevel models adjusting for center effect, and WIT as a continuous variable using multiple linear regression of log-transformed data...
May 2018: Transplantation Direct
Kohei Miura, Yasuhiko Sugawara, Koushi Uchida, Seiichi Kawabata, Daiki Yoshii, Kaori Isono, Shintaro Hayashida, Yuki Ohya, Hidekazu Yamamoto, Takashi Kobayashi, Toshifumi Wakai, Yukihiro Inomata, Taizo Hibi
Background: Living donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) is associated with several technical challenges for its complicated procedures and poor outcomes. Some institutions still consider preexisting PVT as a relatively contraindication for LDLT. Methods: Between April 2010 and May 2016, 129 adults underwent LDLT at our institution, and 28 (21.7%) of whom had preexisting PVT. Portal vein thrombosis was diagnosed using preoperative imaging techniques and intraoperative findings...
May 2018: Transplantation Direct
Jian Y Cheng, Andrew Martin, Ganesh Ramanathan, Bruce A Cooper
Background: Screening potential live kidney donors is an intense process for both candidates and the healthcare system. It is conventionally implemented using a standard generic protocol. Efficiencies in this process could potentially be achieved using personalized protocols that are optimized for a given candidate. Aim: To create personalized protocols (by age, sex, and paired exchange status) and evaluate them relative to the standard generic protocol. Methods: Two personalized protocols were created...
May 2018: Transplantation Direct
Paul N Banks, Ashraf Omar, Rajat Walia, Sarabjit Bhalla, Yun Chong, Sofya Tokman
Background: Lung transplant recipients are treated with a 3-drug immunosuppressive regimen that consists of a calcineurin inhibitor, an antiproliferative agent, and a corticosteroid. Calcineurin inhibitors are the backbone of this regimen, and tacrolimus is used more often than cyclosporine, because tacrolimus is the more potent of the two agents. Tacrolimus-induced hyponatremia has been described among kidney transplant recipients, but not among lung transplant recipients. Methods: We conducted a retrospective chart review of patients who underwent lung transplant at our institution and went on to develop severe hyponatremia...
April 2018: Transplantation Direct
Brett Pearce, Linda Mattheyse, Louise Ellard, Fiona Desmond, Param Pillai, Laurence Weinberg
Background: The avoidance of hypothermia is vital during prolonged and open surgery to improve patient outcomes. Hypothermia is particularly common during orthotopic liver transplantation (OLT) and associated with undesirable physiological effects that can adversely impact on perioperative morbidity. The KanMed WarmCloud (Bromma, Sweden) is a revolutionary, closed-loop, warm-air heating mattress developed to maintain normothermia and prevent pressure sores during major surgery. The clinical effectiveness of the WarmCloud device during OLT is unknown...
April 2018: Transplantation Direct
Hoa Le Mai, Michèle Treilhaud, Shani Leviatan Ben-Arye, Hai Yu, Hélène Perreault, Evelyn Ang, Katy Trébern-Launay, Julie Laurent, Stéphanie Malard-Castagnet, Anne Cesbron, Thi Van Ha Nguyen, Sophie Brouard, Lionel Rostaing, Pauline Houssel-Debry, Christophe Legendre, Sophie Girerd, Michèle Kessler, Emmanuel Morelon, Antoine Sicard, Valérie Garrigue, Georges Karam, Xi Chen, Magali Giral, Vered Padler-Karavani, Jean Paul Soulillou
Background: End-stage renal failure occurs in a substantial number of patients having received a nonrenal transplantation (NRT), for whom a kidney transplantation is needed. The medical strategy regarding the use of immunosuppression (IS) for a kidney graft in patients after an NRT is not well established. The prekidney grafts long-term IS advocates for a mild induction, such as using anti-IL-2R antibodies, whereas addition of new incompatibilities and anti-HLA preimmunization may suggest using stronger IS such as induction by polyclonal antithymocyte globulins (ATG)...
April 2018: Transplantation Direct
Ryan A Helmick, Colleen L Jay, Brittany A Price, Patrick G Dean, Mark D Stegall
Background: Despite substantial evidence demonstrating clear benefit, rates of preemptive kidney transplantation (PreKTx) remain low in the United States. Our goal was to identify barriers to PreKTx. Methods: Using a telephone-administered questionnaire including questions about barriers, timing of referral, timing of education, we retrospectively studied first living donor kidney transplant recipients (2006-2010) at Mayo Clinic, Rochester, MN. Of 235 patients, 145 (62%) responded to the questionnaire (74 PreKTx and 71 non-PreKTx)...
April 2018: Transplantation Direct
Yusuke Tomita, Kazuhiro Iwadoh, Yuichi Ogawa, Katsuyuki Miki, Kotaro Kai, Akihito Sannomiya, Toru Murakami, Ichiro Koyama, Kumiko Kitajima, Ichiro Nakajima, Shohei Fuchinoue
Chronic shortages of organs for transplantation have led to the use of marginal kidneys from donors after circulatory death with acute kidney injury (AKI), but the utilization of kidneys with severe AKI is not well established. We retrospectively analyzed eight kidney transplantation (KTx) cases from donation after circulatory death (DCD) with terminal creatinine (t-Cr) concentrations higher than 10.0 mg/dL and/or oliguria for more than 5 days (AKI network criteria: stage III). Although all patients showed delayed graft function, no cases of primary nonfunction (PNF) were found...
April 2018: Transplantation Direct
Chloe L Rackham, Paramjeet K Dhadda, Sian J S Simpson, Mahdieh Godazgar, Aileen J F King, Peter M Jones
No abstract text is available yet for this article.
April 2018: Transplantation Direct
Patrick J Smith, Gregory L Stonerock, Krista K Ingle, Caroline K Saulino, Benson Hoffman, Brian Wasserman, James A Blumenthal, Scott M Palmer, Jacob A Klapper, Matthew G Hartwig, Valentine R Esposito, Laurie D Snyder
Background: Neurological complications are common after lung transplantation. However, no large cohort studies have examined the incidence, predictors, and clinical significance of neurological events sustained by lung transplant recipients. Methods: We conducted a retrospective cohort analysis of a consecutive series of lung transplant recipients, transplanted at Duke University Medical Center between May 2014 and February 2017 (n = 276). Early neurological complications (ie, occurring during the first week after transplant) were documented by transplant mental health specialists and included delirium, ischemic injury, and posterior reversible encephalopathy syndrome...
April 2018: Transplantation Direct
Hani M Wadei, David D Lee, Kristopher P Croome, Lorraine Mai, Deanne Leonard, Martin L Mai, C Burcin Taner, Andrew P Keaveny
Early allograft dysfunction (EAD) identifies allografts with marginal function soon after liver transplantation (LT) and is associated with poor LT outcomes. The impact of EAD on post-LT renal recovery, however, has not been studied. Data on 69 primary LT recipients (41 with and 28 without history of renal dysfunction) who received renal replacement therapy (RRT) for a median (range) of 9 (13-41) days before LT were retrospectively analyzed. Primary outcome was renal nonrecovery defined as RRT requirement 30 days from LT...
April 2018: Transplantation Direct
Kjersti Lønning, Kristian Heldal, Tomm Bernklev, Cathrine Brunborg, Marit Helen Andersen, Nanna von der Lippe, Anna Varberg Reisæter, Pål-Dag Line, Anders Hartmann, Karsten Midtvedt
Background: We aimed to evaluate changes in health-related quality of life (HRQoL) in patients 65 years or older from time of kidney transplantation (KTx) until 1 year postengraftment. Methods: A single-center prospective study was conducted. HRQoL was measured pre-KTx and at 2, 6, and 12 months postengraftment using self-reported Kidney Disease and Quality of Life short-form version 1.3. Intraindividual scores before and after KTx were evaluated. Liu Comorbidity Index was registered at enlisting...
April 2018: Transplantation Direct
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