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Lisa M Sharkey, Sarah Peacock, Neil K Russell, Stephen J Middleton, Andrew J Butler
Graft versus host disease (GVHD) following transplantation of an intestine-containing graft occurs more frequently than with other solid organ transplants and is known to have a poor outcome. The presentation differs from other solid organ transplants, as the gastrointestinal tract is not involved following intestinal transplant. Diagnosis is based on clinical symptoms arising due to native tissue damage and the detection of donor T lymphocytes in circulating blood (T cell chimerism). The ideal treatment strategy has not been defined, with advocates for both increased or decreased immunosuppression...
March 15, 2018: Clinical Transplantation
L G J Leijssen, A M Dinaux, H Kunitake, L G Bordeianou, D L Berger
PURPOSE: Proximal and distal colon cancers differ in terms of epidemiology, clinical presentation, and pathologic features. The aim of our study was to evaluate the impact of right-sided (RC), transverse (TC), and left-sided (LC) colon cancer on morbidity rates and oncological outcomes. METHODS: A retrospective analysis of patients with resected colon cancer between 2004 and 2014 was conducted. Cox proportional hazard models were used to assess predictors of overall (OS), and disease-specific survival (DSS), as well as disease-free survival (DFS)...
March 14, 2018: International Journal of Colorectal Disease
Lara Danziger-Isakov, William J Steinbach, Grant Paulsen, Flor M Munoz, Leigh R Sweet, Michael Green, Marian G Michaels, Janet A Englund, Alastair Murray, Natasha Halasa, Daniel E Dulek, Rebecca Pellett Madan, Betsy C Herold, Brian T Fisher
Background: Respiratory virus infection (RVI) in pediatric solid organ transplant (SOT) recipients poses a significant risk; however, the epidemiology and effects of an RVI after pediatric SOT in the era of current molecular diagnostic assays are unclear. Methods: A retrospective observational cohort of pediatric SOT recipients (January 2010 to June 2013) was assembled from 9 US pediatric transplant centers. Charts were reviewed for RVI events associated with hospitalization within 1 year after the transplant...
March 10, 2018: Journal of the Pediatric Infectious Diseases Society
Gavin Low, A M James Shapiro
No abstract text is available yet for this article.
March 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Mitchell A Rees, Nikhil B Amesur, Ruy J Cruz, Amir A Borhani, Kareem M Abu-Elmagd, Guilherme Costa, Anil K Dasyam
Intestinal transplantation has evolved from its experimental origins in the mid-20th century to its status today as an established treatment option for patients with end-stage intestinal failure who cannot be sustained with total parenteral nutrition. The most common source of intestinal failure in both adults and children is short-bowel syndrome, but a host of other disease processes can lead to this common end-point. The development of intestinal transplantation has presented multiple hurdles for the transplant community, including technical challenges, immunologic pitfalls, and infectious complications...
March 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Emma Rosander, Caroline Nordenvall, Annika Sjövall, Fredrik Hjern, Torbjörn Holm
BACKGROUND: Locally advanced colon cancer invading surrounding organs or structures is challenging to surgeons and oncologists. Multivisceral resections with tumor removal en bloc with invaded tissues provide the best chance for cure. OBJECTIVE: We aimed to assess the management and outcomes after multivisceral resections in patients with clinically infiltrative, locally advanced primary colon cancer. DESIGN: This is a descriptive retrospective cohort study...
April 2018: Diseases of the Colon and Rectum
Fanping Yang, Sheng-An Chen, Xiaojin Wu, Qingyuan Zhu, Xiaoqun Luo
Drug reaction with eosinophilia and systemic symptoms (DRESS) is characterised by skin rash and multivisceral involvement. The liver is the organ most frequently affected and the degree of liver function impairment often correlates with the mortality rate of DRESS. We aimed to examine the expression of cytotoxic proteins, including soluble Fas ligand (sFasL), TNF-α, granulysin, perforin, and granzyme B in the sera and skin lesions of patients with DRESS and evaluate their clinical significance. Our cohort consisted of 21 patients with DRESS and control groups including 39 patients with Stevens-Johnson syndrome/toxic epidermal necrolysis, 21 patients with maculopapular eruption, and 29 normal controls...
February 1, 2018: European Journal of Dermatology: EJD
Stojan Potrc, Arpad Ivanecz, Bojan Krebs, Urska Marolt, Bojan Iljevec, Tomaz Jagric
Background: Adenocarcinomas at the cardia are biologically aggressive tumors with poor long-term survival following curative resection. For resectable adenocarcinoma of the cardia, mostly esophagus extended total gastrectomy or esophagus extended proximal gastric resection is performed; however, the surgical approach, transhiatal or transthoracic, is still under discussion. Postoperative morbidity, mortality and long-term survival were analyzed to evaluate the potential differences in clinically relevant outcomes...
March 2018: Radiology and Oncology
Thomas S Zajonz, Michael Sander, Winfried Padberg, Andreas Hecker, Ruediger Hörbelt, Christian Koch, Emmanuel Schneck
Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) poses a widely used and accepted treatment option for patients with peritoneal carcinomatosis of gastrointestinal tumors. In contrast to the well-described risks and complications of intravenous cytostatic drugs, literature offers only scarce information of serious complications following HIPEC. To our knowledge no other description of rapid progressive pulmonary hypertension (PH) and consecutive respiratory failure following HIPEC have been described in current literature...
March 2018: Annals of Medicine and Surgery
Jared W Clouse, Chandrashekhar A Kubal, Jonathan A Fridell, Richard S Mangus
This study reports the clinical complication and infection rates of an active pediatric IT program that has never utilized bowel decontamination in either the donor or the recipient. All patients undergoing IT from 2003 to 2015 at a single pediatric IT center were reviewed. Post-transplant surgical, infectious, and immunosuppressive complications are reported. There were 52 patients who underwent IT during the study period. Among these patients, 4% developed a postoperative abscess, one developed an enteric fistula (2%), and one had an enteric or anastomotic leak (2%)...
March 2, 2018: Pediatric Transplantation
Guosheng Wu, Ruy J Cruz
Background and aims: A co-transplanted liver allograft has been thought to protect other organs from rejection-mediated injury; however, detailed analyses of co-transplanted liver on intestinal allograft outcomes have not been conducted to date. The aim of the study was to compare immune-mediated injury, causes of graft failure and clinical outcomes between recipients who underwent either a liver-inclusive intestinal transplant (LITx) or liver-exclusive intestinal transplant (LETx). Methods: Between May 2000 and May 2010, 212 adult patients undergoing LITx ( n  =76) and LETx ( n  =136) were included...
February 2018: Gastroenterology Report
Pablo Stringa, Nidia Monserrat Arreola, Ane M Andres Moreno, Carlota Largo, Martín Rumbo, Francisco Hernandez
BACKGROUND:  Modified multivisceral transplantation (MMVTx) refers to the use of a graft that includes all abdominal organs except the liver. The use of this type of transplant in children and adults expanded over the last years with good results. However, long-term survival in experimental models has not been reported. Our aim is to describe in detail some technical modifications of MMVTx to obtain long-term survival. MATERIALS AND METHODS:  Syngeneic (Lewis-Lewis) heterotopic MMVTx was performed in 16 male rats (180-250 g)...
February 23, 2018: European Journal of Pediatric Surgery
A Lauro, A D Pinna, E Tossani, V Stanghellini, M Manno, G Caio, L Golfieri, C Zanfi, N Cautero, A Bagni, U Volta, M Di Simone, L Pironi, R F Cogliandro, M Serra, A Venturoli, S Grandi, R De Giorgio
BACKGROUND: Clinical and psychosocial outcomes of a multimodal surgical approach for chronic intestinal pseudo-obstruction were analyzed in 24 patients who were followed over a 2- to 12-year period in a single center after surgery or intestinal/multivisceral transplant (CTx). METHODS: The main reasons for surgery were sub-occlusion in surgery and parenteral nutrition-related irreversible complications with chronic intestinal failure in CTx. RESULTS: At the end of follow-up (February 2015), 45...
January 2018: Transplantation Proceedings
Chandrashekhar A Kubal, Catherine Pennington, Jonathan Fridell, Burcin Ekser, Plamen Muhaylov, Richard Mangus
BACKGROUND Patients undergoing re-transplantation often receive high doses of immunosuppression, which may lead to an immunocompromised status of the recipient. This study investigates the outcomes after intestine/multivisceral re-transplantation. MATERIAL AND METHODS Clinical outcomes of 23 patients undergoing 24 re-transplantations at a single intestine transplant center were reviewed. Bone marrow suppression was used as a surrogate marker of immunocompromised status, and was defined as platelet count <50 k/mm3 and absolute lymphocyte count <200/mm³...
February 6, 2018: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Nufar Marcus, Achiya Z Amir, Eyal Grunebaum, Anne Dipchand, Diane Hebert, Vicky L Ng, Thomas Walters, Yaron Avitzur
OBJECTIVES: To describe the prevalence, natural course, outcome, and risk factors of post-transplant de novo allergy and autoimmunity. STUDY DESIGN: A cross-sectional, cohort study of all children (<18 years) who underwent a solid-organ transplantation, between 2000 and 2012, in a single transplant center, with a follow-up period of 6 months or more post-transplant and without history of allergy or immune-mediated disorder pretransplant. RESULTS: A total of 626 eligible patients were screened, and 273 patients (160 males; 59%) met the inclusion criteria; this included 111 liver, 103 heart, 52 kidney, and 7 multivisceral recipients...
January 22, 2018: Journal of Pediatrics
Mitsuyoshi Tei, Masahisa Otsuka, Yozo Suzuki, Hiroki Akamatsu
AIM: The aim of this study was to evaluate the safety and feasibility of single-port laparoscopic multivisceral resection (SLMVR) for locally advanced colon cancer invading or adhering to neighboring organs. METHOD: A prospectively collected database was collated of all patients undergoing SLMVR from January 2011 to December 2014. Short-term and long-term oncologic outcomes were evaluated. RESULTS: Thirty consecutive patients who underwent SLMVR were identified and the completion rate was 90%...
January 22, 2018: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Yong K Kwon, Nathaly Llore, Stuart S Kaufman, Cal S Matsumoto, Thomas M Fishbein, Raffaele Girlanda
Intestinal transplantation in children has evolved with more isolated small intestine transplants being performed compared to combined liver-intestine transplants. Consequently, surgical techniques have changed, frequently requiring the use of vascular homografts of small caliber to revascularize the isolated small intestine, the impact of which on outcomes is unknown. Among 106 pediatric intestine and multivisceral transplants performed at our center since 2003, 33 recipients of an isolated small intestine graft were included in this study...
March 2018: Pediatric Transplantation
Alexandra J Borst, Debra L Sudan, Laura A Wang, Michael J Neuss, Jennifer A Rothman, Thomas L Ortel
BACKGROUND: Pediatric patients undergoing liver transplant are at significant risk for bleeding and thrombotic complications due to the complex nature of rebalanced hemostasis in patients with liver disease. METHODS/OBJECTIVES: We reviewed records of 92 pediatric liver and multivisceral transplant cases at Duke University Medical Center between January 2009 and December 2015. The goal was to define the nature and incidence of bleeding and thrombotic complications in this cohort and define potential risk factors...
January 19, 2018: Pediatric Blood & Cancer
Fiona Hand, Rebeca Sanabria Mateos, Michael Durand, David Fennelly, Ray McDermott, Donal Maguire, Justin Geoghegan, Des Winter, Emir Hoti
Local invasion of adjacent viscera by colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to curative hepatic resection. A growing number of observational analyses have illustrated the feasibility of such resections; however, the evidence base is at best heterogeneous with a lack of evidence comparing similar patient groups. We aimed to evaluate the outcomes of hepatectomy for CRLM when combined with other viscera and compare to a matched cohort of isolated hepatic resections...
January 18, 2018: Digestive Surgery
Mateusz Wierdak, Magdalena Pisarska, Beata Kuśnierz-Cabala, Jan Witowski, Jadwiga Dworak, Piotr Major, Piotr Małczak, Piotr Ceranowicz, Andrzej Budzyński, Michał Pędziwiatr
BACKGROUND: Combination of laparoscopic approach with ERAS protocol in colorectal surgery allows for an early discharge. However there is a risk that some of the discharged patients are developing, asymptomatic at the time, infectious complications. This may lead to a delay in diagnostics and proper treatment introduction. We aimed to assess the usefulness of preoperative plasma albumin concentration and their changes as indicators of infectious complications in patients undergoing colorectal cancer surgery...
January 16, 2018: Surgical Endoscopy
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