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Pancreas transplant rejection

Gabriel Fernandes-Silva, Mayara Ivani de Paula, Érika B Rangel
INTRODUCTION: Patient and pancreas allograft survival improved following reductions in surgical complications, tighter donor selection and optimization in immunosuppressive protocols. However, long-term survival of pancreas allografts is adversely affected by rejection and immunosuppressive regimen toxicity. AREAS COVERED: This article reviews the existing literature and knowledge of mammalian target of rapamycin inhibitors (mTORi). Some clinically relevant drug-drug interactions are highlighted...
September 23, 2016: Expert Opinion on Drug Metabolism & Toxicology
Anne Rebafka
BACKGROUND: Whether or not patients follow the advice given by their healthcare professional is commonly referred to as adherence. In the case of kidney transplantation, transplant recipients need to take immunosuppressive drugs on a regular basis to prevent rejection of their transplant. However, medication adherence can be problematic for many patients. OBJECTIVES: This critical appraisal of evidence aimed to gain insights into factors contributing to adherence and non-adherence in recipients of kidney transplants, and to explore patients' perceptions regarding adherence to immunosuppression...
September 15, 2016: Journal of Renal Care
Aruna V Vanikar, Hargovind L Trivedi, Umang G Thakkar
Type 1 diabetes mellitus (T1DM) is an autoimmune disease causing progressive destruction of pancreatic β cells, ultimately resulting in loss of insulin secretion producing hyperglycemia usually affecting children. Replacement of damaged β cells by cell therapy can treat it. Currently available strategies are insulin replacement and islet/pancreas transplantation. Unfortunately these offer rescue for variable duration due to development of autoantibodies. For pancreas/islet transplantation a deceased donor is required and various shortfalls of treatment include quantum, cumbersome technique, immune rejection and limited availability of donors...
September 2016: Cytotherapy
Bernard Okere, Laura Lucaccioni, Massimo Dominici, Lorenzo Iughetti
The current treatment approach for type 1 diabetes is based on daily insulin injections, combined with blood glucose monitoring. However, administration of exogenous insulin fails to mimic the physiological activity of the islet, therefore diabetes often progresses with the development of serious complications such as kidney failure, retinopathy and vascular disease. Whole pancreas transplantation is associated with risks of major invasive surgery along with side effects of immunosuppressive therapy to avoid organ rejection...
2016: Italian Journal of Pediatrics
Kalpana Mujoo, E Brian Butler, Raj K Pandita, Clayton R Hunt, Tej K Pandita
Pluripotent stem cells (PSCs) hold great promise in regenerative medicine, disease modeling, functional genomics, toxicological studies and cell-based therapeutics due to their unique characteristics of self-renewal and pluripotency. Novel methods for generation of pluripotent stem cells and their differentiation to the specialized cell types such as neuronal cells, myocardial cells, hepatocytes and beta cells of the pancreas and many other cells of the body are constantly being refined. Pluripotent stem cell derived differentiated cells, including neuronal cells or cardiac cells, are ideal for stem cell transplantation as autologous or allogeneic cells from healthy donors due to their minimal risk of rejection...
July 2016: Radiation Research
Brian J Nankivell, Chow H PʼNg, Philip J OʼConnell, Jeremy R Chapman
BACKGROUND: The contribution of calcineurin inhibitors (CNI) nephrotoxicity to progressive kidney transplant injury remains debated, with little long-term data from the modern tacrolimus (TAC) era using lower doses. METHODS: This longitudinal cohort study evaluated histological evidence of CNI nephrotoxicity from normal donor kidneys of successful kidney-pancreas transplant recipients during cyclosporine (CSA) and TAC eras, analyzed by intention-to-treat. RESULTS: From 200 patients, 1622 adequate prospective protocol (84...
August 2016: Transplantation
Deepa Bhartiya
Various stem cell sources are being explored to treat diabetes since the proof-of-concept for cell therapy was laid down by transplanting cadaveric islets as a part of Edmonton protocol in 2000. Human embryonic stem (hES) cells derived pancreatic progenitors have got US-FDA approval to be used in clinical trials to treat type 1 diabetes mellitus (T1DM). However, these progenitors more closely resemble their foetal counterparts and thus whether they will provide long-term regeneration of adult human pancreas remains to be demonstrated...
March 2016: Indian Journal of Medical Research
S Miyagi, A Fujio, K Tokodai, Y Hara, C Nakanishi, H Goto, T Kamei, N Kawagishi, N Ohuchi, S Satomi
OBJECT: Pancreas transplantation has the highest surgical complication rate of all routinely performed organ transplantation procedures. The complications are not only caused by the pancreas itself but also occur due to issues with the transplant recipient. We report the case of a patient who experienced massive gastrointestinal bleeding after simultaneous pancreas-kidney transplantation (SPK), which was stopped successfully using somatostatin analog. PATIENTS AND METHODS: The patient was a 45-year-old woman with diabetes mellitus type 1 who underwent SPK with enteric drainage...
April 2016: Transplantation Proceedings
Jesse C Selber, Edward I Chang, Mark W Clemens, Lilian Gaber, Matthew M Hanasono, Michael Klebuc, Roman J Skoracki, Todd Trask, Peirong Yu, A Osama Gaber
BACKGROUND: Vascularized composite allotransplantation is an emerging field, but the complications of lifelong immunosuppression limit indications. Vascularized composite allotransplantation in solid organ recipients represents a unique opportunity because immunosuppression has already been accepted. This report of a simultaneous scalp, skull, kidney, and pancreas transplant represents both the first skull-scalp transplant and combination of a vascularized composite allotransplantation with double organ transplantation...
June 2016: Plastic and Reconstructive Surgery
Gaël Dos Santos, François Haguinet, Catherine Cohet, Dave Webb, John Logie, Germano L C Ferreira, Dominique Rosillon, Vivek Shinde
BACKGROUND: Annual seasonal influenza vaccination is recommended for transplant recipients. No formal pharmacoepidemiology study has been published on the association between solid organ transplant (SOT) rejection and vaccination with seasonal trivalent inactivated influenza vaccines (TIIVs). METHODS: The risk of SOT (liver, kidney, lung, heart or pancreas) rejection after TIIV vaccination was assessed using a self-controlled case-series method (NCT01715792). SOT recipients in England with transplant rejection were selected from the Clinical Practice Research Datalink and linked Hospital Episode Statistics inpatient data...
June 30, 2016: Vaccine
Benjamin Chaigne, Kirsten Geneugelijk, Benoît Bédat, Mohamed Alibashe Ahmed, Gideon Hönger, Sophie de Seigneux, Sandrine Demuylder-Mischler, Thierry Berney, Eric Spierings, Sylvie Ferrari-Lacraz, Jean Villard
The aim of the current study was to characterize the anti-HLA antibodies before and after pancreatic islet or pancreas transplantation. We assessed the risk of anti-donor specific antibody (DSA) sensitization in a single-center, retrospective clinical study at Geneva University Hospital. Data regarding clinical characteristics, graft outcome, HLA mismatch, donor HLA immunogenicity and anti-HLA antibody characteristic were collected. Between January 2008 and July 2014, 18 patients received islet transplants and 26 patients received a pancreas transplant...
May 18, 2016: Cell Transplantation
Oluwafisayo O Adebiyi, Jane Gralla, Patrick Klem, Brian Freed, Scott Davis, Alexander Wiseman, James E Cooper
Antibodies to donor specific HLA antigens (DSA) detected by single antigen bead (SAB) analysis prior to kidney transplant have been associated with inferior graft outcomes. However, studies of pre-transplant DSA specifically in the setting of a negative flow cytometry crossmatch (FCXM) without desensitization therapy are limited. 660 kidney and kidney/pancreas recipients with a negative pre-transplant FCXM from 09/2007 to 08/2012 without desensitization therapy were analyzed with a median follow-up of 4.2 years...
May 3, 2016: American Journal of Transplantation
Laetitia Albano, Matthias Buchler, Diego Cantarovich, Elisabeth Cassuto, Olivier Cointault, Hakim Mazouz, Fernando Vetromile, Aurélie Lecuyer, Malka Tindel, Nassim Kamar
BACKGROUND Dosing of enteric-coated mycophenolate sodium (EC-MPS) should be adjusted to reflect concomitant immunosuppression, but it is largely undocumented whether such modifications are carried out during routine clinical practice. MATERIAL AND METHODS MyLIFE was an observational study of adult kidney-only or kidney-pancreas transplant patients starting -EC-MPS at 33 French transplant centers. Data were collected at first EC-MPS dose and 6 months later. The primary objective was to describe initial EC-MPS dosing according to concomitant immunosuppression...
2016: Annals of Transplantation: Quarterly of the Polish Transplantation Society
S Orihuela, M Nin, S San Román, O Noboa, L Curi, R Silvariño, F González-Martínez
BACKGROUND: Renal transplantation increases the possibilities of pregnancy in women of reproductive age. The course of pregnancy was analyzed retrospectively in patients with kidney or kidney-pancreas transplant, surveying maternal-fetal or renal graft complications and the relation with pre-pregnancy renal function. METHODS: A cohort that includes all the kidney transplant recipients who went through pregnancy in Uruguay in a period of 28 years is described. Forty pregnancies in 32 patients were registered; the average time between the kidney transplant and the beginning of the gestation period was 47 months...
March 2016: Transplantation Proceedings
Rohit Dewan, Anil K Dasyam, Henke Tan, Alessandro Furlan
Vascular torsion is a rare renal transplant complication which requires prompt diagnosis and surgery to salvage allograft function. We report here a case of renal allograft torsion with interesting imaging findings on unenhanced CT and color Doppler ultrasound. A 60-year-old woman with a history of pancreas and kidney transplant presented to the emergency room with nausea, vomiting, abdominal pain, and minimal urine output. Unenhanced CT of the abdomen demonstrated an enlarged and malrotated renal allograft with moderate hydronephrosis...
2016: Case Reports in Radiology
Eduardo Esteban-Zubero, Francisco Agustín García-Gil, Laura López-Pingarrón, Moisés Alejandro Alatorre-Jiménez, Pablo Iñigo-Gil, Dun-Xian Tan, José Joaquín García, Russel J Reiter
Organ transplantation is a useful therapeutic tool for patients with end-stage organ failure; however, graft rejection is a major obstacle in terms of a successful treatment. Rejection is usually a consequence of a complex immunological and nonimmunological antigen-independent cascade of events, including free radical-mediated ischemia-reperfusion injury (IRI). To reduce the frequency of this outcome, continuing improvements in the efficacy of antirejection drugs are a top priority to enhance the long-term survival of transplant recipients...
June 2016: Journal of Endocrinology
Rafael Zaragoza, José María Aguado, Ricard Ferrer, Alejandro H Rodríguez, Emilio Maseda, Pedro Llinares, Santiago Grau, Patricia Muñoz, Jesús Fortún, Mercedes Bouzada, Juan Carlos Del Pozo, Rafael León
BACKGROUND: Although over the past decade the management of invasive fungal infection has improved, considerable controversy persists regarding antifungal prophylaxis in solid organ transplant recipients. AIMS: To identify the key clinical knowledge and make by consensus the high level recommendations required for antifungal prophylaxis in solid organ transplant recipients. METHODS: Spanish prospective questionnaire, which measures consensus through the Delphi technique, was conducted anonymously and by e-mail with 30 national multidisciplinary experts, specialists in invasive fungal infections from six national scientific societies, including intensivists, anesthetists, microbiologists, pharmacologists and specialists in infectious diseases that responded to 12 questions prepared by the coordination group, after an exhaustive review of the literature in the last few years...
April 8, 2016: Revista Iberoamericana de Micología
Nicole Nesselhauf, Jaclyn Strutt, Bahar Bastani
BACKGROUND: BK virus reactivation is a significant complication following renal transplantation that can result in graft failure. Reduction of immunosuppression and substitution of leflunomide for mycophenolate mofetil (MMF) has been used to treat this entity. OBJECTIVES: To evaluate the use of leflunomide in BK viremia (BKV) and biopsy proven BK nephropathy (BKN) in kidney and kidney-pancreas transplant recipients. PATIENTS AND METHODS: We retrospectively reviewed 28 kidney and kidney-pancreas transplant recipients who had received leflunomide for BKV from January 2006 to November 2012...
January 2016: Journal of Nephropathology
Peter Schenker
No abstract text is available yet for this article.
July 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
Brian C Eby, Robert R Redfield, Thomas M Ellis, Glen E Leverson, Abby R Schenian, Jon S Odorico
BACKGROUND: Imported pancreata accumulate cold ischemia time (CIT), limiting utilization and worsening outcomes. Flow cytometric crossmatching (FXM) is a standard method to assess recipient and donor compatibility, but can prolong CIT. Single-antigen bead assays allow for detection of recipient donor-specific HLA antibodies, enabling prediction of compatibility through a "virtual crossmatch" (VXM). This study investigates the utility and outcomes of VXM after transplantation of imported pancreata...
May 2016: Transplantation
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