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Wound healing renal transplant

Y-M Choe, K-M Park, Y S Jeon, S G Cho, K C Hong, W Y Shin, J H Song
INTRODUCTION: Necrotizing fasciitis is an uncommon soft-tissue infection that involves the superficial fascia, subcutaneous fat, and deep fascia. Herein, we report the first case of Enterobacter cloacae-related necrotizing fasciitis after peritoneal dialysis in delayed graft function. CASE: A 58-year-old man, who was a hepatitis B-viral carrier and had atrial fibrillation, received cadaveric renal transplantation with peritoneal dialysis and encountered delayed graft function...
June 2017: Transplantation Proceedings
Samir G Mallat, Bassem Y Tanios, Houssam S Itani, Tamara Lotfi, Ciaran McMullan, Steven Gabardi, Elie A Akl, Jamil R Azzi
BACKGROUND AND OBJECTIVES: The objective of this meta-analysis is to compare the incidences of cytomegalovirus and BK polyoma virus infections in renal transplant recipients receiving a mammalian target of rapamycin inhibitor (mTOR)-based regimen compared with a calcineurin inhibitor-based regimen. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a comprehensive search for randomized, controlled trials up to January of 2016 addressing our objective. Other outcomes included acute rejection, graft loss, serious adverse events, proteinuria, wound-healing complications, and eGFR...
June 2, 2017: Clinical Journal of the American Society of Nephrology: CJASN
Shelley B Dutt, Josephine Gonzales, Megan Boyett, Anne Costanzo, Peggy P Han, Steven Steinberg, Dianne B McKay, Julie M Jameson
BACKGROUND: Mammalian target of rapamycin (mTOR) inhibitors are approved to prevent allograft rejection and control malignancy. Unfortunately, they are associated with adverse effects, such as wound healing complications that detract from more extensive use. There is a lack of prospective wound healing studies to monitor patients treated with mTOR inhibitors, such as everolimus or sirolimus, especially in nondiabetics. METHODS: Patients receiving everolimus with standard immunosuppressant therapy or standard immunosuppressant therapy without everolimus were administered 3-mm skin biopsy punch wounds in the left scapular region...
April 2017: Transplantation Direct
Stephen H Phillips, Sharon K Hill, Lorie D Lipscomb, Joseph B Africa
OBJECTIVE: To retrospectively analyze the wound issues for obese renal transplant patients, as well as post-transplant outcomes including graft and patient survival, hypothesizing improvement over the standard approach. As the obese population has expanded, minimally invasive renal transplant techniques have attempted to improve the issues of complications related to wounds and hernias. The anterior rectus sheath approach, which facilitates a minimal incision, has been adopted at our center for all renal transplants, including obese patients...
March 31, 2017: Urology
Daniëlle G Leuning, Marlies E J Reinders, Joan Li, Anna J Peired, Ellen Lievers, Hetty C de Boer, Willem E Fibbe, Paola Romagnani, Cees van Kooten, Melissa H Little, Marten A Engelse, Ton J Rabelink
: Mesenchymal stromal cells (MSCs) are immunomodulatory and tissue homeostatic cells that have shown beneficial effects in kidney diseases and transplantation. Perivascular stromal cells (PSCs) identified within several different organs share characteristics of bone marrow-derived MSCs (BM-MSCs). These PSCs may also possess tissue-specific properties and play a role in local tissue homeostasis. We hypothesized that human kidney-derived PSCs (hkPSCs) would elicit improved kidney repair in comparison with BM-MSCs...
September 20, 2016: Stem Cells Translational Medicine
Thomas Welte, Frederic Arnold, Kristin Technau-Hafsi, Elke Neumann-Haefelin, Rika Wobser, Stefan Zschiedrich, Gerd Walz, Albrecht Kramer-Zucker
UNLABELLED: Calciphylaxis is a rare and often fatal condition mostly associated with end-stage renal disease. The pathophysiology remains elusive and treatment options are scarce. We present a rare case of severe calciphylaxis after kidney transplantation in a patient with persistent hyperparathyroidism. CASE DESCRIPTION: A 78-year-old man with a history of end-stage renal disease developed edema and ulcerations on both lower limbs 14 months after kidney transplantation while receiving an mammalian target of rapamycin inhibitor to manage polyoma virus-associated nephropathy...
April 2016: Transplantation Direct
Nowell M Fine, Sudhir S Kushwaha
The mammalian target of rapamycin (mTOR) inhibitors sirolimus and everolimus are increasingly used in cardiothoracic transplantation. Several recent clinical trials have demonstrated their efficacy in combination with reduced cyclosporine dosing in de novo heart transplant recipients, in particular with everolimus. A number of other studies have demonstrated their efficacy for improving renal function and reducing calcineurin inhibitor use, attenuating cardiac allograft vasculopathy progression and reducing cytomegalovirus infections in maintenance heart transplant populations...
December 2016: Transplantation
S Ochman, M J Raschke, C Stukenborg-Colsman, K Daniilidis
OBJECTIVE: Debridement of infected tissue with the main aim being the re-establishment of mobilization with preservation of standing and walking ability. Prevention of secondary pressure points or amputations due to inadequate resection or deficient soft tissue cover. INDICATIONS: In the case of increasing necrosis of the big toe, surgical abrasion and/or amputation is considered unavoidable. Other indications where surgery could be considered include diabetes and its associated angiopathies together with peripheral arterial angiopathy...
October 2016: Operative Orthopädie und Traumatologie
Caroline E Fife, Susan D Horn, Randall J Smout, Ryan S Barrett, Brett Thomson
Objective: To develop a healing index for patients with diabetic foot ulcers (DFUs) for use in clinical practice, research analysis, and clinical trials. Approach: U.S. Wound Registry data were examined retrospectively and assigned a clear outcome (healed, amputated, etc.). Significant variables were identified with bivariate analyses. A multivariable logistic regression model was created based on significant factors (p < 0.05) and tested on a hold-out sample of data. Out of 13,266 DFUs from the original dataset, 6,440 were eligible for analysis...
July 1, 2016: Advances in Wound Care
Vishnu Ambur, Sharven Taghavi, Senthil Jayarajan, John Gaughan, Yoshiya Toyoda, Elizabeth Dauer, Lars Ola Sjoholm, Abhijit Pathak, Thomas Santora, Amy J Goldberg
INTRODUCTION: Impaired wound healing due to immunosuppression has led some surgeons to preferentially use open gastrostomy tube (OGT) over percutaneous gastrostomy tube (PEG) in heart transplant patients when long-term enteral access is deemed necessary. METHODS: The National Inpatient Sample (NIS) database (2005-2010) was queried for all heart transplant patients. Those receiving OGT were compared to those treated with PEG tube. RESULTS: There were 498 patients requiring long-term enteral access treated with a gastrostomy tube, with 424 (85...
May 2016: Annals of Medicine and Surgery
Jason Bennett, Hilary Cassidy, Craig Slattery, Michael P Ryan, Tara McMorrow
Epithelial-mesenchymal transition (EMT), a process which describes the trans-differentiation of epithelial cells into motile mesenchymal cells, is pivotal in stem cell behavior, development and wound healing, as well as contributing to disease processes including fibrosis and cancer progression. Maintenance immunosuppression with calcineurin inhibitors (CNIs) has become routine management for renal transplant patient, but unfortunately the nephrotoxicity of these drugs has been well documented. HK-2 cells were exposed to Tacrolimus (FK506) and EMT markers were assessed by RT PCR and western blot...
2016: Journal of Clinical Medicine
Sharven Taghavi, Vishnu Ambur, Senthil Jayarajan, John Gaughan, Yoshiya Toyoda, Elizabeth Dauer, Lars Ola Sjoholm, Abhijit Pathak, Thomas Santora, Amy J Goldberg
INTRODUCTION: Lung transplant patients require a high degree of immunosuppression, which can impair wound healing when surgical procedures are required. We hypothesized that because of impaired healing, lung transplant patients requiring gastrostomy tubes would have better outcomes with open gastrostomy tube (OGT) as compared to percutaneous endoscopic gastrostomy tube (PEG). METHODS: The National Inpatient Sample (NIS) Database (2005-2010) was queried for all lung transplant recipients requiring OGT or PEG...
February 2016: Annals of Medicine and Surgery
Claudia Sommerer, Barbara Suwelack, Duska Dragun, Peter Schenker, Ingeborg A Hauser, Björn Nashan, Friedrich Thaiss
BACKGROUND: Immunosuppression with calcineurin inhibitors remains the mainstay of treatment after kidney transplantation; however, long-term use of these drugs may be associated with nephrotoxicity. In this regard, the current approach is to optimise available immunosuppressive regimens to reduce the calcineurin inhibitor dose while protecting renal function without affecting the efficacy. The ATHENA study is designed to evaluate renal function in two regimens: an everolimus and reduced calcineurin inhibitor-based regimen versus a standard treatment protocol with mycophenolic acid and tacrolimus in de novo kidney transplant recipients...
February 17, 2016: Trials
P B Shah, J E Cooper, M S Lucia, C Boils, C P Larsen, A C Wiseman
Two common polymorphisms in APOL1 (G1 and G2) are conserved in persons of African ancestry, and the presence of two polymorphisms (commonly referred to as risk variants) has been identified as a risk factor for chronic kidney disease and focal seg-mental glomerulosclerosis. In kidney transplantation, deceased donors with two APOL1 risk variants carry an increased risk of renal allograft failure in the recipient. An emerging question is whether these data should influence deceased donor assessment or be used to refine prediction of allograft survival...
June 2016: American Journal of Transplantation
Susan D Horn, Ryan S Barrett, Caroline E Fife, Brett Thomson
PURPOSE: The purpose of this learning activity is to provide information regarding the creation of a risk-stratification system to predict the likelihood of the healing of body and heel pressure ulcers (PrUs). TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1...
December 2015: Advances in Skin & Wound Care
V Turunç, A Eroğlu, E Cihandide, B Tabandeh, T Oruğ, B Güven
A 39-year-old man who had received cadaveric renal transplantation (RT) 1 month previously presented with rash and pain on his left lower extremity. Initially, bacterial cellulitis was suspected, and ampicillin/sulbactam was initiated; however, 3 days later, skin necrosis occurred and pain increased. Ampicillin/sulbactam was replaced with imipenem+ciprofloxacin, and surgical debridement was performed. Escherichia coli was identified in the wound culture, urine culture, and blood culture. After repeated debridement, wound care, and appropriate antimicrobial treatment, wounds began to heal and skin grafting was planned at the 4th month of therapy...
June 2015: Transplantation Proceedings
B Bozkurt, M Tokac, E G Dumlu, A Yalcin, M Kilic
Multiple comorbidities and environmental factors increase the complications of incisional wounds in patients. It was demonstrated in previous prospective and randomized studies that negative pressure wound therapy (NPWT) reduced wound infection and other complications in clean, closed surgical incisions. In this case report, the Prevena incision management system was implemented on the clean, closed surgical incision of a 52-year-old female patient, who was given a renal transplantation from cadaver postoperatively in the operating theater...
June 2015: Transplantation Proceedings
Chad M Bailey, Christoph Troppmann, Jennifer Kuo, Michael S Wong
BACKGROUND: Patients with end-stage renal disease evaluated for renal transplantation are frequently declined secondary to obesity and decreased functional status. As a result, many of these patients lose weight intentionally in an effort to gain candidacy on the transplant waiting list. This frequently produces a panniculus encompassing the lower abdominal surgical site used for renal transplantation. These patients are declined for renal transplantation secondary to predictable wound-healing complications...
May 2015: Annals of Plastic Surgery
Yi-Ting Chen, Yung-Ming Chen
We report a patient with end-stage renal disease status after two renal transplantations. Milky-like ascites was noted since the immunosuppressant agent was switched to sirolimus (1 mg/day). Chylous ascites was diagnosed owing to the triglyceride of dialysate to serum being 15.98:15.99. Series studies were all negative. It is highly suspected that the cause of chylous ascites is sirolimus related because surgically related lymph vessel injury happens most often 6 months after transplantation. Sirolimus-related chylous ascites is a rare cause of chylous ascites but the incidence rate increases after transplantation...
February 2014: Clinical Kidney Journal
Dean Markić, Marin Marinović, Stanislav Sotosek, Josip Spanjol, Aldo Ivancić, Maricić Anton, Zeljko Fuckar
Kidney transplantation is the best treatment modality for patients with end-stage renal disease. Wound healing is impaired in these patients, and factors such as immunosuppression, older age and comorbidities have a negative impact on wound healing. Recently, negative pressure wound therapy has become an important wound management technique. We present two patients with wound healing issues in the early posttransplant period. In both patients, an imrnunosup- pressive treatment was administered, which included tacrolimus, mycophenolate mophetil and high-dose corticosteroids with anti-IL-2 induction therapy...
December 2014: Collegium Antropologicum
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