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Obesity and transplant

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https://www.readbyqxmd.com/read/28432716/deciphering-tacrolimus-induced-toxicity-in-pancreatic-%C3%AE-cells
#1
J Triñanes, A E Rodriguez-Rodriguez, Y Brito, A Wagner, A P J De Vries, G Cuesto, A Acebes, E Salido, A Torres, E Porrini
β-cell transcription factors like: FoxO1, MafA, PDX-1, NeuroD, are dysfunctional in type 2 diabetes (T2DM). PTDM resembles T2DM and reflects interaction between pre-transplant insulin resistance and immunosuppressants, mainly calcineurin inhibitors. We evaluated the effect of tacrolimus, cyclosporine-A and metabolic stressors (glucose+palmitate) on insulinoma β-cells (INS-1) in vitro and in pancreata of obese and lean Zucker rats. Cells were cultured for five days with 100μM palmitate and 22mM glucose; cyclosporin-A (250ng/mL) or tacrolimus (15ng/mL) were added the last 48h...
April 22, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28432575/liver-transplantation-the-role-of-metabolic-syndrome
#2
REVIEW
Brian C Davis, M Shadab Siddiqui
The long-term survival in liver transplant recipients (LTRs) is currently at an historical high level stemming from improvement in perioperative care, infection control, and immunosuppression medications. However, compared to the general population, LTRs have decreased survival. Metabolic diseases like hypertension, dyslipidemia, type 2 diabetes, and obesity are key determinants of long-term mortality in LTRs. The incidence and prevalence of these metabolic comorbidities is considerably higher in LTRs and likely results from a combination of factors including exposure to chronic immunosuppression, weight gain, and recurrence of chronic liver disease after liver transplantation (LT)...
April 21, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28426902/hepatic-steatosis-after-pediatric-liver-transplant
#3
Emily R Perito, Tabitha Vase, Rageshree Ramachandran, Andrew Phelps, Kuang-Yu Jen, Robert H Lustig, Vickie A Feldstein, Philip Rosenthal
RATIONALE: Hepatic steatosis develops after liver transplant in 30% of adults, and non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in non-transplanted children. However, post-transplant steatosis has been minimally studied in pediatric liver transplant recipients. We explored the prevalence, persistence, and association with chronic liver damage of hepatic steatosis in these children. RESULTS: In this single-center study of pediatric patients transplanted 1988-2015 (n=318), 31% of those with any post-transplant biopsy (n=271) had ≥1 biopsy with steatosis...
April 20, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28425848/the-contribution-of-bone-marrow-derived-cells-to-the-human-adipocyte-pool
#4
Peter Arner, Mikael Rydén
White adipose tissue is a remarkably expandable organ with results in the last decade showing that human white adipocytes are continuously turned over during the entire life-span. Data primarily in murine models have demonstrated that adipocytes are derived from precursors present mainly in the perivascular areas of adipose tissue but their precise origin remains unclear. Subsets of cells present in bone marrow display a multipotent differentiation capacity which has prompted the hypothesis that bone marrow-derived cells (BMDCs) may also contribute to the adipocyte pool present in peripheral fat depots...
March 15, 2017: Adipocyte
https://www.readbyqxmd.com/read/28423197/diabetic-kidney-transplant-recipients-impaired-infection-control-and-increased-alloreactivity
#5
Thomas Schachtner, Maik Stein, Petra Reinke
BACKGROUND: Posttransplantation diabetes mellitus (PTDM) has been associated with inferior patient and allograft outcomes. However, previous studies didn't identify differences in infection control and alloreactivity. METHODS: We studied 449 kidney transplant recipients (KTRs) between 2005 and 2013. 50 (11.1%) KTRs were diagnosed with PTDM and 60 (13.4%) KTRs with pre-existing diabetes. Samples were collected pretransplantation, at +1, +2, +3 months posttransplantation...
April 19, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28422962/docosahexaenoic-acid-blocks-progression-of-western-diet-induced-nonalcoholic-steatohepatitis-in-obese-ldlr-mice
#6
Kelli A Lytle, Carmen P Wong, Donald B Jump
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a major public health concern in western societies. Nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD, is characterized by hepatic steatosis, inflammation, oxidative stress and fibrosis. NASH is a risk factor for cirrhosis and hepatocellular carcinoma. NASH is predicted to be the leading cause of liver transplants by 2020. Despite this growing public health concern, there remain no Food and Drug Administration (FDA) approved NASH treatments...
2017: PloS One
https://www.readbyqxmd.com/read/28417431/robotic-kidney-transplantation-an-update
#7
REVIEW
V Sankaran, S Sinha
PURPOSE OF REVIEW: Over the last decade, there have been advances in kidney transplantation with introduction of minimally invasive surgery. Robotic surgery is becoming increasingly common across the specialities. There is now increasing experience in robotic kidney transplantation, though it remains a niche procedure. Initial reports suggest that this is a safe, feasible operation when performed by teams familiar with robotic surgery. There have been a few modifications to the initially described procedure, as a result of increasing experience...
June 2017: Current Urology Reports
https://www.readbyqxmd.com/read/28411866/addressing-the-challenges-of-sleeve-gastrectomy-in-end-stage-renal-disease-analysis-of-100-consecutive-renal-failure-patients
#8
Young Kim, Junzi Shi, Christopher M Freeman, Andrew D Jung, Vikrom K Dhar, Shimul A Shah, E Steve Woodle, Tayyab S Diwan
BACKGROUND: While previous studies have demonstrated short-term efficacy of laparoscopic sleeve gastrectomy in candidates awaiting renal transplantation, the combination of morbid obesity and end-stage renal disease presents unique challenges to perioperative care. We demonstrate how increasing experience and the development of postoperative care guidelines can improve outcomes in this high-risk population. METHODS: Single-center medical records were reviewed for renal transplantation candidates undergoing laparoscopic sleeve gastrectomy between 2011 and 2015 by a single surgeon...
April 12, 2017: Surgery
https://www.readbyqxmd.com/read/28405876/laparoscopic-sleeve-gastrectomy-in-kidney-transplant-candidates-a-case-series
#9
Sergio Carandina, Laurent Genser, Manuela Bossi, Laura Montana, Alexandre Cortes, Marie Seman, Marc Danan, Christophe Barrat
BACKGROUND: Patients with a body mass index (BMI) >35 kg/m(2) who need kidney transplant present with increased postoperative mortality and reduced kidney graft survival compared to patients with a lower BMI. For this reason, obese patients are often excluded from the transplantation waiting list. The aim of this study was to evaluate the feasibility and the results of laparoscopic sleeve gastrectomy (LSG) for obese patients awaiting a kidney transplant. METHODS: This was a retrospective study on patients with dialysis-dependent renal failure (DDRF) operated on at two first-level bariatric centers in Paris (France)...
April 12, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28394304/the-diet-and-haemodialysis-dyad-three-eras-four-open-questions-and-four-paradoxes-a-narrative-review-towards-a-personalized-patient-centered-approach
#10
REVIEW
Giorgina Barbara Piccoli, Maria Rita Moio, Antioco Fois, Andreea Sofronie, Lurlinys Gendrot, Gianfranca Cabiddu, Claudia D'Alessandro, Adamasco Cupisti
The history of dialysis and diet can be viewed as a series of battles waged against potential threats to patients' lives. In the early years of dialysis, potassium was identified as "the killer", and the lists patients were given of forbidden foods included most plant-derived nourishment. As soon as dialysis became more efficient and survival increased, hyperphosphatemia, was identified as the enemy, generating an even longer list of banned aliments. Conversely, the "third era" finds us combating protein-energy wasting...
April 10, 2017: Nutrients
https://www.readbyqxmd.com/read/28376573/the-gut-microbiome
#11
Mayenaaz Sidhu, David van der Poorten
BACKGROUND: More than a trillion, mostly good, microbes live within our gastrointestinal tract and are responsible for vital metabolic, immune and nutritional functions. Dysbiosis, meaning a maladaptive imbalance of the microbiome, is associated with many common diseases and is a target for therapy. OBJECTIVE: This article provides an overview of the gut microbiome in health and disease, highlighting conditions such as Clostridium difficile infection, inflammatory bowel disease, irritable bowel syndrome, obesity and non-alcoholic fatty liver disease, with which dysbiosis is associated...
2017: Australian Family Physician
https://www.readbyqxmd.com/read/28372330/the-gut-microbiota-and-alzheimer-s-disease
#12
Chunmei Jiang, Guangning Li, Pengru Huang, Zhou Liu, Bin Zhao
The gut microbiota comprises a complex community of microorganism species that resides in our gastrointestinal ecosystem and whose alterations influence not only various gut disorders but also central nervous system disorders such as Alzheimer's disease (AD). AD, the most common form of dementia, is a neurodegenerative disorder associated with impaired cognition and cerebral accumulation of amyloid-β peptides (Aβ). Most notably, the microbiota-gut-brain axis is a bidirectional communication system that is not fully understood, but includes neural, immune, endocrine, and metabolic pathways...
March 29, 2017: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/28366701/altering-the-approach-open-minimally-invasive-renal-transplant-in-obese-patients-through-the-anterior-rectus-sheath
#13
Stephen H Phillips, Sharon K Hill, Lorie D Lipscomb, Joseph B Africa
OBJECTIVES: 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. Retrospectively, we analyzed the wound issues for obese patients as well as outcomes/graft survival, hypothesizing improvement over the standard approach...
March 30, 2017: Urology
https://www.readbyqxmd.com/read/28364810/liver-transplantation-and-bariatric-surgery-best-approach
#14
REVIEW
Duminda Suraweera, Erik Dutson, Sammy Saab
Obesity has become increasingly prevalent, and the number of obese patients in need of liver transplant is expected to continue to increase. In addition, liver disease due to nonalcoholic fatty liver disease is expected to become the leading cause of liver transplantation in the near future. However, obesity remains a relative contraindication in liver transplant. New strategies in managing this patient population are clearly needed. To this end, the authors review the current literature on the efficacy of bariatric surgery in the setting of liver transplantation in obese patients...
May 2017: Clinics in Liver Disease
https://www.readbyqxmd.com/read/28361229/obesity-in-pediatric-kidney-transplant-recipients-and-the-risks-of-acute-rejection-graft-loss-and-death
#15
Maleeka Ladhani, Samantha Lade, Stephen I Alexander, Louise A Baur, Philip A Clayton, Stephen McDonald, Jonathan C Craig, Germaine Wong
BACKGROUND: Obesity is prevalent in children with chronic kidney disease (CKD), but the health consequences of this combination of comorbidities are uncertain. The aim of this study was to evaluate the impact of obesity on the outcomes of children following kidney transplantation. METHODS: Using data from the ANZDATA Registry (1994-2013), we assessed the association between age-appropriate body mass index (BMI) at the time of transplantation and the subsequent development of acute rejection (within the first 6 months), graft loss and death using adjusted Cox proportional hazards models...
March 30, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28361113/overweight-kidney-transplant-recipients-are-at-risk-of-being-overdosed-following-standard-bodyweight-based-tacrolimus-starting-dose
#16
Louise M Andrews, Brenda C M de Winter, Jiang-Tao Tang, Nauras Shuker, Rachida Bouamar, Ron H N van Schaik, Birgit C P Koch, Teun van Gelder, Dennis A Hesselink
BACKGROUND: Bodyweight-based dosing of tacrolimus (Tac) is considered standard care, even though the available evidence is thin. An increasing proportion of transplant recipients is overweight, prompting the question if the starting dose should always be based on bodyweight. METHODS: For this analysis, data were used from a randomized-controlled trial in which patients received either a standard Tac starting dose or a dose that was based on CYP3A5 genotype. The hypothesis was that overweight patients would have Tac overexposure following standard bodyweight-based dosing...
February 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28355381/bariatric-surgery-in-individuals-with-liver-cirrhosis-a-narrative-review
#17
Everton Cazzo, Martinho Antonio Gestic, Murillo Pimentel Utrini, Felipe David Mendonça Chaim, Francisco Callejas-Neto, José Carlos Pareja, Elinton Adami Chaim
Introduction: Bariatric surgery has become the gold standard treatment for morbid obesity, but there is no consensus regarding its safety and efficacy among individuals with chronic liver diseases. Objective: To critically evaluate the existing evidence on literature about bariatric surgery in individuals with liver cirrhosis. Method: Narrative review performed by means of an online search in the MEDLINE and LILACS databases. Results: Bariatric surgery is safe and effective in individuals with chronic liver disease without clinical decompensation or significant portal hypertension...
February 2017: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/28352024/anesthetic-management-of-two-cases-of-bardet-biedl-syndrome-for-renal-transplantation
#18
Kalpana S Vora, Manisha P Modi, Bina P Butala, Veena R Shah
Bardet-Biedl syndrome (BBS) is a multisystem autosomal recessive disorder with clinical and genetic heterogeneity. It is a type of ciliopathy characterized by retinal dystrophy, central obesity, polydactyly, cognitive impairment, and gonadal and renal dysgenesis. It has been suggested that the involved proteins attach to the basal body of ciliated cells making this a disorder of ciliary dysfunction. We report two cases of typical BBS in a 17-year-old female and 29-year-old male patient, who presented for live-related renal transplant...
March 2017: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/28352021/prevalence-of-the-metabolic-syndrome-in-kidney-transplant-recipients-a-single-center-study
#19
Maryam Hami, M Ghorban Sabbagh, A Sefidgaran, M J Mojahedi
Metabolic syndrome (MS) is characterized by a combination of cardiovascular (CV) risk factors (hypertension, dyslipidemia, obesity, and alterations in glucose homeostasis). Insulin resistance is suggested to be the common pathogenic background. This syndrome is also a risk factor for diabetes and chronic kidney disease. In renal transplant recipients, MS has been shown to be an independent risk factor for chronic allograft dysfunction, graft failure, new-onset diabetes, and CV disease. We performed a cross-sectional study on 106 stable renal transplant recipients to detect MS between January 2013 and August 2013...
March 2017: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/28342282/pharmacokinetic-and-pharmacogenetic-analysis-of-immunosuppressive-agents-after-laparoscopic-sleeve-gastrectomy
#20
Tayyab S Diwan, Alicia B Lichvar, Abbie D Leino, Alexander A Vinks, Uwe Christians, Adele R Shields, Michael A Cardi, Tsuyoshi Fukuda, Tomoyuki Mizuno, Tiffany Kaiser, E Steve Woodle, Rita R Alloway
BACKGROUND: Severe obesity has been shown to limit access to renal transplantation in patients with end stage renal disease (ESRD). Laparoscopic sleeve gastrectomy (LSG) has been performed in the ESRD population to assist in achieving waitlist and transplant eligibility. Little is known about how LSG impacts the bioequivalence tacrolimus products and immunosuppression pharmacokinetics. METHODS: This was a prospective, open-label, single-dose, crossover, two-period pharmacokinetic (PK) study...
March 25, 2017: Clinical Transplantation
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