Successful kidney transplantation from a live donor with immune thrombocytopenia: a case report.

Organ transplantation from donors with immune thrombocytopenia (ITP), a condition involving the autoantibody-mediated destruction of platelets, is a topic of debate due to the potential for transplantation-mediated autoimmune thrombocytopenia (TMAT), a rare but potentially fatal complication. Previous reports have described transplants from deceased liver donors with ITP who had very low platelet counts and disease largely refractory to treatment. Here, we present the first case of living kidney transplantation from a donor with ITP who underwent preoperative treatment, with concurrent splenectomy performed to reduce the long-term risk of spontaneous hemorrhage. To ensure the safety of the procedure, we monitored perioperative rotational thromboelastometry parameters and platelet counts, leading to the normalization of the donor's platelet levels. The recipient experienced an uneventful recovery of renal function without perioperative bleeding or the development of TMAT. Our report suggests that kidney transplantation from a donor with well-managed ITP is safe, and such a condition should not be considered a contraindication for donation.

Effectiveness of Chinese Herbal Medicine as a Complementary Treatment for Neutropenia Prevention and Immunity Modulation During Chemotherapy in Patients With Breast Cancer: Protocol for a Real-World Pragmatic Clinical Trial.

BACKGROUND: In recent years, advancements in cancer treatment have enabled cancer cell inhibition, leading to improved patient outcomes. However, the side effects of chemotherapy, especially leukopenia, impact patients' ability to tolerate their treatments and affect their quality of life. Traditional Chinese medicine is thought to provide complementary cancer treatment to improve the quality of life and prolong survival time among patients with cancer. OBJECTIVE: This study aims to evaluate the effectiveness of Chinese herbal medicine (CHM) as a complementary treatment for neutropenia prevention and immunity modulation during chemotherapy in patients with breast cancer. METHODS: We will conduct a real-world pragmatic clinical trial to evaluate the effectiveness of CHM as a supplementary therapy to prevent neutropenia in patients with breast cancer undergoing chemotherapy. Patients will be classified into CHM or non-CHM groups based on whether they received CHM during chemotherapy. Using generalized estimating equations or repeated measures ANOVA, we will assess differences in white blood cell counts, absolute neutrophil counts, immune cells, and programmed cell death protein 1 (PD-1) expression levels between the 2 groups. RESULTS: This study was approved by the research ethics committee of Hualien Tzu Chi Hospital (IRB 110-168-A). The enrollment process began in September 2021 and will stop in December 2024. A total of 140 patients will be recruited. Data cleaning and analysis are expected to finish in the middle of 2025. CONCLUSIONS: Traditional Chinese medicine is the most commonly used complementary medicine, and it has been reported to significantly alleviate chemotherapy-related side effects. This study's findings may contribute to developing effective interventions targeting chemotherapy-related neutropenia among patients with breast cancer in clinical practice. TRIAL REGISTRATION: International Traditional Medicine Clinical Trial Registry ITMCTR2023000054; https://tinyurl.com/yc353hes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55662.

Serum Phenylacetylglutamine among Potential Risk Factors for Arterial Stiffness Measuring by Carotid-Femoral Pulse Wave Velocity in Patients with Kidney Transplantation.

Phenylacetylglutamine (PAG), a gut microbiota metabolite, is associated with cardiovascular diseases. Arterial stiffness (AS), which is a marker of aging-associated vascular diseases, is an independent risk factor for cardiovascular morbidity and mortality. This study aimed to assess the correlation between serum PAG levels and AS in kidney transplantation (KT) patients, potentially uncovering new insights into the cardiovascular risks in this population. In this study, 100 KT patients were included. Carotid-femoral pulse wave velocity (cfPWV) was measured, and patients with cfPWV > 10 m/s were categorized as the AS group. Serum PAG levels were assessed using liquid chromatography-tandem mass spectrometry. Thirty KT patients (30.0%) exhibited AS, with higher percentages of diabetes mellitus, older age, and elevated levels of systolic blood pressure, serum fasting glucose, and PAG than the control group. After adjusting for factors significantly associated with AS by multivariate logistic regression analysis, serum PAG, age, fasting glucose levels, and systolic blood pressure were independent factors associated with AS. Furthermore, PAG levels had a negative correlation with the estimated glomerular filtration rate and a positive correlation with cfPWV values. Serum PAG levels are positively associated with cfPWV values and are a biomarker of AS in KT patients.

Association of serum osteopontin with first hospitalization and all-cause mortality after kidney transplantation.

Objective: Osteopontin (OPN) is involved in vascular calcification and atherosclerosis. We evaluated the association between serum OPN levels and the first postoperative hospitalization and all-cause mortality in patients who received kidney transplantation (KT). Materials and Methods: Seventy KT recipients were enrolled in this study from January to April 2012. The primary end point was first postoperative hospitalization or death. All patients were monitored in the outpatient clinics until June 30, 2017. Serum OPN level was measured by enzyme-linked immunosorbent assay. Results: During follow-up (median length, 65 months), 47 first postoperative hospitalizations and 8 deaths occurred. In comparison with serum median OPN levels, serum OPN level was positively associated with KT duration (P = 0.048), serum blood urea nitrogen (BUN; P = 0.043), and serum creatinine levels (P = 0.045) but negatively associated with estimated glomerular filtration rate (eGFR; P = 0.049). Hospitalized KT recipients had a higher prevalence of diabetes mellitus (DM) (P = 0.032), BUN (P = 0.002), and serum OPN level (P = 0.001) but lower eGFR (P = 0.030) than did patients not hospitalized. KT recipients who died had higher serum level of creatinine (P = 0.009) and OPN (P = 0.001) but lower eGFR (P = 0.036) than did surviving patients. Multivariate Cox analysis adjusted for age, gender, DM, hypertension, eGFR, KT duration, and steroid used showed that serum OPN level was associated with both first postoperative hospitalization (P = 0.049) and all-cause mortality (P = 0.017). Conclusions: Serum OPN level is a potential biomarker for first postoperative hospitalization and all-cause mortality in KT recipients.

Serum myostatin level is a positive predictor of endothelial function measured by digital thermal monitoring of vascular reactivity in kidney transplantation patients.

OBJECTIVES: Myostatin is a myokine predominantly expressed and secreted in skeletal muscle in response to stimulations, including oxidative stress or inflammation. We investigated a potential association between myostatin levels and endothelial function among kidney transplantation (KT) patients. MATERIALS AND METHODS: Fasting blood samples were collected from 64 KT patients. The endothelial function that indicated by vascular reactivity index (VRI) was measured by digital thermal monitoring test. Serum myostatin levels were measured using a commercial enzyme-linked immunosorbent assay kit. All patients were categorized into three groups according to their VRI values: poor vascular reactivity was considered if VRI <1.0; 1.0 ≤VRI <2.0 indicated intermediate vascular reactivity, and VRI ≥2.0 was grouped as good vascular reactivity. RESULTS: Seven KT patients (10.9%) were categorized as poor vascular reactivity, 24 KT patients (37.5%) were grouped as intermediate vascular reactivity, and 33 KT patients had good vascular reactivity. Advanced age (r = -0.372, P = 0.002) and serum alkaline phosphate (ALP) level (r = -0.341, P = 0.006) were negatively correlated with VRI. However, serum myostatin level (r = 0.430, P < 0.001) was positively correlated with VRI. In multivariable forward stepwise linear regression analysis, high serum level of myostatin (ß = 0.441, adjusted R 2 change = 0.171; P < 0.001), advanced age (ß = -0.317, adjusted R 2 change = 0.138; P = 0.003), and serum ALP level (ß = -0.270, adjusted R 2 change = 0.060; P = 0.011) were significantly associated with VRI in KT patients. CONCLUSION: Our study showed that fasting myostatin level was positively associated with VRI and endothelial function among KT patients.

Optimal imaging time for Tc-99m phytate lymphoscintigraphy for sentinel lymph node mapping in patients with breast cancer.

OBJECTIVES: Sentinel lymph node (SLN) sampling has become a standard practice in managing early-stage breast cancer. Lymphoscintigraphy is one of the major methods used. The radioactive tracer used in Taiwan is Tc-99m phytate. However, this agent is not commonly used around the world and the optimal imaging time has not been studied. Thus, we investigated the optimal imaging time of Tc-99m phytate lymphoscintigraphy for SLN mapping in patients with breast cancer. MATERIALS AND METHODS: We retrospectively reviewed SLN Tc-99m phytate lymphoscintigraphies in 135 patients with breast cancer between August 2013 and November 2017. The time for the first SLN to be visualized after radiotracer injection was recorded to determine the optimal imaging time. If no SLN was identified on imaging, the scan was continued to 60 min. We also recorded the presurgical technical and clinical factors to analyze the risk factors for nonvisualization of SLN. Each patient's postoperative axillary lymph node status was also recorded. RESULTS: Axillary SLNs were identified on imaging in 94.8% of the patients. All first SLNs presented within 30 min. In 6 of 7 patients with negative imaging, SLNs were identified during surgery using either blue dye or a hand-held gamma probe. Nonvisualization of SLNs on lymphoscintigraphy was significantly associated with a lower injection dose (1.0 mCi vs. 2.0 mCi), 4-injection protocol (compared to 2-injection), and injection around an outer upper quadrant tumor. In addition, patients with axillary lymph node metastasis had a higher percentage of SLN image mapping failure, with a marginally significant difference. CONCLUSION: Based on our study, 30 min after Tc-99m phytate injection is the optimal time for lymphoscintigraphy and delayed imaging beyond 30 min is not necessary. In addition, a lower injection dose, the 4-injection method, and an injection near the outer upper quadrant tumor should be avoided to minimize nonvisualization of SLNs.

Serum adipocyte fatty acid-binding protein level is associated with arterial stiffness quantified with cardio-ankle vascular index in kidney transplant patients.

BACKGROUND: Arterial stiffness is an established marker of cardiovascular risk and an independent predictor of cardiovascular disease (CVD) events and mortality in kidney transplant (KT) patients. Adipocyte fatty acid-binding protein (A-FABP), a novel adipokine, is positively associated with atherosclerosis. The present study evaluated the relationship between fasting circulating A-FABP and peripheral arterial stiffness using the cardio-ankle vascular index (CAVI) in KT patients. METHODS: Fasting blood samples were collected from 74 KT patients, and serum A-FABP levels were measured using an enzyme immunoassay. CAVI was calculated using a waveform device (CAVI-VaSera VS-1000). The cutoff values for high and low levels of arterial stiffness were defined by the CAVI values of ≥9 and <9, respectively. RESULTS: Thirty-four patients (45.9%) were classified into the high arterial stiffness group. Compared with the low arterial stiffness group, the high arterial stiffness group had higher values for age (p = 0.015), systolic blood pressure (p < 0.001), pulse pressure (p < 0.001), duration of kidney transplantation (p = 0.005), serum total cholesterol and triglyceride levels (p = 0.033 and 0.047, respectively), glomerular filtration rate (p = 0.019), fasting glucose levels (p = 0.012), and serum A-FABP levels (p < 0.001). Multivariate forward stepwise linear regression analysis showed that age (p = 0.004), systolic blood pressure (p = 0.001), and serum A-FABP levels (p = 0.003) were independent predictors of CAVI value in KT patients. CONCLUSION: Serum fasting A-FABP level is positively associated with peripheral arterial stiffness in KT patients.

Exendin-4, a glucagon-like peptide-1 analogue accelerates healing of chronic gastric ulcer in diabetic rats.

BACKGROUND: Diabetes mellitus is an independent risk factor for impaired healing of peptic ulcers, and there are currently no supplementary therapeutics other than the standard antipeptic medicine to improve the ulcer healing in diabetes. This study examined the potential pleiotropic effect of a glucagon-like peptide (Glp)-1 analogue exendin (Ex)-4 on the regeneration of gastric ulcer in streptozotocin-induced diabetic rats. METHODS AND RESULTS: Chronic ulcer was created in rat stomach by submucosal injection of acetic acid and peri-ulcer tissues were analyzed 7 days after operation. Ulcer wound healing was impaired in diabetic rats with suppressed tissue expression of eNOS and enhanced levels of pro-inflammatory reactions. Treatment with intraperitoneal injection of Ex4 (0.5 µg/kg/d) significantly reduced the area of gastric ulcer without changing blood glucose level. Ex-4 restored the expression of pro-angiogenic factors, and attenuated the generation of regional inflammation and superoxide anions. The improvement of ulcer healing was associated with increased expression of MMP-2 and formation of granulation tissue in the peri-ulcer area. CONCLUSION: Administration of Ex4 may induce pro-angiogenic, anti-inflammatory and anti-oxidative reactions in the peri-ulcer tissue of diabetic rats that eventually enhances tissue granulation and closure of ulcerative wounds. Our results support the potential clinical application of Glp-1 analogues as supplementary hypoglycemic agents in the antipeptic ulcer medication in diabetes.

Elevated serum osteoprotegerin may predict peripheral arterial disease after kidney transplantation: a single-center prospective cross-sectional study in Taiwan.

BACKGROUND: Osteoprotegerin (OPG) is a potential biomarker for severity and complications of cardiovascular diseases. Peripheral arterial disease (PAD) is associated with an increased risk of death in kidney transplantation (KT) patients. This prospective cross-sectional study evaluated the relationship between serum OPG and PAD in KT patients. METHODS: Seventy-four KT patients were enrolled for this PAD study. Fasting blood samples were obtained to measure serum OPG levels by using enzyme-linked immunosorbent assay kits. The ankle-brachial index (ABI) of less than 0.9 was applied for PAD diagnosis. RESULTS: Thirteen patients (17.6%) were diagnosed with PAD. Diabetes (P = 0.025), smoking (P = 0.010), and increased OPG levels (P = 0.001) were significantly more frequent in the PAD group. Multivariate logistic regression analysis showed that serum OPG (odds ratio [OR], 1.336; 95% CI [1.108-1.611]; P = 0.002) and diabetes (OR, 7.120; 95% CI [1.080-46.940]; P = 0.041) were independent predictors of PAD in KT patients. The area under the receiver operating characteristic (ROC) curve determined that the probability of a serum OPG level of 7.117 pg/L in predicting PAD in KT patients was 0.799 (95% CI [0.690-0.884]; P < 0.001). DISCUSSION: Exploration of reliable biomarkers for early identification of vascular risk is crucial for KT patients. Elevated serum OPG levels may predict PAD in KT patients with cutoff value of 7.117 pg/L.

Serum adiponectin is a negative predictor of central arterial stiffness in kidney transplant patients.

BACKGROUND: The role of adiponectin in arterial stiffness and its relationship to cardiovascular disease is not fully demonstrated and needs further elaboration. In this study, the association between adiponectin level and arterial stiffness is studied among kidney transplant patients. MATERIAL AND METHODS: Anthropometric data and biochemical data including fasting glucose, lipid profile, renal function and serum adiponectin were determined in 55 kidney transplant patients. Central arterial stiffness was measured and presented by carotid-femoral pulse wave velocity. RESULTS: Univariate linear analysis showed that body weight, waist circumference, brachial pulse pressure and body mass index were correlated positively with carotid-femoral pulse wave velocity in this patient group. However, logarithmically transformed adiponectin level (log-adiponectin) correlated negatively with carotid-femoral pulse wave velocity. In multivariate regression analysis of factors significantly associated with carotid-femoral pulse wave velocity, it showed that both log-adiponectin (ß = -0.427; R(2) = 0.205, p = 0.001) and body weight (ß = 0.327; R(2 )=( )0.106, p = 0.007) were independently predictive of central arterial stiffness. CONCLUSION: Our study suggests that fasting serum adiponectin is negatively associated with carotid-femoral pulse wave velocity, hence arterial stiffness, in kidney transplant patients.