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1.
Materials (Basel) ; 17(10)2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38793251

RESUMO

Laser-directed energy deposition (DED), a metal additive manufacturing method, is renowned for its role in repairing parts, particularly when replacement costs are prohibitive. Ensuring that repaired parts avoid residual stresses and deformation is crucial for maintaining functional integrity. This study conducts experimental and numerical analyses on trapezoidal shape repairs, validating both the thermal and mechanical models with experimental results. Additionally, the study presents a methodology for creating a toolpath applicable to both the DED process and Abaqus CAE software. The findings indicate that employing a pre-heating strategy can reduce residual stresses by over 70% compared to no pre-heating. However, pre-heating may not substantially reduce final distortion. Notably, final distortion can be significantly mitigated by pre-heating and subsequently cooling to higher temperatures, thereby reducing the cooling rate. These insights contribute to optimizing DED repair processes for enhanced part functionality and longevity.

2.
Materials (Basel) ; 17(7)2024 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-38612013

RESUMO

In recent decades, laser additive manufacturing has seen rapid development and has been applied to various fields, including the aerospace, automotive, and biomedical industries. However, the residual stresses that form during the manufacturing process can lead to defects in the printed parts, such as distortion and cracking. Therefore, accurately predicting residual stresses is crucial for preventing part failure and ensuring product quality. This critical review covers the fundamental aspects and formation mechanisms of residual stresses. It also extensively discusses the prediction of residual stresses utilizing experimental, computational, and machine learning methods. Finally, the review addresses the challenges and future directions in predicting residual stresses in laser additive manufacturing.

3.
Materials (Basel) ; 17(6)2024 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-38541487

RESUMO

Scalmalloy® is an Al-Mg-Sc-Zr-based alloy specifically developed for additive manufacturing (AM). This alloy is designed for use with a direct aging treatment, as recommended by the manufacturer, rather than with a multistep treatment, as often seen in conventional manufacturing. Most work with Scalmalloy® is conducted using powder bed rather than powder-fed processes. This investigation seeks to fill this knowledge gap and expand beyond single-step aging to promote an overall balanced AM-fabricated component. For this study, directed energy deposition (DED)-fabricated Scalmalloy® components were subjected to low-temperature treatments to minimize residual stresses inherent in the material due to the layer-by-layer build process. X-ray diffraction (XRD) indicated the possibility of stress minimization while reducing the detriment to mechanical strength through lower temperature treatments. Microstructural analyses consisting of energy dispersion spectroscopy (EDS) and electron backscatter diffraction (EBSD) revealed the presence of grain growth detrimentally affecting the strength and elongation made possible by very small grains inherent to AM and rapid solidification. Tensile testing determined that treatment at 175 °C for 1 h provides the best relief from the existing residual stresses; however, this is accompanied by a diminishment in the yield and tensile strength of 19 and 9.5%, respectively. It is noted that treatment at 175 °C for 2 h did not provide as great of a decrease in residual stresses, theorized to be the result of grain growth and other strengthening mechanisms further stressing the structure; however, the residual stresses are still significantly diminished compared with the as-built condition. Furthermore, a minimal reduction of the tensile strengths indicates the possibility of finding a balance between property diminishment and stress state through the work proposed here.

4.
Materials (Basel) ; 17(4)2024 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-38399140

RESUMO

Coaxial wire-based laser metal deposition is a versatile and efficient additive process that can achieve a high deposition rate in the manufacturing of complex structures. In this paper, a three-beam coaxial wire system is studied, with particular attention to the effects of deposition height and laser defocusing on the resulting bead geometry. As the deposition standoff distance changes, so does the workpiece illumination proportion, which describes the ratio of energy going directly into the feedstock wire and into the substrate. Single titanium beads are deposited at varying defocus levels and deposition rates and the bead aspect ratio is measured and analyzed. Over the experimental settings, the defocusing level and deposition rate were found to have a significant effect on the resulting bead aspect ratio. As the defocusing level is increased away from the beam convergence plane, the spot size increases and the deposited track is wider and flatter. Process parameters can be used to tune the deposited material to a desired aspect ratio. In coaxial wire deposition, defocusing provides an adjustment mechanism to the distribution of heat between the wire and substrate and has an important impact on the resulting deposit.

5.
Cardiovasc Intervent Radiol ; 46(1): 43-48, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36509940

RESUMO

INTRODUCTION: Clinical outcomes of implantable port catheters (IPCs) placed via alternative veins such as the external jugular and cervical collaterals have not been well established. This investigation evaluates the short- and long-term outcomes of IPCs inserted via alternate cervical veins (ACV) compared to traditionally inserted IPCs via the internal jugular vein (IJV). MATERIALS AND METHODS: A total of 24 patients who received an IPC between 2010 and 2020 via an ACV-defined as the external jugular vein, superficial cervical vein, or unnamed collateral veins-were identified. Based on power analysis, a matched control group of 72 patients who received IPCs via the IJV was identified. Non-inferiority analysis for port complications was performed between the two groups based on the selected non-inferiority margin of 20%. Secondary end points included complication-free survival and comparison of complications by the time at which they occurred. RESULTS: ACV access was non-inferior to traditional access for overall complications. Alternate access resulted in fewer complications than traditional access with an estimated reduction of - 7.0% [95% CI - 23.6%, 39.7%]. There was no significant difference in peri-procedural and post-procedural complications between the two groups. Complication-free survival was also equivalent between the two groups. CONCLUSION: IPC placement via ACVs was non-inferior to IPCs placed via traditional access through the IJV. When abnormal pathology obviates the use of IJV access, other cervical veins may be considered prior to seeking alternate locations such as femoral, translumbar, inferior vena cava, and hepatic veins.


Assuntos
Cateterismo Venoso Central , Dispositivos de Acesso Vascular , Humanos , Cateterismo Venoso Central/métodos , Cateteres de Demora , Veias Jugulares , Veia Cava Inferior
6.
Materials (Basel) ; 15(11)2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35683242

RESUMO

In this study, laser-directed energy deposition was applied to build a Ti-rich ternary Ti-Ni-Cu shape-memory alloy onto a TiNi shape-memory alloy substrate to realize the joining of the multifunctional bi-metallic shape-memory alloy structure. The cost-effective Ti, Ni, and Cu elemental powder blend was used for raw materials. Various material characterization approaches were applied to reveal different material properties in two sections. The as-fabricated Ti-Ni-Cu alloy microstructure has the TiNi phase as the matrix with Ti2Ni secondary precipitates. The hardness shows no high values indicating that the major phase is not hard intermetallics. A bonding strength of 569.1 MPa was obtained by tensile testing, and digital image correlation reveals the different tensile responses of the two sections. Differential scanning calorimetry was used to measure the phase-transformation temperatures. The austenite finishing temperature of higher than 80 °C was measured for the Ti-Ni-Cu alloy section. For the TiNi substrate, the austenite finishing temperature was tested to be near 47 °C at the bottom and around 22 °C at the upper substrate region, which is due to the repeated laser scanning that acts as annealing on the substrate. Finally, the multiple shape-memory effect of two shape-memory alloy sides was tested and identified.

7.
Polymers (Basel) ; 14(2)2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35054735

RESUMO

Multifunctional carbon fiber composites provide promising results such as high strength-to-weight ratio, thermal and electrical conductivity, high-intensity radiated field, etc. for aerospace applications. Tailoring the electrical and structural properties of 3D-printed composites is the critical step for multifunctional performance. This paper presents a novel method for evaluating the effects of the coating material system on the continuous carbon fiber strand on the multifunctional properties of 3D-printed composites and the material's microstructure. A new method was proposed for the quasi-static characterization of the Compressive-Electrical properties on the additively manufactured continuous carbon fiber solid laminate composites. In this paper, compressive and electrical conductivity tests were simultaneously conducted on the 3D-printed test coupons at ambient temperature. This new method modified the existing method of addressing monofunctional carbon fiber composites by combining the monofunctionality of two or more material systems to achieve the multifunctional performance on the same component, thereby reducing the significant weight. The quasi-static multifunctional properties reported a maximum compressive load of 4370 N, ultimate compressive strength of 136 MPa, and 61.2 G Ohms of electrical resistance. The presented method will significantly reduce weight and potentially replace the bulky electrical wires in spacecraft, unmanned aircraft systems (UAS), and aircraft.

8.
Materials (Basel) ; 14(21)2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34772100

RESUMO

Manufacturing processes for monofunctional and multifunctional materials vary depending on the design optimization. Multifunctional continuous carbon fiber composites provide great potential in achieving coupled structural and electrical properties for their applications in aircraft, unmanned aircraft systems, and spacecraft. Proper optimization of tensile and electrical properties offers benefits early in the design and continuous operational safety phases to obtain coupled multifunctional properties. In this paper, fused filament fabrication additive manufacturing (AM) technique was used to fabricate continuous carbon fiber solid laminated composites test coupons. The proposed new method characterizes the electrical conductivity's coupled effects on the tensile properties, including the failure loads and modes. This paper addresses a novel way of integrating electrical function into the composites that significantly reduce weight, potentially replacing the bulky electrical wires. Tensile and electrical conductivity tests were concurrently conducted on coupons, and the results were plotted and tabulated. The results showed the multifunctional properties of the maximum ultimate tensile strength of 392 MPa with the maximum tensile load of 8907 N, and resistance of 37.5 G·Ω. The average values for ultimate tensile strength and maximum load were 371 MPa and 8459 N, respectively.

9.
Materials (Basel) ; 14(6)2021 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-33799448

RESUMO

Directed energy deposition (DED) has been widely used for component repair. In the repair process, the surface defects are machined to a groove or slot and then refilled. The sidewall inclination angle of the groove geometry has been recognized to have a considerable impact on the mechanical properties of repaired parts. The objective of this work was to investigate the feasibility of repairing various V-shaped defects with both experiments and modeling. At first, the repair volume was defined by scanning the defective zone. Then, the repair volume was sliced to generate the repair toolpath. After that, the DED process was used to deposit Ti6Al4V powder on the damaged plates with two different slot geometries. Mechanical properties of the repaired parts were evaluated by microstructure analysis and tensile test. Testing of the repaired parts showed excellent bonding between the deposits and base materials with the triangular slot repair. 3D finite element analysis (FEA) models based on sequentially coupled thermo-mechanical field analysis were developed to simulate the corresponding repair process. Thermal histories of the substrate on the repair sample were measured to calibrate the 3D coupled thermo-mechanical model. The temperature measurements showed very good verification with the predicted temperature results. After that, the validated model was used to predict the residual stresses and distortions in the parts. Predicted deformation and stress results can guide the evaluation of the repair quality.

10.
Materials (Basel) ; 14(3)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33503969

RESUMO

In the fabrication of 17-4 PH by laser powder bed fusion (L-PBF) the well-documented occurrence of large amounts of retained austenite can be attributed to an elevated concentration of nitrogen present in the material. While the effects of continuous wave (CW) laser processing on in-situ nitrogen absorption characteristics have been evaluated, power modulated pulsed wave (PW) laser processing effects have not. In this study the effects of PW L-PBF processing of 17-4 PH on nitrogen absorption, phase composition, and mechanical performance are explored using commercially available PW L-PBF equipment and compared to samples produced by CW L-PBF. PW L-PBF samples fabricated in cover gas conditions with varying amounts of nitrogen demonstrated reduced absorption levels compared to those produced by CW L-PBF with no effects on phase composition and minimal effects on mechanical performance.

11.
Materials (Basel) ; 13(16)2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32806690

RESUMO

The laser powder directed energy deposition process is a metal additive manufacturing technique, which can fabricate metal parts with high geometric and material flexibility. The unique feature of in-situ powder feeding makes it possible to customize the elemental composition using elemental powder mixture during the fabrication process. Thus, it can be potentially applied to synthesize industrial alloys with low cost, modify alloys with different powder mixtures, and design novel alloys with location-dependent properties using elemental powder blends as feedstocks. This paper provides an overview of using a laser powder directed energy deposition method to fabricate various types of alloys by feeding elemental powder blends. At first, the advantage of laser powder directed energy deposition in manufacturing metal alloys is described in detail. Then, the state-of-the-art research and development in alloys fabricated by laser powder directed energy deposition through a mix of elemental powders in multiple categories is reviewed. Finally, critical technical challenges, mainly in composition control are discussed for future development.

12.
Materials (Basel) ; 13(7)2020 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-32244376

RESUMO

In additive manufacturing, the variation of the fabrication process parameters influences the mechanical properties of a material such as tensile strength, impact toughness, hardness, fatigue strength, and so forth, but fatigue testing of metals fabricated with all different sets of process parameters is a very expensive and time-consuming process. Therefore, the nominal process parameters by means of minimum energy input were first identified for a dense part and then the optimized process parameters were determined based on the tensile and impact toughness test results obtained for 304L stainless steel deposited in laser powder bed fusion (LPBF) process. Later, the high cycle fatigue performance was investigated for the material built with these two sets of parameters at horizontal, vertical, and inclined orientation. In this paper, displacement controlled fully reversed (R = -1) bending type fatigue tests at different levels of displacement amplitude were performed on Krouse type miniature specimens. The test results were compared and analyzed by applying the control signal monitoring (CSM) method. The analysis shows that specimen built-in horizontal direction for optimized parameters demonstrates the highest fatigue strength while the vertical specimen built with nominal parameters exhibits the lowest strength.

13.
Materials (Basel) ; 12(12)2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31216677

RESUMO

Metallic components can gain defects such as dents, cracks, wear, heat checks, deformation, etc., that need to be repaired before reinserting into service for extending the lifespan of these parts. In this study, a hybrid process was developed to integrate reverse engineering, pre-repair processing, additive manufacturing, and material testing for the purpose of part remanufacturing. Worn components with varied defects were scanned using a 3D scanner to recreate the three-dimensional models. Pre-repair processing methods which include pre-repair machining and heat-treatment were introduced. Strategies for pre-repair machining of defects including surface impact damage, surface superficial damage and cracking were presented. Pre-repair heat-treatment procedure for H13 tool steel which was widely used in die/mold application was introduced. Repair volume reconstruction methodology was developed to regain the missing geometry on worn parts. The repair volume provides a geometry that should be restored in the additive manufacturing process. A damaged component was repaired using the directed energy deposition process to rebuild the worn geometry. The repaired part was inspected in microstructure and mechanical aspects to evaluate the repair. The hybrid process solved key issues associated with repair, providing a solution for automated metallic component remanufacturing.

14.
Sci Rep ; 8(1): 1846, 2018 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-29382925

RESUMO

This paper presents a new concept for making battery electrodes that can simultaneously control macro-/micro-structures and help address current energy storage technology gaps and future energy storage requirements. Modern batteries are fabricated in the form of laminated structures that are composed of randomly mixed constituent materials. This randomness in conventional methods can provide a possibility of developing new breakthrough processing techniques to build well-organized structures that can improve battery performance. In the proposed processing, an electric field (EF) controls the microstructures of manganese-based electrodes, while additive manufacturing controls macro-3D structures and the integration of both scales. The synergistic control of micro-/macro-structures is a novel concept in energy material processing that has considerable potential for providing unprecedented control of electrode structures, thereby enhancing performance. Electrochemical tests have shown that these new electrodes exhibit superior performance in their specific capacity, areal capacity, and life cycle.


Assuntos
Íons/química , Lítio/química , Fontes de Energia Elétrica , Eletricidade , Eletrodos , Manganês/química
15.
Entropy (Basel) ; 21(1)2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-33266718

RESUMO

Through laser metal deposition, attempts were made to coat AlCoCrFeNi, a high-entropy alloy (HEA), on an AISI 304 stainless steel substrate to integrate their properties. However, the direct coating of the AlCoCrFeNi HEA on the AISI 304 substrate was found to be unviable due to cracks at the interface between these two materials. The difference in compositional change was suspected to be the source of the cracks. Therefore, a new transition route was performed by coating an intermediate layer of CoFe2Ni on the AISI 304 substrate. Investigations into the microstructure, phase composition, elemental composition and Vickers hardness were carried out in this study. Consistent metallurgical bonding was observed along both of the interfaces. It was found that the AlCoCrFeNi alloy solidified into a dendritic microstructure. The X-ray diffraction pattern revealed a transition of the crystal structure of the AISI 304 substrate to the AlCoCrFeNi HEA. An intermediate step in hardness was observed between the AISI 304 substrate and the AlCoCrFeNi HEA. The AlCoCrFeNi alloy fabricated was found to have an average hardness of 418 HV, while the CoFe2Ni intermediate layer had an average hardness of 275 HV.

16.
Sci Rep ; 7(1): 7977, 2017 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-28801685

RESUMO

Joining titanium alloy and stainless steel is becoming an urgent need since their outstanding mechanical properties can be utilized integratedly. However, direct fusion joining of Ti6Al4V to SS316 can cause brittle Ti-Fe intermetallics which compromise join bonds' mechanical properties. In this research, Laser 3D Printing was applied to explore a new Ti6Al4V to SS316 multi-metallic structure. A novel filler transition route was introduced (Ti6Al4V → V → Cr → Fe → SS316) to avoid the Ti-Fe intermetallics. Two experimental cases were performed for comparison to evaluate this novel route's effect. In the first case, SS316 layer was directly deposited on Ti6Al4V substrate by laser 3D printing, but the sample cracked in the printing process. Then fracture morphology, phase identification, and micro-hardness were analyzed. In the second case, a multi-metallic structure was fabricated via laser 3D printing following the transition route. Microstructure characterization and composition distribution were analyzed via scanning electron microscope(SEM) and energy dispersive spectrometry(EDS). x-ray diffraction(XRD) tests demonstrated the intermetallics were effectively avoided following the transition route. Vickers hardness number(VHN) showed no significant hard brittle phases in the sample. Comparing with directly depositing SS316 on Ti6Al4V, the usage of the novel transition route can eliminate the intermetallics effectively. These research results are good contributions in joining titanium alloy and stainless steel.

17.
Clin Transplant ; 31(4)2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28135788

RESUMO

BACKGROUND: Corticosteroid withdrawal after heart transplantation is limited to select immune-privileged patients but it is not known whether this predisposes patients to a higher risk for sensitization. METHODS: A total of 178 heart transplant recipients had panel-reactive antibody (PRA) measurements at transplant and every 6 months and were monitored for rejection with protocol endomyocardial biopsies. Corticosteroid withdrawal was initiated at 6 months post-transplant in select patients. RESULTS: Patients successfully weaned off prednisone (SPW; n=103) had lower PRA compared to those maintained on prednisone (MP; n=51) at pretransplant (34% vs 63%), 6 months (18% vs 49%), 12 months (19% vs 51%), and 18 months (15% vs 47%) after transplant (P<.05). Among 68 nonsensitized patients at transplant in the SPW group, seven (10%) developed de novo PRA at 12 months, compared to four of 19 (21%) of MP patients. Freedom from any treated rejection (97% vs 69% vs 67%), acute cellular rejection (100% vs 86% vs 71%), and antibody-mediated rejection (100% vs 88% vs 88%; all P≤.001) at 2 years was higher in SPW compared to MP and those who failed prednisone wean, respectively. CONCLUSION: Few patients successfully weaned off prednisone after heart transplant develop de novo circulating antibodies but are not at increased risk for developing rejection.


Assuntos
Rejeição de Enxerto/tratamento farmacológico , Transplante de Coração , Isoanticorpos/imunologia , Complicações Pós-Operatórias , Prednisona/administração & dosagem , Suspensão de Tratamento , Adulto , Anti-Inflamatórios/administração & dosagem , Formação de Anticorpos , Feminino , Seguimentos , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Fatores de Tempo
18.
J Heart Lung Transplant ; 36(3): 258-263, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27646064

RESUMO

BACKGROUND: The Organ Care System, an ex-vivo heart perfusion platform, represents an alternative to the current standard of cold organ storage that sustains the donor heart in a near-physiologic state. It is unknown whether using the Organ Care System influences 2-year outcomes after heart transplantation. We reviewed our institutional experience to compare 2-year outcomes for patients randomized to the Organ Care System or standard cold storage. METHODS: Between 2011 and 2013, heart transplant candidates from a single tertiary-care medical center enrolled within the PROCEED II trial were randomized to either standard cold storage or the Organ Care System. Outcomes assessed included 2-year survival, freedom from cardiac allograft vasculopathy (CAV), non-fatal major cardiac events (NF-MACE), biopsy-proven cellular rejection (CMR) and biopsy-proven antibody-mediated rejection (AMR). RESULTS: Thirty-eight patients were randomized to the Organ Care System (n = 19) or cold storage group (n = 19). There was no significant difference in 2-year patient survival (Organ Care System: 72.2%; cold storage: 81.6%; p = 0.38). Similarly, there were no differences in freedom from CAV, NF-MACE, CMR or AMR. The Organ Care System group had significantly longer total ischemia time (361 ± 96 minutes vs 207 ± 50 minutes; p < 0.001) and shorter cold ischemia time (134 ± 45 minutes vs 207 ± 50 minutes; p < 0.001) compared with the cold storage group. CONCLUSION: The Organ Care System did not appear to be associated with significant differences in intermediate results compared with conventional strategies. These results suggest that this ex-vivo allograft perfusion system is a promising and valid platform for donor heart transportation.


Assuntos
Criopreservação/métodos , Circulação Extracorpórea/métodos , Transplante de Coração/métodos , Preservação de Órgãos/métodos , Perfusão/instrumentação , Adulto , Aloenxertos , Circulação Extracorpórea/instrumentação , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Transplante de Coração/efeitos adversos , Humanos , Internacionalidade , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Doadores de Tecidos , Coleta de Tecidos e Órgãos/métodos , Resultado do Tratamento
19.
J Heart Lung Transplant ; 35(8): 1018-23, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27138702

RESUMO

BACKGROUND: Elevated immune monitoring (IM), as measured by adenosine triphosphate (ATP) release from activated lymphocytes, has been suggested to represent an under-immunosuppressed state. Its association with the development of angiographic cardiac allograft vasculopathy (CAV) is unknown. METHODS: Patients transplanted between January 2007 and December 2011 with annual angiograms and at least 1 IM assay were included in the analysis. Peak IM scores were determined for each patient. Patients with peak IM in the highest quartile (Group 2) were compared with those with scores in the lower quartiles (Group 1). Mild disease was scored as Grade 1 (CAV1) and moderate or severe disease was scored as Grades 2 or 3 (CAV2/3). RESULTS: Two hundred forty patients were included. The mean age at transplant was 54.2 ± 12.1 years. Time to peak IM assay was 105.9 ± 44.1 days and average number of assays obtained per patient was 3.1 ± 1.8. Patients in the highest quartile (Group 2) had peak IM ≥446 ng ATP/ml. Mean clinical follow-up was 4.6 ± 1.7 years. CAV1 was observed in 86 of 180 (47.8%) patients in Group 1 and 39 of 60 (65.0%) in Group 2. Freedom from CAV1 was significantly lower in patients in Group 2 (log rank, p = 0.012). CAV2/3 occurred in 7 of 180 (3.7%) patients in Group 1 and 9 of 60 (15.0%) patients in Group 2. Freedom from CAV2/3 was significantly lower in patients in Group 2 (p = 0.003). In multivariate analysis elevated peak IM assay was still found to be associated with angiographic CAV (hazard ratio 1.647, confidence interval 1.020 to 2.661, p = 0.041). CONCLUSION: Elevated peak IM, as measured by increased ATP production, in activated lymphocytes is associated with decreased freedom from angiographic CAV.


Assuntos
Transplante de Coração , Trifosfato de Adenosina , Aloenxertos , Humanos , Linfócitos , Pessoa de Meia-Idade , Monitorização Imunológica
20.
J Heart Lung Transplant ; 35(2): 165-72, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26683810

RESUMO

BACKGROUND: The virtual crossmatch relies on the assignment of unacceptable antigens (UAs) to identify compatible donors. The purpose of our study was to identify an algorithm for assignment of UAs such that a negative complement-dependent cytotoxicity (CDC) crossmatch and concomitant negative or weakly positive flow cytometric crossmatch (FXM) are obtained. METHODS: We used 4 antibody methods: (1) Luminex single antigen (LSA), (2) LSA with a 1:8 serum dilution, (3) C1q LSA, and (4) CDC panel. The UAs were prioritized in the following order: (1) all C1q+/CDC+, (2) LSA 1:8 >7,500 median fluorescence intensity, and (3) LSA >10,000 median fluorescence intensity. RESULTS: Of 295 heart transplants that were performed at our center, 69 (23%) recipients had detectable human leukocyte antigen specific antibody at the time of transplant. All donor specific antibodies (DSAs) were avoided for 44 of 69 (64%) (DSA-). There were 25 recipients who had DSA at the time of transplant: 12 (48%) had negative FXM (DSA+/FXM-), and 13 (52%) had positive T-cell and/or B-cell FXM (DSA+/FXM+). Lower freedom from antibody-mediated rejection was observed for the DSA+/FXM+ group compared with the DSA- group (p < 0.0001). DSA remained detectable after transplant in the sera of 14 recipients, and de novo DSA was detected in 32 recipients. Freedom from antibody-mediated rejection was comparable for both groups (p = 0.53) but was lower than the DSA- group (p < 0.0001). Survival was comparable for all groups at 1,200 days post-transplant. CONCLUSIONS: Strategic prioritization of UA assignment has allowed transplantation of highly sensitized patients across the DSA barrier with survival rates comparable to DSA- heart transplant recipients.


Assuntos
Antígenos HLA/análise , Transplante de Coração , Miocárdio/imunologia , Algoritmos , Dessensibilização Imunológica , Feminino , Citometria de Fluxo , Teste de Histocompatibilidade , Humanos , Terapia de Imunossupressão , Isoanticorpos/análise , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Doadores de Tecidos
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