Dual kidney transplantation: a single-center experience.

BACKGROUND: Dual kidney transplantation (DKT) is an alternate approach to use marginal kidneys not suitable to be allocated for single kidney transplant. This retrospective study reviewed the short- and long-term outcomes regarding graft and patient survivals over a 9-year period at a single center. METHODS: From 2005 to 2013, 33 DKTs were performed in our unit, where allocation was guided by clinical parameters mainly. The mean ages for recipients and donors were 58.6 ± 12.5 and 54.8 ± 13.6 years, respectively. Cold ischemia time was 21.4 ± 4 hours, and mean HLA mismatch for HLA-A, HLA-B, and HLA-DR was 3.06 ± 1.07. Immunosuppression regime was tacrolimus based. RESULTS: Median follow-up time of 56 months showed patient and death-censored graft survivals at 1, 3, and 5 years to be 90% and 84%, 90% and 81%, and 84% and 81%, respectively. The rate of delayed graft function was 46.9% (n = 15), the rate of primary graft function was 46.9% (n = 15), the rate of and primary graft nonfunction was 6.2% (n = 2). Nineteen patients (59.4%) required biopsy: 12 of them showed acute tubular necrosis and 7 had rejection (1 needed graft removal, 4 were treated successfully with steroid and/or antithymocyte globulin, and 2 did not require treatment). CONCLUSIONS: Outcomes of DKT in our center were satisfactory and similar to those of other transplant centers regarding patient and graft survivals.

The cellular immune system in myelomagenesis: NK cells and T cells in the development of myeloma [corrected] and their uses in immunotherapies.

As vast strides are being made in the management and treatment of multiple myeloma (MM), recent interests are increasingly focusing on understanding the development of the disease. The knowledge that MM develops exclusively from a protracted phase of monoclonal gammopathy of undetermined significance provides an opportunity to study tumor evolution in this process. Although the immune system has been implicated in the development of MM, the scientific literature on the role and status of various immune components in this process is broad and sometimes contradictory. Accordingly, we present a review of cellular immune subsets in myelomagenesis. We summarize the current literature on the quantitative and functional profiles of natural killer cells and T-cells, including conventional T-cells, natural killer T-cells, γδ T-cells and regulatory T-cells, in myelomagenesis. Our goal is to provide an overview of the status and function of these immune cells in both the peripheral blood and the bone marrow during myelomagenesis. This provides a better understanding of the nature of the immune system in tumor evolution, the knowledge of which is especially significant considering that immunotherapies are increasingly being explored in the treatment of both MM and its precursor conditions.

Mechanical complications of long-term Tesio catheters.

Vascular access catheters such as Tesio-Caths are preferentially inserted in the internal jugular vein and serve as access for hemodialysis. Complications related to the removal of these types of lines are uncommon. We report four patients in whom the tip of the Tesio-Cath broke and was left stuck in the superior vena cava. Although there is no defined limit to the maximum length of stay of vascular access catheters for dialysis, the possibility of catheter entrapment should be considered. It remains to be determined whether removing Tesio-Caths every 16- 18 months is beneficial in avoiding this complication.