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1.
Medicine (Baltimore) ; 98(51): e18015, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860951

RESUMEN

RATIONALE: Despite vast improvements in technique, several complications still challenge surgeons and medical practitioners alike, including biliary and vascular complications, acute and chronic rejection, and disease recurrence. PATIENT CONCERNS: A 59-year-old man was admitted to hospital on July, 2016. He had hepatitis B cirrhosis related recurrent hepatocellular carcinoma and underwent living donor liver transplantation in our hospital. DIAGNOSIS: At the time of admission, the patient's spirit, diet, sleep, normal urine and stool, and weight did not change significantly. The test indicators are as follows: total bilirubin: 100.1 µmol/L, direct bilirubin: 65.0 µmol/L. Emergency CT in the hospital after admission showed that hepatic artery pseudoaneurysm formation after liver transplantation was observed. INTERVENTIONS: This patient underwent minimal invasive endovascular treatment. The demographic, clinical, and laboratory data were collected and reviewed. He was treated successfully by endovascular stent grafting and thrombolytic treatment. OUTCOMES: The blood concentration of tacrolimus (FK506) was 6.3 ng/mL total bilirubin 19.6 µmol/L before discharge. The changing of total bilirubin and direct bilirubin were investigated (Fig. 1). The patient recovered well and was discharged 2 weeks later. The patient is doing well and regularly followed up. LESSONS: Coil embolization of aneurysmal sac or placement of a stent graft is a minimally invasive alternative to surgery and definitively excludes a bleeding hepatic artery pseudoaneurysm. This technique can be considered as an effective treatment option for hepatic artery pseudoaneurysm instead of a difficult surgical repair.


Asunto(s)
Aneurisma Falso/etiología , Carcinoma Hepatocelular/cirugía , Embolización Terapéutica/métodos , Arteria Hepática , Ictericia Obstructiva/etiología , Trasplante de Hígado/efectos adversos , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/virología , Estudios de Seguimiento , Supervivencia de Injerto , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/diagnóstico , Humanos , Ictericia Obstructiva/fisiopatología , Ictericia Obstructiva/terapia , Cirrosis Hepática/etiología , Cirrosis Hepática/fisiopatología , Trasplante de Hígado/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Medición de Riesgo , Resultado del Tratamiento
2.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(5): 760-764, 2019 Sep.
Artículo en Chino | MEDLINE | ID: mdl-31762248

RESUMEN

OBJECTIVE: To analyze of the minimum graft-to-recipient weight ratio (GRWR) required for living donor liver transplantation (LDLT) without middle hepatic vein branch (MHVT) reconstruction. METHODS: We retrospectively collected the clinical data and outcomes of 303 LDLT patients over 16 years from 2001 to 2017. The minimum GRWR of non-middle hepatic vein reconstruction was analyzed by propensity score (PSM). RESULTS: With PSM analysis, no significant differences were observed in postoperative complications, SFSS, inpatient time, liver function, and coagulation function, but significant differences in 1-year, 3-year and 5-year survival between MHVT reconstruction and non-reconstruction group. The patients with MHVT reconstruction had better short-term and long-term survival than those without reconstruction. CONCLUSION: For LDLT patients without HMVT reconstruction, GRWR should be greater than 0.86%; for patients with HMVT reconstruction, GRWR is acceptable between 0.5% and 0.6%.


Asunto(s)
Venas Hepáticas/cirugía , Trasplante de Hígado , Hígado/anatomía & histología , Donadores Vivos , Supervivencia de Injerto , Humanos , Tamaño de los Órganos , Puntaje de Propensión , Estudios Retrospectivos , Tasa de Supervivencia
3.
Am Surg ; 85(9): 1025-1027, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31638518

RESUMEN

From 1991 to 2013, Mississippi was without liver transplant services. In 2013, a new liver transplant program was established at the University of Mississippi Medical Center. Here, we describe our experience with the first 150 transplants over a 4.5-year period. This study is a review of 147 patients who underwent the first 150 liver transplants at the University of Mississippi Medical Center between March 5, 2013, and January 4, 2018. There were no exclusion criteria for this study. Donor, recipient, and outcome variables were analyzed. Recipients were 46% female and 74% white. Age at the time of transplant was 57 [IQR 49-63]. BMI at transplant was 30 [IQR 25-35]. Thirty per cent of transplants were for alcoholic cirrhosis, 25% non-alcoholic steatohepatitis, 24% hepatitis C, and 12% cholestatic. Mean model for end-stage liver disease (MELD) at the time of transplant was 20 [95% confidence interval 19-21] and MELD-Na was 22 [95% confidence interval 20-23]. One-year patient- and graft survival were 89% and 87%, respectively, which were as expected based on Scientific Registry of Transplant Recipient reports after risk adjustment. The data published here verifies it is possible to establish a new liver transplant center in an underserved area previously lacking comprehensive liver care and to achieve results similar to other high-volume centers across the country.


Asunto(s)
Centros Médicos Académicos , Trasplante de Hígado , Índice de Masa Corporal , Colestasis/cirugía , Hígado Graso/cirugía , Femenino , Supervivencia de Injerto , Hepatitis C/cirugía , Humanos , Tiempo de Internación , Cirrosis Hepática Alcohólica/cirugía , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/normas , Masculino , Persona de Mediana Edad , Mississippi , Complicaciones Posoperatorias , Desarrollo de Programa , Reoperación
4.
Am Surg ; 85(9): 1056-1060, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31638524

RESUMEN

Skin substitutes have shown success in complex wound reconstruction. We evaluate the use of a human acellular dermal matrix (ADM) as a viable alternative to autologous skin grafting for defects secondary to skin cancer excision. An institutional review board-approved, retrospective review of ADM-reconstructed defects secondary to skin cancer excision between 2012 and 2018 was conducted. ADM was indicated in patients with preclusive factors for general anesthesia, protracted procedure time, reluctance for additional donor site wound, and personal choice. We reviewed defect characteristics, healing time, postoperative outcomes, and patient demographics. The 228 participants (151 males, 77 females) had a median age of 72 years (range, 29-95 years), with melanoma diagnosed in 113 (49.6%), squamous cell carcinoma in 61 (26.8%), and basal cell carcinoma in 28 (12.2%) patients. The median interval to complete epidermal coverage was 42 days, with graft failure evident in six patients (2.6%). ADM is a viable, low-morbid alternative for reconstruction of defects secondary to skin cancer excision, with no donor site morbidity. With exception to complete healing time, outcomes are similar to those of autologous grafting.


Asunto(s)
Dermis Acelular , Neoplasias Cutáneas/cirugía , Trasplante de Piel , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Femenino , Supervivencia de Injerto , Costos de la Atención en Salud , Humanos , Masculino , Melanoma/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Trasplante Autólogo , Cicatrización de Heridas
5.
Am Surg ; 85(9): 1066-1072, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31638526

RESUMEN

To assess renal transplant outcomes after donation by kidney-only (KO) versus multiple-organ (MO) donors on a national scale. The United Network for Organ Sharing database was examined for patients undergoing isolated kidney transplant from a deceased donor from 2000 through 2016. Comparison was made between recipients of grafts from KO versus MO donors at baseline and in a cohort of KO and MO recipients matched via propensity scoring. Outcomes of interest included delayed graft function (DGF), patient survival, and the cumulative incidence of graft loss. There were 33,326 recipients in the KO cohort versus 144,690 in the MO cohort. Donation after cardiac death donors were more prevalent in the KO group (43.8% vs 5.3%; P < 0.001). DGF occurred in 36.1 per cent of the KO versus 22.7 per cent of the MO recipients (P < 0.001). Five-year survival was 79.5 per cent versus 83.4 per cent (P < 0.001) in the KO versus MO group. After propensity matching, DGF was still more common in the KO group (33.1% vs 30.1%; P < 0.001). Patient survival was similar (79.5% KO vs 80.1% MO; P = 0.117). Cumulative incidence of graft loss was higher in the KO group (17.8% vs 16.8%). Survival outcomes from KO donors are actually quite good and should not be considered as inferior to MO donors.


Asunto(s)
Trasplante de Riñón , Donantes de Tejidos , Cadáver , Supervivencia de Injerto , Humanos , Tiempo de Internación , Puntaje de Propensión , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento
8.
Bone Joint J ; 101-B(9): 1151-1159, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31474143

RESUMEN

AIMS: We analyzed the long-term outcomes of patients observed over ten years after resection en bloc and reconstruction with extracorporeal irradiated autografts. PATIENTS AND METHODS: This retrospective study included 27 patients who underwent resection en bloc and reimplantation of an extracorporeal irradiated autograft. The mean patient age and follow-up period were 31.7 years (9 to 59) and 16.6 years (10.3 to 24.3), respectively. The most common diagnosis was osteosarcoma (n = 10), followed by chondrosarcoma (n = 6). The femur (n = 13) was the most frequently involved site, followed by the tibia (n = 7). There were inlay grafts in five patients, intercalary grafts in 15 patients, and osteoarticular grafts in seven patients. Functional outcome was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS: There were no recurrences in the irradiated autograft and the autograft survived in 24 patients (88.9%). Major complications included nonunion (n = 9), subchondral bone collapse (n = 4), and deep infection (n = 4). Although 34 revision procedures were performed, 25 (73.5%) and four (11.8%) of these were performed less than five years and ten years after the initial surgery, respectively. The mean MSTS score at the last follow-up was 84.3% (33% to 100%). CONCLUSION: Considering long-term outcomes, extracorporeal irradiated autograft is an effective method of reconstruction for malignant musculoskeletal tumours Cite this article: Bone Joint J 2019;101-B:1151-1159.


Asunto(s)
Neoplasias Óseas/radioterapia , Neoplasias Óseas/cirugía , Huesos/cirugía , Recuperación del Miembro/métodos , Reimplantación , Trasplante Autólogo/métodos , Adolescente , Adulto , Autoinjertos/efectos de la radiación , Huesos/efectos de la radiación , Niño , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Persona de Mediana Edad , Radioterapia/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Recuperación de la Función , Estudios Retrospectivos , Trasplante Autólogo/efectos adversos , Adulto Joven
9.
Rev. bras. cir. plást ; 34(3): 414-418, jul.-sep. 2019. ilus
Artículo en Inglés, Portugués | LILACS | ID: biblio-1047171

RESUMEN

O aumento do dorso nasal nas rinoplastias é foco de estudo de diversos trabalhos que buscam as melhores fontes de enxerto e técnicas cirúrgicas. A utilização de cartilagem já é consagrada para este fim, a partir do septo nasal, da concha auricular ou dos arcos costais. Nos últimos anos, têm-se buscado meios para reduzir a palpabilidade e dispersibilidade dos enxertos cartilaginosos. Assim, são descritos materiais sintéticos, como o SURGICEL®; e, autólogos, representados pelas fáscias. A fáscia temporal é mais amplamente utilizada, porém requer uma nova incisão cirúrgica, aumentando o tempo e a morbidade da cirurgia. É também descrito o uso de fáscia lata e fáscia reto abdominal, comparativamente mais espessas e menos flexíveis. Em muitos casos de rinoplastia fazse necessária a retirada da cartilagem costal, o que permite a coleta de fáscia do músculo peitoral maior pela mesma incisão cirúrgica. Dessa forma, descrevemos a utilização da fáscia do músculo peitoral maior envolvendo cartilagem costal picada, em uma rinoplastia estruturada com aumento do dorso.


Increasing the nasal dorsum in rhinoplasty is the focus of several studies that seek the best graft sources and surgical techniques. The use of cartilage from the nasal septum, ear shell, or costal arches is already established for this purpose. In recent years, methods have been sought to reduce the palpability and dispersibility of cartilaginous grafts. Thus, synthetic materials such as SURGICEL® and autologous materials such as fascia have been explored. Temporal fascia are more widely used but require a new surgical incision, increasing surgical time and morbidity. Also described is the use of fascia lata and rectus abdominis fascia, which are comparatively thicker and less flexible. In many rhinoplasty procedures, it is necessary to remove the costal cartilage, which allows the collection of fascia from the major chest muscles through the same surgical incision. Thus, we describe the use of major chest muscle fascia and chopped costal cartilage in structured rhinoplasty to increase the dorsum.


Asunto(s)
Humanos , Femenino , Adulto , Historia del Siglo XXI , Prótesis e Implantes , Rinoplastia , Trasplante Autólogo , Fascia , Cartílago Costal , Supervivencia de Injerto , Prótesis e Implantes/efectos adversos , Rinoplastia/efectos adversos , Rinoplastia/métodos , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Trasplantes/cirugía , Fascia/anatomía & histología , Fascia/trasplante , Cartílago Costal/cirugía , Cartílago Costal/citología
10.
Rev. bras. cir. plást ; 34(3): 368-377, jul.-sep. 2019. ilus, tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-1047157

RESUMEN

Introdução: Com o objetivo de obter lipoenxerto autógeno e injetável de tecido ressecado em dermolipectomias, este estudo propõe um novo método para colheita e processamento do tecido adiposo, através de um dispositivo fragmentador específico. O principal objetivo foi estabelecer uma análise comparativa das características de qualidade e viabilidade do novo lipofragmentado em relação ao já conhecido lipoaspirado, amplamente aceito como fonte viável de lipoenxerto. Ensaios in vivo e in vitro foram delineados para avaliar o comportamento biológico das amostras, a fim de orientar novos e possíveis estudos em humanos com aplicações clínicas. Métodos: Uma paciente pós-bariátrica que foi submetida a dermolipectomia abdominal teve sua peça cirúrgica ressecada e dividida em quatro partes que foram submetidas a Lipoaspiração e Lipofragmentação, sem e com infiltração prévia. Todas as amostras foram submetidas a centrifugação e então distribuídas para os ensaios que envolveram avaliação histológica, imunohistoquímica, citometria de fluxo, cultura celular e ainda a injeção de xenoenxerto no dorso de 10 ratos Wistar, retirados após seis semanas para avaliação de massa, volume e características histológicas. Resultados: As amostras de gordura fragmentada, seca e infiltrada, mostraram características estruturais e comportamento biológico semelhantes aos das amostras de lipoaspirado. Conclusões: A fragmentação da gordura transformou o tecido celular subcutâneo das dermolipectomias em uma nova variante de lipoenxerto injetável e viável, com características biológicas semelhantes àquelas do lipoaspirado tradicional. Embora ainda preliminares, nossos resultados embasam a realização de novas investigações buscando otimizar a técnica com vistas ao aprimoramento da enxertia gordurosa e suas possíveis aplicações na medicina regenerativa.


Introduction: Aiming to obtain autogenous and injectable lipografts from resected tissues in dermolipectomies, this study proposes a new method for harvesting and processing adipose tissue through a specific fragmenting device. The main objective was to establish a comparative analysis of the quality and viability characteristics of the new lipofragmentation technique and those of the well-known liposuction technique, widely accepted as a viable source of fat grafting. In vivo and in vitro assays were designed to evaluate the biological behavior of the samples to guide new and possible human studies with clinical applications. Methods: A post-bariatric patient who underwent abdominal dermolipectomy had her surgical specimen resected, which was divided into four parts that underwent liposuction and lipofragmentation, with and without prior infiltration. All samples were centrifuged and distributed for assays with assessments involving histological analysis, immunohistochemistry, flow cytometry, cell culture, and xenograft injection on the back of 10 Wistar rats, which was evaluated after six weeks for mass, volume, and histological features. Results: The structural characteristics and biological behaviors of fragmented, dry, and infiltrated fat samples were similar to those of liposuction samples. Conclusions: Fat fragmentation transformed the subcutaneous cellular tissue of dermolipectomies into a new, viable injectable lipograft variant, with biological characteristics similar to those of traditional liposuction. Although still preliminary, our results support further investigations to optimize the technique and improve fat grafting and its possible applications in regenerative medicine.


Asunto(s)
Humanos , Femenino , Adulto , Ratas , Historia del Siglo XXI , Manejo de Especímenes , Cirugía Plástica , Trasplante Autólogo , Bioprótesis , Tejido Adiposo , Procedimientos Quirúrgicos Reconstructivos , Supervivencia de Injerto , Manejo de Especímenes/métodos , Cirugía Plástica/métodos , Trasplante Autólogo/métodos , Bioprótesis/normas , Tejido Adiposo/anatomía & histología , Procedimientos Quirúrgicos Reconstructivos/métodos
11.
Life Sci ; 233: 116740, 2019 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-31398416

RESUMEN

Although intravenous injection is the most convenient and feasible approach for mesenchymal stem cells (MSCs) delivery, the proportion of donor stem cells in the target myocardium after transplantation is small. It is believed that TCM enhances the effect of stem cell therapy by improving the hostile microenvironment and promoting the migration and survival of stem cells. Guanxin Danshen (GXDS) formulation is one of the main prescriptions for clinical treatment of ischemic heart diseases in China. The purpose of this study was to evaluate the effects of GXDS formulation administration combined with MSCs transplantation on cardiac function improvement, apoptosis, angiogenesis and survival of transplanted cells in an acute model of acute myocardial infarction (MI). After being labeled with GFP, MSCs were transplanted via intravenous injection. Meanwhile, GXDS dripping pills were given by intragastric administration for 4 weeks from 2 days before MI. Echocardiography showed moderate improvement in cardiac function after administration of GXDS formulation or intravenous transplantation of MSCs. However, GXDS formulation combined with MSCs transplantation significantly improved cardiac function after MI. The myocardial infarct size in rats treated with MSCs was similar to that in rats treated with GXDS formulation. However, GXDS formulation combined with MSCs transplantation significantly reduced infarction area. In addition, GXDS formulation combined with MSCs transplantation not only decreased cell apoptosis according to the TUNEL staining, but also enhanced angiogenesis in the peri-infarction and infarction area. Interestingly, the use of GXDS formulation increased the number of injected MSCs in the infarct area. Furthermore, GXDS formulation combined with MSCs transplantation increased SDF-1 levels in the infarcted area, but did not affect the expression of YAP. Our study provided a more feasible and accessible strategy to enhance the migration of stem cells after intravenous injection by oral administration of GXDS formulation. The combination of GXDS formulation and stem cell therapy has practical significance and application prospects in the treatment of ischemic cardiomyopathy such as MI.


Asunto(s)
Apoptosis/efectos de los fármacos , Medicamentos Herbarios Chinos/química , Medicamentos Herbarios Chinos/farmacología , Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas/citología , Infarto del Miocardio/terapia , Neovascularización Patológica/prevención & control , Animales , Células Cultivadas , Terapia Combinada , Supervivencia de Injerto , Masculino , Infarto del Miocardio/patología , Ratas
12.
Transplant Proc ; 51(6): 1785-1790, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31399164

RESUMEN

BACKGROUND: Hypothermic machine perfusion is used to improve renal perfusion and reduce the rate of early and late graft dysfunction. It has been used in our unit since 2001. It has 2 modes of flow: continuous or pulsatile. The aim of this study is to compare the modes of perfusion in terms of perfusion-related parameters, graft survival, and estimated glomerular filtration rate. METHODS: All donation after cardiac death kidneys between 2002 and 2014 were reviewed. A total of 64 pairs of kidneys were identified of which one kidney underwent pulsatile and the other continuous perfusion. Machine parameters including resistance and perfusion flow index levels at 0, 1, 2, 3, and 4 hours were recorded and glutathione S-transferase was measured in perfusate. Estimated glomerular filtration rate from the first week of transplant until the fifth year and graft survival rates were determined. RESULTS: Machine parameters were similar at all time points. Estimated glomerular filtration rates and graft survival were the same irrespective of perfusion mode. CONCLUSION: Pulsatile perfusion may be regarded as more physiological. However, we could not identify difference in outcome following transplant of kidneys from the same donor that had been perfused under pulsatile or continuous conditions.


Asunto(s)
Circulación Extracorporea/métodos , Hipotermia Inducida/métodos , Preservación de Órganos/métodos , Perfusión/métodos , Flujo Pulsátil , Muerte , Femenino , Tasa de Filtración Glomerular , Glutatión Transferasa/análisis , Supervivencia de Injerto , Humanos , Riñón/irrigación sanguínea , Riñón/fisiopatología , Trasplante de Riñón , Masculino , Tasa de Supervivencia , Donantes de Tejidos , Trasplantes/irrigación sanguínea , Trasplantes/fisiopatología , Resultado del Tratamiento
13.
Transplant Proc ; 51(6): 1796-1800, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31399165

RESUMEN

BACKGROUND: In kidney transplantation, donor recipient human leukocyte antigen (HLA)-DR mismatch signals high immunologic risk and portends inferior outcomes. We compared the impacts of depleting vs non-depleting antibody induction on the outcomes in kidney transplant recipients (KTRs) at different levels of HLA-DR mismatches. METHODS: Using the Organ Procurement and Transplantation Network/United Network for Organ Sharing database, we identified adult KTRs from 2001 to 2015 who received induction therapy with either depleting (thymoglobulin/alemtuzumab) or non-depleting (basiliximab/daclizumab) antibody and were discharged on calcineurin inhibitor/mycophenolic acid maintenance. Patients were then stratified by the number of donor-recipient HLA-DR mismatches (0, 1, 2) in both living donor (LD) and deceased donor (DD) KTRs. Under each HLA-DR mismatch category, long-term outcomes were compared for depleting vs non-depleting induction using a Cox model. RESULTS: A total of 63,821 LD (HLA-DR mismatches: 0, n = 6945 [depleting = 4409, non-depleting = 2536]; 1, n = 19,557 [depleting = 13,558, non-depleting = 6019]; and 2, n = 10,727 [depleting = 7694, non-depleting = 3033]) and 64,922 DD (HLA-DR mismatches: 0, n = 13,915 [depleting = 10,124, non-depleting = 3791]; 1, n = 27,994 [depleting = 20,454, non-depleting = 7540]; and 2, n = 23,013 [depleting = 16,908, non-depleting = 6105]) KTRs were included in the analysis. Adjusted patient death risk was significantly lower in the depleting vs non-depleting antibody induction group among DD kidney recipients (hazard ratio 0.90, 95% CI 0.85-0.96, P = .001) and trended lower among LD kidney recipients (HR 0.88, 95% 0.79-1.01, P = .05) with 2 HLA-DR mismatches. DISCUSSION: Our study found a patient survival benefit associated with the use of perioperative induction with depleting when compared to non-depleting antibody in KTRs with 2 HLA-DR mismatches and maintained on a calcineurin inhibitor/mycophenolic acid regimen.


Asunto(s)
Incompatibilidad de Grupos Sanguíneos/inmunología , Supervivencia de Injerto/inmunología , Antígenos HLA-DR/inmunología , Inmunosupresión/métodos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/efectos adversos , Adulto , Alemtuzumab/uso terapéutico , Anticuerpos/inmunología , Suero Antilinfocítico/inmunología , Suero Antilinfocítico/uso terapéutico , Basiliximab/inmunología , Basiliximab/uso terapéutico , Inhibidores de la Calcineurina/inmunología , Inhibidores de la Calcineurina/uso terapéutico , Contraindicaciones de los Procedimientos , Daclizumab/inmunología , Daclizumab/uso terapéutico , Bases de Datos Factuales , Femenino , Prueba de Histocompatibilidad , Humanos , Riñón/inmunología , Donadores Vivos , Masculino , Persona de Mediana Edad , Ácido Micofenólico/inmunología , Ácido Micofenólico/uso terapéutico , Modelos de Riesgos Proporcionales , Resultado del Tratamiento
14.
Transplant Proc ; 51(6): 1801-1809, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31399166

RESUMEN

BK viremia (BKV) is a recognized and potentially serious problem in renal transplantation. The risk factors and the impact of BKV on renal allograft and patient survival are controversial. This study reports an 8-year, single-center experience on the prevalence, risk factors, and outcomes of BKV in kidney transplant recipients. This is a retrospective analysis of all patients who received a kidney transplant at the University of Kentucky and had BK viral titers available from 2009 to 2017. BKV was defined by a polymerase chain reaction viral load of ≥ 10,000 copies per mL. Demographic, clinical, and laboratory data generated during routine outpatient follow up and inpatients records were collected. Independent risk factors for BKV were determined using uni- and multivariate analysis. Graft and patient survival was compared using Kaplan-Meier analysis, and the severity of polyomavirus nephropathy on biopsy was scored using the Banff 2017 classification. We identified 122 BK positive (19%) and 527 BK negative (81%) patients. BKV developed after a median of 115 days (range, 80-249 days) following kidney transplantation. The 1-, 5-, and 10-year graft survival was 97%, 75%, and 33% in the BKV group and 96%, 85%, and 71% in the BK negative group, respectively. Likewise, the 1-, 5-, and 10-year patient survival was 98%, 84%, and 52% in the BKV group and 98%, 92%, and 84% in the BK negative group. Male sex, age at transplantation, maintenance steroids, and alemtuzumab induction were associated with developing BKV in the multivariate analysis. We concluded that BKV is not uncommon after renal transplantation. The determinants for BKV are male sex, older transplant recipients, and maintenance steroids. BKV adversely affected graft and patient survival. A unified approach for BKV and polyomavirus nephropathy treatment is needed.


Asunto(s)
Virus BK , Enfermedades Renales/virología , Trasplante de Riñón/efectos adversos , Infecciones por Polyomavirus/virología , Complicaciones Posoperatorias/virología , Infecciones Tumorales por Virus/virología , Viremia/virología , Adulto , Biopsia , Femenino , Supervivencia de Injerto , Humanos , Estimación de Kaplan-Meier , Riñón/virología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Trasplante Homólogo , Carga Viral
15.
Transplant Proc ; 51(6): 1934-1938, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31399178

RESUMEN

Excessive alcohol consumption has a negative impact on graft survival after liver transplantation (LT). However, it is difficult to predict alcohol relapse before LT. This study surveyed the alcohol consumption of LT recipients to identify the risk factors for harmful drinking. We surveyed the alcohol consumption of LT recipients by using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). AUDIT-C scores ≥ 5 points in men and ≥ 4 points in women indicated a high risk for harmful and hazardous drinking. Excessive alcohol consumption was considered to be > 20 g per day. Ninety-nine LT recipients completely filled out the questionnaire. Alcohol consumption after LT was detected in 26 recipients (26.5%); 4 of them had alcoholic liver disease before transplantation and 22 did not have alcoholic liver disease. The amount of alcohol consumption per day significantly decreased after LT (alcohol consumption per day: 49.6 g before LT vs 8.1 g after LT, P < .05). Fourteen recipients (14.1%) consumed alcohol excessively after LT. The AUDIT-C score before LT and smoking were risk factors for excessive alcohol consumption in the multivariate analysis. To properly manage post-transplant recipients, assessing the risk of excessive alcohol consumption by using the AUDIT-C is necessary.


Asunto(s)
Alcoholismo/diagnóstico , Hepatopatías Alcohólicas/cirugía , Trasplante de Hígado/efectos adversos , Medición de Riesgo/métodos , Adulto , Alcoholismo/complicaciones , Femenino , Supervivencia de Injerto , Humanos , Hepatopatías Alcohólicas/etiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Periodo Posoperatorio , Recurrencia , Factores de Riesgo , Encuestas y Cuestionarios
16.
Transplant Proc ; 51(6): 2043-2050, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31399182

RESUMEN

BACKGROUND: Pigs are considered suitable animal donor models for xenotransplantation. For successful organ transplantation, immune rejection must be overcome. Xenotransplantation has recently been successfully performed using galactose-alpha1,3-galactose epitopes knockout (GalTKO) and a human membrane cofactor protein (hCD46) in a pig model. However, the growth and lifespan of the grafted organ have not been evaluated. Therefore, in the present study we evaluated aging and 84 senescence-related genes using the RT2 Profiler PCR array and whole blood samples from GalTKO/hCD46 Massachusetts General Hospital (MGH) pigs. METHODS: Experimental groups were double GalTKO/hCD46 (5-month-old), single GalTKO/hCD46 (2-year-old), and non-genetically modified (>3.5-year-old; control group within the same strain). Age-matched white hairless Yucatan (WHY) miniature pig groups were used as controls. RESULTS: Among the 19 senescence-related genes selected from the 84 genes for further evaluation, 13 were upregulated in the double GalTKO/hCD46 MGH pigs compared to control MGH pigs; however, in WHY pigs, only 4 genes were up- or down-regulated among the 19 genes. Moreover, in double GalTKO/hCD46 MGH and WHY pigs, the expression of the 19 genes changed only 1- to 2-fold, suggesting that there were no significant differences in senescence signals between the 2 pig lines. CONCLUSIONS: The present results indicate that the double GalTKO/hCD46 MGH pig might be a suitable model for human xenotransplantation studies. However, we used a limited number of experimental individuals, so further studies using larger experimental groups should be conducted to verify the present results.


Asunto(s)
Envejecimiento/genética , Animales Modificados Genéticamente , Galactosa/deficiencia , Proteína Cofactora de Membrana/genética , Trasplante Heterólogo/métodos , Animales , Preescolar , Modelos Animales de Enfermedad , Epítopos , Galactosa/genética , Galactosiltransferasas/genética , Técnicas de Inactivación de Genes , Supervivencia de Injerto/inmunología , Xenoinjertos , Humanos , Persona de Mediana Edad , Porcinos , Porcinos Enanos
17.
Transplant Proc ; 51(6): 2081-2098, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31399186

RESUMEN

Sphingosine-1-phosphate (S1P) is a biologically active sphingolipid that acts through the members of a family of 5 G protein-coupled receptors (S1P1 to S1P5). Among these, S1P1 is a major regulator of lymphocyte trafficking. Fingolimod, whose active metabolite, fingolimod phosphate, acts as a nonselective S1P-receptor agonist, exerts its immunomodulatory effect, at least in part, by regulating lymphocyte trafficking via downregulation of S1P1 expression on lymphocytes. Here, we describe the pharmacologic profile of a novel S1P1 agonist, ASP1126. ASP1126 preferentially activated S1P1 compared to S1P3 in rat and human guanosine-5'-(γ-thio)-triphosphate (GTPγS) assays. Oral single administration of ASP1126 decreased the number of peripheral lymphocytes and repeated dosing showed a cumulative effect on lymphopenia in both rats and monkeys. ASP1126 prolonged allograft survival in a rat heterotopic heart transplantation model in combination with a subtherapeutic dose of tacrolimus that was independent of drug-drug interactions. In addition, in nonhuman primate (NHP) renal transplantation, pretreatment with ASP1126 reduced not only the number of naive T cells and central memory T cells but also effector memory T cells in the peripheral blood, all of which could contribute to acute graft rejection and prolonged allograft survival in combination with tacrolimus. Further, we confirmed that ASP1126 has a broad ranging safety margin with respect to its effect on lung weight in rats and bradycardia in NHPs, which were the adverse events found in clinical studies of fingolimod. ASP1126 with improved safety profile has the potential to be an adjunct therapy in combination with tacrolimus in clinical transplantation.


Asunto(s)
Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Inmunosupresores/farmacología , Lisofosfolípidos/agonistas , Esfingosina/análogos & derivados , Aloinjertos/efectos de los fármacos , Aloinjertos/metabolismo , Animales , Bradicardia/inducido químicamente , Sinergismo Farmacológico , Humanos , Linfocitos/efectos de los fármacos , Macaca fascicularis , Masculino , Ratas , Esfingosina/agonistas , Tacrolimus/farmacología , Trasplante Homólogo/métodos
18.
Transplant Proc ; 51(6): 2132-2135, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31399189

RESUMEN

OBJECTIVE: We aimed to compare the clinical and histopathological results of skin graft transplants between rats that had been injected with lymphocytes into the anterior chamber of the eye with those that had not. METHODS: A total of 16 Wistar albino, male rats were included in the study. Subjects were divided into 2 groups, namely a test group and a control group. Lymphocyte suspensions derived from the subjects of the control group were injected into the anterior chamber of the eye of each opposing subject of the test group. Also, an identical volume of physiological saline was injected into the anterior chamber of each subject in the control group to prevent bias. One week after this procedure, circular skin grafts of 1 cm in diameter were transplanted within the opposing groups. After a period of 1 week, transplanted graft tissues were excised to compare tissue healing. RESULTS: The occurence of granulation and reepithelialization was more evident in the test group (96% and 33%, respectively, vs 80% and 17% for the control group, respectively). On the other hand, it was determined that acute inflammation was more intense in the control group (77% vs 50% for the test group). CONCLUSION: We had created immune tolerance in rats through anterior chamber lymphocyte injection, which slowed down the rejection process. If this can be successfully implemented in practice, survival for transplant patients without long-term rejection will move closer to becoming a reality.


Asunto(s)
Cámara Anterior/inmunología , Supervivencia de Injerto/inmunología , Linfocitos/inmunología , Trasplante de Piel/métodos , Tolerancia al Trasplante/inmunología , Animales , Masculino , Ratas , Ratas Wistar
19.
Acta Cir Bras ; 34(6): e201900605, 2019 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-31432996

RESUMEN

PURPOSE: To evaluate the use of adipose-derived stem cells (ADSC) in reducing the necrosis area in an experimental model of cutaneous ischemic flap in rats submitted to subcutaneous nicotine injection to simulate a smoker patient. METHODS: In an experimental study, 30 rats were enrolled and divided into two experimental groups of 15 animals all submitted to a subcutaneous nicotine injection to create ischemic cutaneous flaps on their backs. Other 10 animals were used only to obtain adipose tissue derived stem cells (ADSC). The first group (n=15) received ADSC treatment at the end of surgery while the other group, the control (n=15), received no other interventions. After euthanasia, a decal was performed on the whole area of the flap, accurately defining the transition from necrosis to healthy region. Photos of all animals were collected and evaluated by scales standardized by Paint-Autocad- 2015 software to define the area of flap necrosis in each rat. Student T test was performed to compare the groups, considering a p< 0.05 significant. Data were analyzed using SPSS IBM® 18 version. RESULTS: Through the analysis of the images by the program Paint-Autocad-2015 and the area of decal obtained by the transparent sheet, we obtained a mean of 46% necrosis of the total area of the flap in the treatment group and 69.4% in the control group. In the descriptive analysis, a mean of 3.7 cm of necrosis CI 95% (3.2 - 4.2) was evident in the treatment group whereas a mean value of 5.56 CI 95% (5.2 - 5.9) was found in control group, with p value <0.001 for this comparison. CONCLUSION: The application of adipose-derived stem cells reduces the percentage of necrosis in an experimental model of randomized cutaneous flap in rats submitted to subcutaneous nicotine injection.


Asunto(s)
Adipocitos/trasplante , Tejido Adiposo/trasplante , Cicatriz/terapia , Necrosis/prevención & control , Nicotina/efectos adversos , Animales , Modelos Animales de Enfermedad , Supervivencia de Injerto , Masculino , Necrosis/inducido químicamente , Nicotina/administración & dosificación , Ratas
20.
Stud Health Technol Inform ; 264: 10-14, 2019 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-31437875

RESUMEN

Kidney transplantation is recommended for patients with End-Stage Renal Disease (ESRD). However, complications, such as graft rejection are hard to predict due to donor and recipient variability. This study discusses the role of machine learning (ML) in predicting graft rejection following kidney transplantation, by reviewing the available related literature. PubMed, DBLP, and Scopus databases were searched to identify studies that utilized ML methods, in predicting outcome following kidney transplants. Fourteen studies were included. This study reviewed the deployment of ML in 109,317 kidney transplant patients from 14 studies. We extracted five different ML algorithms from reviewed studies. Decision Tree (DT) algorithms revealed slightly higher performance with overall mean Area Under the Curve (AUC) for DT (79.5% ± 0.06) was higher than Artificial Neural Network (ANN) (78.2% ± 0.08). For predicting graft rejection, ANN and DT were at the top among ML models that had higher accuracy and AUC.


Asunto(s)
Rechazo de Injerto , Trasplante de Riñón , Aprendizaje Automático , Supervivencia de Injerto , Humanos , Donantes de Tejidos
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