The Histological Picture of Indication Biopsies in the First 2 Weeks after Kidney Transplantation.

BACKGROUND AND OBJECTIVES: In preclinical studies, ischemia-reperfusion injury and older donor age are associated with graft inflammation in the early phase after transplantation. In human kidney transplantation, impaired allograft function in the first days after transplantation is often adjudicated to donor- and procedure-related characteristics, such as donor age, donor type, and ischemia times. DESIGN: , setting, participants, & measurementsIn a cohort of 984 kidney recipients, 329 indication biopsies were performed within the first 14 days after transplantation. The histologic picture of these biopsies and its relationship with alloimmune risk factors and donor- and procedure-related characteristics were studied, as well as the association with graft failure. Multivariable Cox models were applied to quantify the cause-specific hazard ratios for early rejection and early inflammatory scores, adjusted for potential confounders. For quantification of hazard ratios of early events for death-censored graft failure, landmark analyses starting from day 15 were used. RESULTS: Early indication biopsy specimens displayed microvascular inflammation score ≥2 in 30% and tubulointerstitial inflammation score ≥2 in 49%. Rejection was diagnosed in 186 of 329 (57%) biopsies and associated with the presence of pretransplant donor-specific HLA antibodies and the number of HLA mismatches, but not nonimmune risk factors in multivariable Cox proportional hazards analysis. In multivariable Cox proportional hazards analysis, delayed graft function, the graft dysfunction that prompted an early indication biopsy, HLA mismatches, and pretransplant donor-specific HLA antibodies were significantly associated with a higher risk for death-censored graft failure, whereas early acute rejection was not. CONCLUSIONS: Indication biopsies performed early after kidney transplantation display inflammatory changes related to alloimmune risk factors. Nonimmune risk factors for ischemia-reperfusion injury, such as cold and warm ischemia time, older donor age, and donor type, were not identified as strong risk factors for early inflammation after human kidney transplantation.

Is iliac autogenous graft augmentation in medial open wedge high tibial osteotomies superior to no augmentation in terms of bone healing?

OBJECTIVES: This study aims to investigate if iliac autogenous graft augmentation in medial open wedge high tibial osteotomies (OWHTOs) is superior to no augmentation in terms of bone healing. PATIENTS AND METHODS: Twenty-five patients (14 males, 11 females; mean age 40.9±4.0 years; range, 33 to 48 years) with medial compartmental osteoarthritis of knee joint who underwent high tibial osteotomy with medial open wedge between January 2016 and December 2018 were included in this retrospective study. Twelve of the operated knees were the right knee. Graft was used in 13 patients (52%). Data including age, gender, body mass index (BMI), direction, follow-up period, union, Lysholm and International Knee Documentation Committee (IKDC) scores, pre- and postoperative femoral tibial angles (FTAs) and posterior tibial slopes were evaluated. RESULTS: The mean BMI was 26.4±1.9 (range, 22.0 to 30.0). Only 48% of the patients were smoking. The mean follow-up period was 28.6±5.3 months (range, 24 to 38 months). No statistically significant difference was found between the grafted and non-grafted groups in terms of age, BMI, follow-up time, gender, side and smoking status (p>0.05) There was no statistically significant difference between two groups in terms of pre- and postoperative Lysholm scores, pre- and postoperative IKDC scores, or pre- and postoperative FTA values (p>0.050). CONCLUSION: Iliac autogenous graft augmentation in medial OWHTO has no effect on union but shortens the union time. Preoperative high varus degree adversely affects union. Therefore, routine use of iliac crest autograft is not recommended.

Effects of Autograft Types on Muscle Strength and Functional Capacity in Patients Having Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

BACKGROUND: The effects of different autograft types for anterior cruciate ligament reconstruction (ACL-R) on muscle function are sparsely investigated in randomized controlled trials. Our aim was to investigate the effects of quadriceps tendon autograft (QTB) vs. semitendinosus-gracilis autograft (StG) on thigh muscle strength and functional capacity, and a patient-reported outcome 1 year after ACL-R, and to compare the results to healthy controls. METHODS: ACL-R patients (n = 100) and matched controls (CON, n = 50) were recruited, with patients being randomly assigned to QTB (n = 50) or StG (n = 50) ACL-R. One year after ACL-R, bilateral knee extensor (KE) and flexor (KF) muscle strength (isometric, dynamic, explosive, limb symmetry index [LSI], hamstring:quadriceps ratio [HQ ratio]) were assessed by isokinetic dynamometry, along with functional capacity (single leg hop distance [SHD]) and a patient-reported outcome (International Knee Documentation Committee [IKDC] score). RESULTS: KE muscle strength of the operated leg was lower (9-11%) in QTB vs. StG as was KE LSI, while KF muscle strength was lower (12-17%) in StG vs. QTB as was KF LSI. HQ ratios were lower in StG vs. QTB. Compared with the controls, KE and KF muscle strength were lower in StG (10-22%), while KE muscle strength only was lower in QTB (16-25%). Muscle strength in the StG, QTB, and CON groups was identical in the non-operated leg. While SHD and IKDC did not differ between StG and QTB, SHD in both StG and QTB was lower than CON. The IKDC scores improved significantly 1 year following ACL-R for both graft types. CONCLUSION: One year after ACL-R, muscle strength is affected by autograft type, with StG leading to impairments of KE and KF muscle strength, while QTB results in more pronounced impairments of KE only. Functional capacity and patient-reported outcome were unaffected by autograft type, with the former showing impairment compared to healthy controls. CLINICAL TRIALS REGISTRATION NUMBER: NCT02173483.

Mechano-biological adaptation of the pulmonary artery exposed to systemic conditions.

Cardiac surgeries may expose pulmonary arterial tissue to systemic conditions, potentially resulting in failure of that tissue. Our goal was to quantitatively assess pulmonary artery adaptation due to changes in mechanical environment. In 17 sheep, we placed a pulmonary autograft in aortic position, with or without macroporous mesh reinforcement. It was exposed to systemic conditions for 6 months. All sheep underwent 3 ECG-gated MRI's. Explanted tissue was subjected to mechanical and histological analysis. Results showed progressive dilatation of the unreinforced autograft, while reinforced autografts stabilized after two months. Some unreinforced pulmonary autograft samples displayed more aorta-like mechanical behavior with increased collagen deposition. The mechanical behavior of reinforced autografts was dominated by the mesh. The decrease in media thickness and loss of vascular smooth muscle cells was more pronounced in reinforced than in unreinforced autografts. In conclusion, altering the mechanical environment of a pulmonary artery causes changes in its mechano-biological properties.

The course of recovery of locomotor function over a 10-week observation period in a rat model of femoral nerve resection and autograft repair.

BACKGROUND: A great extent of knowledge on peripheral nerve regeneration has been gathered using the rat sciatic nerve model. The femoral nerve model of the rat offers an interesting alternative, as it lacks disadvantageous features such as automutilation. For the analysis of locomotor behavior in rats after sciatic nerve injury, the CatWalk™ XT Gait Analysis System is often used. However, lesions of the femoral nerve in the rat have yet remained unstudied with this method. MATERIAL AND METHODS: Ten male Sprague Dawley rats were evaluated with the CatWalk XT to study their gait after a 6-mm resection of the right femoral nerve and reconstruction with an autologous nerve graft. Animals were observed for 10 weeks after surgery. RESULTS: Print Area, Print Length, Swing Speed, and Duty Cycle decreased to a minimum of 40% of baseline 2 weeks after surgery. Swing Time was elevated more than twofold at this time point. However, all these parameters recovered back to >90% of baseline values at 10 weeks after surgery. This degree of functional recovery has not been reported after sciatic nerve resection and autograft repair. Base of support varied minimally postoperatively in contrast to a strong decrement after sciatic nerve resection and repair. CONCLUSION: We hereby provide a comprehensive in-depth analysis of how to study functional recovery after injury of the femoral nerve in the rat via the CatWalk XT. We place special emphasis on highlighting the differences between the femoral nerve and sciatic nerve injury model in this context.

Nondestructive Assessment of Articular Cartilage Electromechanical Properties after Osteochondral Autologous and Allogeneic Transplantation in a Goat Model.

OBJECTIVE: To determine the applicability of a minimally invasive diagnostic device to evaluate the quality of articular cartilage following autologous (OAT) and allogeneic (OCA) osteochondral graft transplantation in goat model. DESIGN: OAT grafts were harvested from lateral femoral condyles (LFCs) and transplanted into osteochondral defects created in medial femoral condyles (MFCs) of contralateral knees. OCA grafts were transplanted into MFC condyles after in vitro storage. Autologous platelet-rich plasma (PRP) was administered intraarticularly after the surgery and at 1 and 2 months postoperatively. OAT and OCA grafts were evaluated macroscopically (Oswestry arthroscopy score [OAS]), electromechanically (quantitative parameter, QP), and histologically (O'Driscoll score, safranin O staining intensity) at 3 and 6 months after transplantation. Results were compared with preoperative graft evaluation. RESULTS: Transplanted cartilage deteriorated within 6 months in all groups. Cartilage quality was better retained in OAT group compared with a decline in OCA group. QP and OAS scores were comparable in OAT and OCA groups at 3 months, but superior in OAT group at 6 months, according to all the methods applied. PRP injections significantly improved QP and OAS score at 6 months compared with 3 months in OAT group. QP moderately correlated with OAS, O'Driscoll score, and safranin O staining intensity. CONCLUSIONS: Grafts did not retain preoperative quality parameters at 6 months follow-up; however, OAT were superior to OCA grafts. PRP may have a beneficial effect on macroscopic and electromechanical properties of cartilage; however, histological improvement is yet to be proved. Electromechanical diagnostic device enables reliable assessment of transplanted cartilage.

Compared efficacy of University of Wisconsin and histidine-tryptophan-ketoglutarate solutions in ex-situ liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis patients.

BACKGROUND: The University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy in end-stage hepatic alveolar echinococcosis patients who underwent ex-situ liver resection and autotransplantation (ELRA). METHODS: A total of 81 patients received ELRA from August 2010 to March 2018. They were allocated into UW (n = 48) and HTK groups (n = 33) based on the type of solutions used. Demographic and operational data were retrospectively analyzed. Primary outcomes included 90-day mortality, incidence of early graft loss, primary dysfunction, and postoperative complications. RESULTS: Demographic and operational characteristics were similarly distributed in the two groups. No statistically significant differences were observed with regard to 90-day mortality (12.77% vs. 12.12%) and early graft loss rate (8.51% vs. 9.09%) between the two groups. Patients in the UW and HTK groups showed a primary dysfunction rate of 27.66% and 27.27%, respectively. The UW group exhibited a higher incidence tendency of biliary complications, albeit with no statistical significance. CONCLUSIONS: This is the largest cohort study comparing the efficacy of the UW and HTK organ-preserving solutions in end-stage hepatic alveolar echinococcosis patients in ELRA settings. UW and HTK solutions presented similar efficacy and safety. A randomized clinical trial with larger scale is needed for further investigation in future clinical applications.

Pretreatment of nerve grafts with resveratrol improves axonal regeneration following replantation surgery for nerve root avulsion injury in rats.

BACKGROUND: Replantation of the avulsed nerve root has been proposed for the treatment of severe brachial plexus injury for several decades. However, due to the complexity of the technique and limited functional improvement, practical applications are yet to be implemented. OBJECTIVE: In the present study, we investigated the effect of pretreatment with resveratrol on nerve autografts used for replantation surgery in a rat model of nerve root avulsion. METHODS: Resveratrol pretreatment was performed using an explant culture technique. Two surgical procedures were performed. During the first surgery, Sprague-Dawley rats were subjected to left C6 nerve root avulsion, and nerves were harvested for autografting. The harvested grafts were explant-cultured for 1 week. A second procedure was performed to replant the C6 nerve root using the explant-cultured nerve graft 1 week after the first procedure. Histological and immunohistochemical analyses were performed 8 weeks after the second procedure. We first compared findings between explant-cultured nerve grafts and fresh nerve grafts, following which we compared findings between explant-cultured grafts pretreated with and without resveratrol. Changes induced within nerve grafts by 1 week of explant culture with or without resveratrol were investigated in vitro. RESULTS: There was no significant difference in outcomes between 1 week-explant-cultured and fresh nerve grafts. Addition of resveratrol to the explant culture medium resulted in a significant increase in the number and myelin thickness of regenerated axons, and in the number of regenerating motor neurons in the C6 spinal cord segment. In vitro analyses revealed that nerve grafts pretreated with resveratrol exhibited significant increases in glial cell line-derived neurotrophic factor (GDNF) expression and the number of dedifferentiated Schwann cells. CONCLUSIONS: Resveratrol may promote axonal regeneration following replantation surgery for the treatment of nerve root avulsion injury; however, further studies are required to verify these findings in humans.

The vascularization pattern of acellular nerve allografts after nerve repair in Sprague-Dawley rats.

OBJECTIVE: We have demonstrated that angiogenesis in acellular nerve allografts (ANAs) can promote neuroregeneration. The present study aimed to investigate the microvascular regeneration pattern of ANAs in Sprague-Dawley (SD) rats. METHODS: Sixty male SD rats were randomly divided into an autologous group and a rat acellular nerve allograft group (rANA), and 10-mm sciatic nerve defects were induced in these rats. On the 7th, 14th and 21st days after surgery, systemic perfusion with Evans Blue (EB) or lead oxide was performed on the rats through carotid intubation. Samples were then collected for gross observation, and the microvessels in the nerves were reconstructed through microscopic CT scans using MIMICS software. The vascular volume fraction (VF, %) and microvessel growth rate (V, mm/d) in both groups were then measured, and 1 month after surgery, NF-200 staining was performed to observe and compare the growth condition of the axons. RESULTS: Early post-operative perfusion with gelatin/EB showed EB permeation around the acellular nerve. Perfusion with gelatin/lead oxide showed that the blood vessels had grown into the allograft from both ends 7 days after the operation. Fourteen days after the operation, the microvessel growth rate of the autologous group was faster than that of the rANA group (0.39 ± 0.17 mm/d vs. 0.26 ± 0.14 mm/d, p < 0.05), and the vascular VF was also higher than that of the rANA group (8.92% ± 1.54% vs. 6.31% ± 1.21%, p < 0.05). Twenty-one days after the operation, the blood vessels at both ends of the allograft had connected to form a microvessel network. The growth rate was not significantly different between the two groups; however, the vascular VF of the autologous group was higher than that of the rANA group (12.18% ± 2.27% vs. 9.92% ± 0.84%, p < 0.05). One month after the operation, the NF-200 fluorescence (IOD) in the autologous group significantly increased compared with that of the rANA group (540,278 ± 17,424 vs. 473,310 ± 14,636, respectively, p < 0.05), suggesting that the results of the repair after nerve injury were significantly better in the autologous group than in the rANA group. CONCLUSION: Both the autologous nerve and ANAs rely on the permeation of tissue fluids to supply nutrients during the early stage, and microvessel growth mainly starts at both ends of the graft and enters the graft along the long axis. Compared to ANAs, the growth speed of revascularization in autologous nerve grafts was faster, leading to a better outcome in the autologous nerve group.

Injerto costal en rinoplastia. Recaudos anatómicos para la recolección de cartílago costal / Costal graft in rhinoplasty. Anatomical collections for thecollection of costal cartilage / Enxerto costal na rinoplastia. Coleções anatômicas para a cartilagem colheitacostela

Introducción: la finalidad es ponderar el conocimiento anatómico indispensable de la pared torácica para la recolección segura de cartílago costal en rinoplastia. Materiales y métodos: Se dividió en dos fases. Esta presentación corresponde a la Fase I, de tipo descriptiva observacional. La Fase II (actualmente en curso) tiene un diseño prospectivo y experimental para una futura presentación. Primera instancia: recolección de información bibliográfica, de no más de 5 años de antigüedad en bases de datos médicos y textos específicos. Segunda instancia: representación del acto quirúrgico en 3 especímenes cadavéricos humanos. En cada espécimen se realizaron 4 abordajes (2 submamarios y 2 subcostales inferiores) se hizo hincapié en la descripción de aquellas estructuras anatómicas importantes para respetar en el abordaje de la pared torácica. Resultados: Fue posible recrear las diferentes técnicas de abordaje de la pared costal. Se pudo constatar que la ubicación del paquete vasculonervioso dentro del surco costal fue constante inter especímenes e intra espécimen. La relación entre el pericondrio interno, la fascia endotorácica y la hoja parietal de la pleura resultó ser un sistema fibroadhesivo complejo y variable. Coincidimos con la bibliografía acerca de que la técnica se dificulta cuando se realiza la recolección a nivel costal más proximal. Conclusiones: Creemos que el conocimiento de la anatomía torácica es indispensable para realizar una correcta técnica de disección y posterior recolección de cartílago costal; esto disminuiría las complicaciones y la morbilidad en el sitio dador. El neumotórax y el dolor neuropático provienen del daño de estructuras anatómicas constantes.

Introduction: the purpose is to weight the anatomical knowl edge essential to the chestwall for the safe collection of costal cartilage in rhinoplasty. Materials and methods: It is divided in to two phases. This presentation corresponds to Phase I, of an observational descriptive type. Phase II (currently underway) has a prospective and experimental design for future presentation. First instance: collection of bibliographic information, not more than 5 years old in medical databases and specific texts. Second instance: representation of the surgical act in 3 human cadaveric specimens. In each specimen, 4 approaches (2 sub mamarios and 2 lower subcostals) were performed, emphasizing the description of those anatomical structures important to respect in the thoracic wall approach. Results: It was possible to recreate the different techniques of approaching the costal wall. It was observed that the location of the vasculo nervioso package with in the costal groove was constant between specimens and intra specimen. The relationship between the internal perichondrium, the endothoracic fascia and the parietal leaf of the pleura turned out to be a complex and variable fibro adhesive system. We agree with the bibliography that the technique is difficult twhen the collection is carried out at the most proximal costal level. Conclusions: We believe that knowl edge of the thoracic anatomy is essential to perform a correct technique of dissection and later collection of costal cartilage, this would reduce complications and morbidity in the donor site. Pneumothorax and neuropathic painarise from the damage of constant anatomical structures.

Introdução: o objetivo é avaliar o conhecimento anatômico essencial da parede torácica para a recolha de cartilagem costal em rinoplastia. Materiais e métodos: dividido em duas fases. Esta apresentação corresponde à Fase I, observacional descritivo. Fase II (em curso) tem um desenho prospectivo e experimental para uma apresentação futuro. Primeira instância: recolha de informação bibliográfica, não mais de 5 anos de idade em bancos de dados médicos e textos específicos. Segunda instância: a representação da cirurgia em 3 espécimes de cadá- veres humanos. Em cada espécime 4 abordagens (2 submamária e 2 inferior subcostal) enfatizou a descrição dessas estruturas anatômicas importantes a respeitar no tratamento da parede torácica foram realizadas. Resultados: Foi possível recriar as diferentes técnicas de abordagem parede torácica. Verificou-se que a localização do feixe neurovascular no sulco costal foi constante espécimes inter e intra espécime. A relação entre o pericôndrio interno, a fáscia e a folha intratorácica pleura parietal provou ser um sistema de fibro adhesive complexa e variável. Estamos de acordó com a literatura que a técnica é difícil quando a coleção é composta nível costal mais proximal. Conclusão: Acreditamos que o conhecimento da anatomia torácica é essencial para uma correta técnica de dissecção e subsequenterecolha de cartilagem costal, este iria diminuir as complicações e morbidade no sítiodoador. Pneumotórax e dorneuropática vem de danos causados por estrutura sanatômicas constantes.

[Indices of intraoperative flowmetry, determining patency of grafts in the remote period after revascularization of the right coronary artery].

The authors studied the threshold values of ultrasound flowmetry concerning composite T-grafts, combined I-grafts, and autovenous shunts during revascularization of the right coronary artery (RCA), determining high risk for the development of shunt occlusion in the remote postoperative period. The retrospective study included a total of 223 patients subjected to revascularization of the RCA's basin with the help of composite T-grafts, combined I-grafts, and autovenous shunts. Depending on the method of bypass grafting of the RCA and its branches, all patients were subdivided into 3 groups: Group 1 was composed of 65 patients in whom the RCA basin was revascularized by a branch of the composite T-graft, Group 2 comprised 112 patients who endured autovenous aortocoronary bypass grafting, and Group 3 consisted of 46 patients in whom the RCA basin was shunted by a combined mammarovenous I-graft. The groups had no statistically significant differences on the main clinical and demographic parameters. Intraoperative assessment of the blood flow through the coronary shunts was carried out by means of ultrasound flowmetry. The remote results were evaluated based on the findings of the control coronaroshuntography which was carried out in all patients within the terms varying from 16 to 43 months. In the remote period in Group 1 patients (T-graft), 59 (90%) mammary shunts were patent, in Group 2 - 99 (88.4%) autovenous shunts, and in Group 3 (I-graft) 42 (95.5%) shunt were patent. Cumulative probability of freedom from shunt occlusion within the terms up to 3 years after surgery in Group 1 amounted to 82±0.5%, in Group 2 to 58±2.1%, and in Group 3 to 86±1.9%, with the differences between Group 2 and other groups being statistically significant (p=0.01). The Poisson regression analysis showed that the risk for graft occlusion increased by 10% with the resistance index in the branch of the T-graft from 4.0; by 8% with the resistance index in the autovein from 2.9; and by 3% with the index of resistance in the I-graft from 3.2. The conclusion was made that composite T-grafts and combined I-grafts demonstrated similar results of patency within the terms up to 3 years, possessing advantages over autovenous conduits while shunting the RCA basin. The optimal index of peripheral resistance for the autovein during revascularization of the RCA basin is up to 2.9; for the combined T-graft - up to 3.2, and for the composite T-graft - up to 4.0. Probability of shunt occlusion in the remote period does not depend upon the average volumetric blood velocity (Qmean) but is directly proportional to the value of the pulsatility index (Pi) which reflects the state of the distal bed.

Mechanism of autograft insufficiency after the Ross operation in children.

BACKGROUND: It is unclear how autografts grow and dilate after the Ross operation in children. We analysed autograft growth and dilatation in children who underwent the Ross operation and examined the relationship of these factors to autograft failure. METHODS: From our institutional database, we retrospectively identified 33 children who underwent the Ross operation without aortic root reinforcement (mean age 9.9 years) and had normal body measurements and echocardiographic data throughout follow-up. RESULTS: Autograft insufficiency developed in 10 patients 5.1 years after the Ross operation. The average Z score at the development of autograft insufficiency was -0.1 (range from -2.0 to 6.1). The proportions of patients who remained free of autograft insufficiency at 5 and 10 years were 87.2% and 55.7%, respectively. A consistent trend in the time course of Z score was not found in any age group studied. CONCLUSIONS: Autograft growth and dilation after the Ross operation varied widely among patients, and the incidence of autograft insufficiency was independent of annulus size.