Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 339
Filtrar
1.
BMC Nephrol ; 22(1): 91, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33722190

RESUMO

BACKGROUND: COVID-19 infection in kidney transplant recipients often lead to allograft dysfunction. The allograft injury has various histopathological manifestations. Our case illustrates the unusual combination of allograft rejection, acute kidney injury secondary to oxalate nephropathy and SARS CoV-2 nephropathy as the cause of irreversible allograft failure. CASE PRESENTATION: A 56 year old renal allograft recipient presented with a history of fever and diarrhoea for the preceding 4 weeks, tested positive for Sars-CoV2 on nasal swab and was found to have severe allograft dysfunction, necessitating haemodialysis. He subsequently underwent an allograft biopsy, which demonstrated antibody mediated rejection along with the presence of extensive oxalate deposition in the tubules. Ultrastructural examination demonstrated spherical spiked particles in the glomerular capillary endothelium and the presence of tubulo-reticular inclusions suggestive of an active COVID-19 infection within the kidney. The intra-tubular oxalate deposition was considered to be the result of high dose, supplemental Vitamin C used as an immune booster in many patients with COVID - 19 infection in India. CONCLUSIONS: This case highlights the complex pathology that may be seen in following COVID-19 disease and the need for kidney biopsies in these patients to better understand the aetiology of disease.


Assuntos
Ácido Ascórbico/efeitos adversos , Rejeição de Enxerto/etiologia , Hiperoxalúria/complicações , Transplante de Rim , Disfunção Primária do Enxerto/etiologia , Lesão Renal Aguda/etiologia , Ácido Ascórbico/administração & dosagem , Evolução Fatal , Humanos , Nefropatias/complicações , Nefropatias/patologia , Masculino , Pessoa de Meia-Idade , Disfunção Primária do Enxerto/patologia , Disfunção Primária do Enxerto/virologia
2.
J Card Surg ; 35(10): 2847-2852, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32683723

RESUMO

BACKGROUND: With the limited number of available suitable donor hearts resulting in plateaued numbers of heart transplantations, short- and long-term mechanical circulatory support devices, including the implantation of total artificial hearts (TAHs) are modalities that are increasingly being used as treatment options for patients with end-stage heart failure. The superior vena cava syndrome has been described in this context in various disease processes. We report successful venoplasty for superior vena cava syndrome in a patient with a TAH. CASE PRESENTATION: A 65-year-old man with a history of nonischemic cardiomyopathy had received a left ventricular assist device, and then 2 years later, underwent orthotopic heart transplantation using the bicaval anastomosis technique. The postprocedural course was complicated by primary graft failure, resulting in the need for implantation of a TAH. About 5 months after TAH implantation, he started to develop complications such as volume retention, swelling of the upper extremities, and was diagnosed to have a superior vena cava syndrome. The patient underwent a successful venoplasty of his superior vena cava by interventional radiology with resolution of upper body edema, normalization of renal, and liver function. CONCLUSION: Potential fatal complications caused by catheter or wire entrapment in the right-sided mechanical valve of a TAH have been reported. We describe a safe method for the treatment of superior vena cava syndrome in patients with TAH.


Assuntos
Transplante de Coração/efeitos adversos , Transplante de Coração/métodos , Coração Artificial/efeitos adversos , Coração Auxiliar/efeitos adversos , Disfunção Primária do Enxerto/etiologia , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Superior/cirurgia , Idoso , Constrição Patológica/cirurgia , Humanos , Masculino , Radiografia Intervencionista , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Veia Cava Superior/patologia
3.
J Card Surg ; 35(6): 1314-1321, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32353909

RESUMO

BACKGROUND: The saphenous vein remains the most frequently used conduit for coronary artery bypass grafting, despite reported unsatisfactory long-term patency rates. Understanding the pathophysiology of vein graft failure and attempting to improve its longevity has been a significant area of research for more than three decades. This article aims to review the current understanding of the pathophysiology and potential new intervention strategies. METHODS: A search of three databases: MEDLINE, Web of Science, and Cochrane Library, was undertaken for the terms "pathophysiology," "prevention," and "treatment" plus the term "vein graft failure." RESULTS: Saphenous graft failure is commonly the consequence of four different pathophysiological mechanisms, early acute thrombosis, vascular inflammation, intimal hyperplasia, and late accelerated atherosclerosis. Different methods have been proposed to inhibit or attenuate these pathological processes including modified surgical technique, topical pretreatment, external graft support, and postoperative pharmacological interventions. Once graft failure occurs, the available treatments are either surgical reintervention, angioplasty, or conservative medical management reserved for patients not eligible for either procedure. CONCLUSION: Despite the extensive amount of research performed, the pathophysiology of saphenous vein graft is still not completely understood. Surgical and pharmacological interventions have improved early patency and different strategies for prevention seem to offer some hope in improving long-term patency.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/prevenção & controle , Oclusão de Enxerto Vascular/terapia , Disfunção Primária do Enxerto/prevenção & controle , Disfunção Primária do Enxerto/terapia , Veia Safena/transplante , Enxerto Vascular/métodos , Oclusão de Enxerto Vascular/etiologia , Humanos , Disfunção Primária do Enxerto/etiologia , Resultado do Tratamento , Grau de Desobstrução Vascular
4.
Gulf J Oncolog ; 1(32): 66-70, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32342922

RESUMO

Chronic immunosuppression is known to cause an increased risk of cancers in organ transplant recipients leading to the rise in morbidity and mortality among these patients. Recent studies have observed that thyroid lesions are more frequently encountered in kidney transplant recipients. A 45-year-old woman with history of chronic hypertension, kidney transplant and graft failure, was admitted for assessment for a second renal transplant and detected to have a thyroid nodule by ultrasound (US). A fine needle aspirate (FNA) on the nodule was reported as Hurthle cell neoplasm. Histopathology revealed a Hurthle cell adenoma with an incidental micro papillary carcinoma. On follow up a year later, US investigation revealed another nodule in the inferior pole of the remnant lobe of thyroid. FNA showed sheets of uniform small round cells arranged in micro follicles, intermixed with Hurthle-like cells with absence of colloid, raising the possibility of a parathyroid lesion. Biochemical tests, clinical history, cytomorphological, immunocytochemical and biochemical tests supported a parathyroid adenoma. Advancements in diagnostic techniques and management strategies have not only improved survival rates in patients with chronic renal disease but have also identified an increasing number of multiple primary tumors in these patients. Thyroid lesions have cytomorphological similarities and may masquerade parathyroid neoplasms. Regular thyroid screening in post- transplant patients, meticulous pathological examination and parathormone assay are crucial in the early diagnosis, management and prevention of morbidity and mortality in these patients. Keywords: Fine needle aspiration, kidney transplant, Hurthle cell neoplasm, parathyroid adenoma, micropapillary carcinoma.


Assuntos
Adenoma/metabolismo , Carcinoma Papilar/diagnóstico , Células Oxífilas/metabolismo , Neoplasias das Paratireoides/diagnóstico , Disfunção Primária do Enxerto/etiologia , Carcinoma Papilar/complicações , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias das Paratireoides/complicações , Transplantados
6.
EBioMedicine ; 52: 102600, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31981974

RESUMO

BACKGROUND: Primary graft dysfunction (PGD) is a known acute lung injury (ALI) and a major cause of fatality post-lung transplantation. Though some long non-coding RNAs (lncRNAs) have been studied in ALI through regulation of microRNAs (miRNAs), their effects on PGD remain undefined. The present study aims to explore the underlying mechanism of lncRNA X-inactive specific transcript (XIST) in PGD after lung transplantation. METHODS: Initially, the expression of miR-21, IL-12A and XIST was determined by RT-qPCR and western blot analysis. The dual luciferase reporter assay, RNA pull-down and RIP assay were performed to identify the targeting relationship between miR-21 and IL-12A and the binding relationship between miR-21 and XIST. Loss- and gain-of-function investigations were conducted in rats treated with prolonged cold ischemia and polymorphonuclear neutrophils (PMNs). FINDINGS: miR-21 was decreased, whilst XIST and IL-12A were increased in the bronchoalveolar lavage fluid of PGD patients after lung transplantation. Enhanced miR-21 expression in rats and PMNs resulted in downregulated expression of pro-inflammatory factors and chemokines, and enhanced the apoptosis of PMNs. XIST was found to upregulate IL-12A expression in a miR-21-dependent manner. Additionally, XIST silencing enhanced the apoptosis of PMNs and inhibited the neutrophil extracellular trap (NET) formation through upregulation of miR-21 but downregulation of IL-12A in vivo. INTERPRETATION: In summary, lncRNA XIST upregulates IL-12A by binding to miR-21, thereby inducing NET formation and accelerating PGD after lung transplantation. This suggests that inhibition of XIST and NET may be beneficial for the treatment of PGD.


Assuntos
Inativação Gênica , Transplante de Pulmão , MicroRNAs/genética , Disfunção Primária do Enxerto/etiologia , Interferência de RNA , RNA Longo não Codificante/genética , Regiões 3' não Traduzidas , Animais , Biomarcadores , Biópsia , Armadilhas Extracelulares/genética , Regulação da Expressão Gênica , Humanos , Imuno-Histoquímica , Subunidade p35 da Interleucina-12/genética , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/métodos , Modelos Animais , RNA Mensageiro , Ratos , Transplante Homólogo
7.
PLoS One ; 15(1): e0226488, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929536

RESUMO

KL-6 is an antigen produced mainly by damaged type II pneumocytes that is involved in interstitial lung disease. Chronic lung allograft dysfunction (CLAD) after lung transplantation (LT) is a major concern for LT clinicians, especially in patients with restrictive allograft syndrome (RAS). We investigated KL-6 levels in serum and bronchoalveolar lavage fluid (BALF) as a potential biomarker of the RAS phenotype. Levels of KL-6 in serum and BALF were measured in 73 bilateral LT recipients, and patients were categorized into 4 groups: stable (ST), infection (LTI), bronchiolitis obliterans syndrome (BOS), and RAS. We also studied a healthy cohort to determine reference values for serum KL-6. The highest levels of KL-6 were found in the serum of patients with RAS (918 [487.8-1638] U/mL). No differences were found for levels of KL-6 in BALF. Using a cut-off value of 465 U/mL serum KL-6 levels was able to differentiate RAS patients from BOS patients with a sensitivity of 100% and a specificity of 75%. Furthermore, higher serum KL-6 levels were associated with a decline in Forced Vital Capacity (FVC) at 6 months after sample collection. Therefore, KL-6 in serum may well be a potential biomarker for differentiating between the BOS and RAS phenotypes of CLAD in LT recipients.


Assuntos
Transplante de Pulmão/efeitos adversos , Mucina-1/sangue , Disfunção Primária do Enxerto/etiologia , Adulto , Idoso , Área Sob a Curva , Biomarcadores/sangue , Bronquiolite Obliterante/diagnóstico , Bronquiolite Obliterante/etiologia , Líquido da Lavagem Broncoalveolar/química , Feminino , Humanos , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Mucina-1/análise , Fenótipo , Disfunção Primária do Enxerto/diagnóstico , Curva ROC , Sensibilidade e Especificidade , Transplante Homólogo , Capacidade Vital , Adulto Jovem
8.
Transplantation ; 104(4): 770-778, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31568395

RESUMO

BACKGROUND: While portal flow (PF) plays an important role in determining graft outcomes in living donor liver transplantation, its impact in deceased donor liver transplantation (DDLT) is unclear. The aim of this study was to investigate the correlations between graft PF and graft outcomes in DDLT. METHODS: We retrospectively investigated 1001 patients who underwent DDLT between January 2007 and June 2017 at our institution. The patients were divided into 3 groups according to hazard ratio for 1-year graft loss at each PF value, which was standardized with graft weight. Graft and recipient outcomes were compared between the groups. RESULTS: The low-PF group (PF < 65 mL/min/100 g, n = 210, P = 0.011) and the high-PF group (PF ≥ 155 mL/min/100 g, n = 159, P = 0.018) showed significantly poorer 1-year graft survival compared with the intermediate-PF group (PF ≥ 65 mL/min/100 g and < 155 mL/min/100 g, n = 632). The patients in the low-PF group had severe reperfusion injury and were more frequently complicated with primary nonfunction (P = 0.013) and early allograft dysfunction (P < 0.001) compared with the other groups. In contrast, the patients in the high-PF group had milder reperfusion injury, but had lower intraoperative hepatic artery flow with higher incidence of hepatic artery thrombosis (P = 0.043) and biliary complication (P = 0.041) compared with the other groups. CONCLUSIONS: These results suggest that intraoperative PF plays an important role in determining early graft outcomes after DDLT.


Assuntos
Hemodinâmica , Circulação Hepática , Transplante de Fígado , Veia Porta/transplante , Adulto , Idoso , Doenças Biliares/etiologia , Doenças Biliares/fisiopatologia , Velocidade do Fluxo Sanguíneo , Feminino , Sobrevivência de Enxerto , Artéria Hepática/fisiopatologia , Humanos , Período Intraoperatório , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Disfunção Primária do Enxerto/etiologia , Disfunção Primária do Enxerto/fisiopatologia , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Trombose/etiologia , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
9.
Am J Respir Crit Care Med ; 201(1): 63-72, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31394048

RESUMO

Rationale: Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after lung transplantation, but the immunologic mechanisms are poorly understood. Innate lymphoid cells (ILC) are a heterogeneous family of immune cells regulating pathologic inflammation and beneficial tissue repair. However, whether changes in donor-derived lung ILC populations are associated with PGD development has never been examined.Objectives: To determine whether PGD in chronic obstructive pulmonary disease or interstitial lung disease transplant recipients is associated with alterations in ILC subset composition within the allograft.Methods: We performed a single-center cohort study of lung transplantation patients with surgical biopsies of donor tissue taken before, and immediately after, allograft reperfusion. Donor immune cells from 18 patients were characterized phenotypically by flow cytometry for single-cell resolution of distinct ILC subsets. Changes in the percentage of ILC subsets with reperfusion or PGD (grade 3 within 72 h) were assessed.Measurements and Main Results: Allograft reperfusion resulted in significantly decreased frequencies of natural killer cells and a trend toward reduced ILC populations, regardless of diagnosis (interstitial lung disease or chronic obstructive pulmonary disease). Seven patients developed PGD (38.9%), and PGD development was associated with selective reduction of the ILC2 subset after reperfusion. Conversely, patients without PGD exhibited significantly higher ILC1 frequencies before reperfusion, accompanied by elevated ILC2 frequencies after allograft reperfusion.Conclusions: The composition of donor ILC subsets is altered after allograft reperfusion and is associated with PGD development, suggesting that ILCs may be involved in regulating lung injury in lung transplant recipients.


Assuntos
Imunidade Inata , Transplante de Pulmão/efeitos adversos , Linfócitos/imunologia , Disfunção Primária do Enxerto/etiologia , Disfunção Primária do Enxerto/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
10.
BMC Cardiovasc Disord ; 19(1): 305, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856732

RESUMO

BACKGROUND: Coronary artery spasm (CAS) is an underdiagnosed disease especially in heart transplant patients, and in those patients the etiology and pathophysiology remain largely unknown, although it has been associated with cardiac allograft vasculopathy or graft rejection. CASE PRESENTATION: We report the case of a heart-transplant patient whose cardiac graft experienced two coronary vasospasms: the first before transplantation, and the other at one-month of a postoperative course complicated by primary graft failure. CONCLUSION: Our case illustrates that a transplanted heart predisposed with coronary vasospasm may suffer from early relapse in the recipient despite of complete post-surgical autonomic denervation. Exacerbated endothelial dysfunction of the donor heart after transplant, with the addition of systemic factors in the recipient may be involved in the genesis of this puzzling phenomenon.


Assuntos
Vasoespasmo Coronário/etiologia , Transplante de Coração/efeitos adversos , Disfunção Primária do Enxerto/etiologia , Vasoespasmo Coronário/diagnóstico por imagem , Vasoespasmo Coronário/fisiopatologia , Vasoespasmo Coronário/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Primária do Enxerto/diagnóstico por imagem , Disfunção Primária do Enxerto/fisiopatologia , Disfunção Primária do Enxerto/terapia , Recuperação de Função Fisiológica , Recidiva , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
BMC Nephrol ; 20(1): 428, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752739

RESUMO

BACKGROUND: Adenine phosphoribosyl transferase (APRT) deficiency is a rare genetic form of kidney stones and/or kidney failure characterized by intratubular precipitation of 2,8 dihydroxyadenine crystals. Early diagnosis and prompt management can completely reverse the kidney injury. CASE PRESENTATION: 44 year old Indian male, renal transplant recipient got admitted with acute graft dysfunction. Graft biopsy showed light brown refractile intratubular crystals with surrounding giant cell reaction, consistent with APRT deficiency. Patient improved after receiving allopurinol and hydration. CONCLUSION: APRT forms a reversible cause of crystalline nephropathy. High index of suspicion is required for the correct diagnosis as timely diagnosis has therapeutic implications.


Assuntos
Adenina Fosforribosiltransferase/deficiência , Adenina/análogos & derivados , Transplante de Rim , Erros Inatos do Metabolismo/complicações , Disfunção Primária do Enxerto/etiologia , Urolitíase/complicações , Adenina/metabolismo , Adulto , Alopurinol/uso terapêutico , Antimetabólitos/uso terapêutico , Biópsia , Cristalização , Humanos , Hidroterapia , Masculino , Erros Inatos do Metabolismo/patologia , Erros Inatos do Metabolismo/terapia , Disfunção Primária do Enxerto/patologia , Disfunção Primária do Enxerto/terapia , Urolitíase/patologia , Urolitíase/terapia
12.
Exp Clin Transplant ; 17(6): 803-812, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31615381

RESUMO

OBJECTIVES: Primary graft dysfunction is a severe form of acute lung injury and a major cause of early morbidity and mortality encountered after lung transplant.We used a customized PExA 2.0 instrument (PExA, Gothenburg, Sweden) to measure particle flow in exhaled air during mechanical ventilation in the intensive care unit. Our objective was to discover whether patients who developed primary graft dysfunction had different particle flow patterns from the airways. We used volume-controlled ventilation and pressure-controlled ventilation to see whether changes in particle patterns could be observed in both mechanical ventilation settings. MATERIALS AND METHODS: First, we investigated whether it was safe to use a customized PExA 2.0 in conjunction with mechanical ventilation. Next, 12 lung transplant patients were randomized to either daily volumecontrolled ventilation or pressure-controlled ventilation as the first mode of treatment until extubation. RESULTS: In our study group, 6 patients did not develop primary graft dysfunction and 6 developed primary graft dysfunction. Patients with primary graft dysfunction underwent mechanical ventilation significantly longer; they also showed a stepwise increase in particle count from day 0 until extubation. We observed no adverse events related to the PExA 2.0 device. CONCLUSIONS: This study suggests that the PExA 2.0 device is safe to use in conjunction with mechanical ventilation in the intensive care unit. Lung transplant patients who developed primary graft dysfunction showed a different particle profile from the airways before clinical signs of primary graft dysfunction developed. Online assessment of ventilation impact before presentation of tissue changes may allow realtime detection of primary graft dysfunction, thus preventing or reducing its effects.


Assuntos
Testes Respiratórios/instrumentação , Transplante de Pulmão/efeitos adversos , Disfunção Primária do Enxerto/etiologia , Respiração Artificial/efeitos adversos , Extubação , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Disfunção Primária do Enxerto/diagnóstico , Disfunção Primária do Enxerto/fisiopatologia , Fatores de Risco , Suécia , Fatores de Tempo , Resultado do Tratamento
13.
J Heart Lung Transplant ; 38(12): 1246-1256, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31474492

RESUMO

BACKGROUND: Obesity is associated with an increased risk of primary graft dysfunction (PGD) after lung transplantation. The contribution of specific adipose tissue depots is unknown. METHODS: We performed a prospective cohort study of adult lung transplant recipients at 4 U.S. transplant centers. We measured cross-sectional areas of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) on chest and abdominal computed tomography (CT) scans and indexed each measurement to height.2 We used logistic regression to examine the associations of adipose indices and adipose classes with grade 3 PGD at 48 or 72 hours, and Cox proportional hazards models to examine survival. We used latent class analyses to identify the patterns of adipose distribution. We examined the associations of adipose indices with plasma biomarkers of obesity and PGD. RESULTS: A total of 262 and 117 subjects had available chest CT scans and underwent protocol abdominal CT scans, respectively. In the adjusted models, a greater abdominal SAT index was associated with an increased risk of PGD (odds ratio 1.9, 95% CI 1.02-3.4, p = 0.04) but not with survival time. VAT indices were not associated with PGD risk or survival time. A greater abdominal SAT index correlated with greater pre- and post-transplant leptin (r = 0.61, p < 0.001, and r = 0.44, p < 0.001), pre-transplant IL-1RA (r = 0.25, p = 0.04), and post-transplant ICAM-1 (r = 0.25, p = 0.04). We identified 3 latent patterns of adiposity. The class defined by high thoracic and abdominal SAT had the greatest risk of PGD. CONCLUSIONS: Subcutaneous, but not visceral, adiposity is associated with an increased risk of PGD after lung transplantation.


Assuntos
Tecido Adiposo/anatomia & histologia , Transplante de Pulmão , Disfunção Primária do Enxerto/epidemiologia , Tecido Adiposo/diagnóstico por imagem , Idoso , Composição Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Tamanho do Órgão , Disfunção Primária do Enxerto/etiologia , Estudos Prospectivos , Medição de Risco , Tomografia Computadorizada por Raios X
14.
Ann Transplant ; 24: 481-488, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31417074

RESUMO

BACKGROUND Adequate microcirculatory perfusion is essential for the provision of oxygen to the liver following transplantation. Data from the Oxygen Persufflation in Liver Transplantation (OPAL) study (ISRCTN00167887) were analyzed from liver transplants performed at a single center to determine the role of factors affecting the hepatic microcirculation and early allograft dysfunction (EAD). MATERIAL AND METHODS Retrospective data from 116 patients from the Oxygen Persufflation as Adjunction in Liver Transplantation (OPAL) study who underwent liver transplantation at a single center were analyzed. Oxygen saturation of hemoglobin (SO2), relative capillary hemoglobin concentration (rHb), relative tissue blood flow (rBF) using laser Doppler flow measurements, and the Oxygen-to-See (O2C) spectrometry were measured and with post-transplant allograft function were analyzed using univariate and multivariate logistic regression statistics. RESULTS Livers donors had a median donor risk index of 1.8. Most liver transplant recipients were men (60.3%), with a median age of 54 years (IQR, 23-68 years). Mean post-transplant 3-month survival was 90.5%. The EAD rate was 22.4%, the median SO2 was 78% (IQR, 29.5-95.8%), the median rHb was 55.6 AU (IQR, 16.8-74.8 AU), and the median rBF was 110.1 AU (IQR, 35.8-406.8 AU). Multivariate logistic regression analysis showed that tissue SO2 (p=0.01), body mass index (BMI) of the transplant recipient (p=0.002), serum alanine transaminase (ALT) of the donor (p=0.02), and portal blood flow (p=0.01) were predictive factors for EAD. CONCLUSIONS Non-invasive investigations of the liver microcirculation and hemoglobin oxygenation were shown to be predictive factors for EAD following liver transplantation.


Assuntos
Transplante de Fígado/métodos , Fígado/irrigação sanguínea , Microcirculação/fisiologia , Disfunção Primária do Enxerto/etiologia , Adulto , Idoso , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão , Medição de Risco , Fatores de Risco , Transplantados , Resultado do Tratamento , Adulto Jovem
15.
Sci Rep ; 9(1): 9925, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31289357

RESUMO

Neutrophil serine proteases (NSPs), like proteinase 3 (PR3) and neutrophil elastase (NE) are implicated in ischemia-reperfusion responses after lung transplantation (LTx). Cathepsin C (CatC) acts as the key regulator of NSP maturation during biosynthesis. We hypothesized that CatC inhibitors would reduce vascular breakdown and inflammation during reperfusion in pretreated lung transplant recipients by blocking NSP maturation in the bone marrow. An orthotopic LTx model in mice was used to mimic the induction of an ischemia-reperfusion response after 18 h cold storage of the graft and LTx. Recipient mice were treated subcutaneously with a chemical CatC inhibitor (ICatC) for 10 days prior to LTx. We examined the effect of the ICatC treatment by measuring the gas exchange function of the left lung graft, protein content, neutrophil numbers and NSP activities in the bone marrow 4 h after reperfusion. Pre-operative ICatC treatment of the recipient mice improved early graft function and lead to the disappearance of active NSP protein in the transplanted lung. NSP activities were also substantially reduced in bone marrow neutrophils. Preemptive NSP reduction by CatC inhibition may prove to be a viable and effective approach to reduce immediate ischemia reperfusion responses after LTx.


Assuntos
Catepsina C/antagonistas & inibidores , Inflamação/prevenção & controle , Transplante de Pulmão/efeitos adversos , Pré-Medicação/métodos , Disfunção Primária do Enxerto/prevenção & controle , Inibidores de Proteases/farmacologia , Animais , Inflamação/etiologia , Inflamação/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Disfunção Primária do Enxerto/etiologia , Disfunção Primária do Enxerto/patologia
16.
Clin Transplant ; 33(10): e13678, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31355953

RESUMO

BACKGROUND: Prior studies of post-lung transplant acute kidney injury (AKI) have not accounted for confounding effects of primary graft dysfunction (PGD). We sought to test the impact of PGD on AKI risk factors and on the association of AKI with mortality. METHODS: We included patients transplanted at the University of Pennsylvania from 2005-12, defined AKI using consensus criteria during transplant hospitalization, and defined PGD as grade 3 at 48-72 hours. We used multivariable logistic regression to test the impact of PGD on AKI risk factors and Cox models to test association of AKI with one-year mortality adjusting for PGD and other confounders. RESULTS: Of 299 patients, 188 (62.9%) developed AKI with 142 (75%) cases occurring by postoperative day 4. In multivariable models, PGD was strongly associated with AKI (OR 3.76, 95% CI 1.72-8.19, P = .001) but minimally changed associations of other risk factors with AKI. Both AKI (HR 3.64, 95% CI 1.68-7.88, P = .001) and PGD (HR 2.55, 95% CI 1.40-4.64, P = .002) were independently associated with one-year mortality. CONCLUSIONS: Post-lung transplant AKI risk factors and association of AKI with mortality were independent of PGD. AKI may therefore be a target for improving lung transplant mortality rather than simply an epiphenomenon of PGD.


Assuntos
Lesão Renal Aguda/mortalidade , Rejeição de Enxerto/mortalidade , Transplante de Pulmão/mortalidade , Complicações Pós-Operatórias/mortalidade , Disfunção Primária do Enxerto/mortalidade , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/patologia , Adulto , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto , Humanos , Transplante de Pulmão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Disfunção Primária do Enxerto/etiologia , Disfunção Primária do Enxerto/patologia , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
18.
J Thorac Cardiovasc Surg ; 158(3): 955-962.e1, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31204131

RESUMO

OBJECTIVES: The current score for primary graft dysfunction after lung transplantation relies heavily on chest radiographs, and radiologic judgment can make the difference between the lowest (primary graft dysfunction 0) and the highest (primary graft dysfunction 3) grade. This study aimed to evaluate interobserver variability of the scoring of postoperative chest radiographs and its impact on primary graft dysfunction grades in a large single-center cohort. METHODS: We retrospectively analyzed 497 lung transplantations performed between January 2010 and July 2016 at the Medical University of Vienna. Five trained thoracic radiologists were asked to independently examine postoperative chest radiographs performed at 0 to 6 hours, 24 hours, 48 hours, and 72 hours after arrival at the intensive care unit. Interobserver variability was calculated using Fleiss' kappa (κ) statistics. RESULTS: A total of 1988 chest radiographs were evaluated. Consensus among all 5 radiologists was found in only 826 cases (43.0%). At 0 to 6 hours and 24 hours, only a moderate agreement was found among the 5 radiologists (κ = 0.456 and 0.456, respectively), and agreement was even worse at 48 and 72 hours (κ = 0.405 and κ = 0.409). On the basis of this high interobserver variability, best and worst case scenarios were calculated leading to primary graft dysfunction 3 rates of 8.4% versus 28.4% at 0 to 6 hours, 1.8% versus 4.8% at 24 hours, 2.0% versus 5.3% at 48 hours, and 0.2% versus 3.1% at 72 hours. A high recipient body mass index and size-reduced transplants were found to be factors associated with higher rates of interobserver variability. CONCLUSIONS: The substantial interobserver variability found in this retrospective analysis underlines the difficulty to adequately grade post-transplant organ function. Future revisions of the primary graft dysfunction grading should take this problem into consideration.


Assuntos
Transplante de Pulmão/efeitos adversos , Disfunção Primária do Enxerto/diagnóstico por imagem , Radiografia Torácica , Áustria , Humanos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Disfunção Primária do Enxerto/etiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
19.
Clin Transplant ; 33(7): e13593, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31148258

RESUMO

OBJECTIVE: Potential interactions between donor-recipient age difference and outcomes after heart transplantation are not well known. We thus aimed to study the impact of donor-recipient age difference on heart transplantation outcomes. METHODS: Between 1995 and 2017, we assessed 234 heart transplantation patients. Based on donor-recipient age difference histogram, we stratified these patients into three groups: older donors (donor-recipient difference > 0; n = 48), younger donors (donor-recipient difference 0 to -20 years; n = 82), and much younger donors (donor-recipient difference <-20 years; n = 104). RESULTS: The baseline metabolic risk profile of the recipients was significantly higher for the much younger donor group compared with the younger and older groups, including hypertension (52% vs 33% vs 25%, P = 0.002), dyslipidemia (51% vs 51% vs 29%, P = 0.027), diabetes (30% vs 16% vs 17%, P = 0.044), and smoking history (53% vs 46% vs 29%, P = 0.024), respectively. There were no significant differences between the groups in long-term survival, cardiac allograft vasculopathy, or rejection-free survival in unadjusted and adjusted analyses. In the much younger donor group, gender matching was associated with a lower incidence of primary graft dysfunction (37% vs 58% P = 0.05). CONCLUSIONS: Donor-recipient age difference does not significantly impact long-term heart transplantation outcomes.


Assuntos
Rejeição de Enxerto/mortalidade , Transplante de Coração/mortalidade , Complicações Pós-Operatórias/mortalidade , Disfunção Primária do Enxerto/mortalidade , Doadores de Tecidos/provisão & distribução , Transplantados/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Transplante de Coração/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Disfunção Primária do Enxerto/etiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Doadores de Tecidos/estatística & dados numéricos , Adulto Jovem
20.
Medicine (Baltimore) ; 98(23): e16033, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169745

RESUMO

BACKGROUND: The worldwide organ shortage continues to be the main limitation of liver transplantation. To bridge the gap between the demand and supply of liver grafts, it becomes necessary to use extended criteria donor livers for transplantation. Hypothermic machine perfusion (HMP) is designed to improve the quality of preserved organs before implantation. In clinical liver transplantation, HMP is still in its infancy. METHODS: A systematic search of the PubMed, EMBASE, Springer, and Cochrane Library databases was performed to identify studies comparing the outcomes in patients with HMP versus static cold storage (SCS) of liver grafts. The parameters analyzed included the incidences of primary nonfunction (PNF), early allograft dysfunction (EAD), vascular complications, biliary complications, length of hospital stay, and 1-year graft survival. RESULTS: A total of 6 studies qualified for the review, involving 144 and 178 liver grafts with HMP or SCS preservation, respectively. The incidences of EAD and biliary complications were significantly reduced with an odds ratio (OR) of 0.36 (95% confidence interval [CI] 0.17-0.77, P = .008) and 0.47 (95% CI 0.28-0.76, P = .003), respectively, and 1-year graft survival was significantly increased with an OR of 2.19 (95% CI 1.14-4.20, P = .02) in HMP preservation compared to SCS. However, there was no difference in the incidence of PNF (OR 0.30, 95% CI 0.06-1.47, P = .14), vascular complications (OR 0.69, 95% CI 0.29-1.66, P = .41), and the length of hospital stay (mean difference -0.30, 95% CI -4.10 to 3.50, P = .88) between HMP and SCS preservation. CONCLUSIONS: HMP was associated with a reduced incidence of EAD and biliary complications, as well as an increased 1-year graft survival, but it was not associated with the incidence of PNF, vascular complications, and the length of hospital stay.


Assuntos
Hipotermia Induzida/métodos , Transplante de Fígado/métodos , Preservação de Órgãos/métodos , Perfusão/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Aloenxertos/irrigação sanguínea , Doenças dos Ductos Biliares/epidemiologia , Doenças dos Ductos Biliares/etiologia , Doenças dos Ductos Biliares/prevenção & controle , Feminino , Sobrevivência de Enxerto , Humanos , Incidência , Fígado/irrigação sanguínea , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Disfunção Primária do Enxerto/epidemiologia , Disfunção Primária do Enxerto/etiologia , Disfunção Primária do Enxerto/prevenção & controle , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...