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1.
J Assoc Physicians India ; 69(1): 28-31, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34227772

RESUMO

Background: Renal transplantation is the treatment of choice for selected patients with end-stage renal disease. In this study, we present our experience and follow up data of renal transplantations done at this center with special emphasis on demographic characteristics, outcome and its complications. Materials and Methods: All those patients who underwent renal transplantations and had been followed up at this center were studied and their details were recorded. For living donor transplantation, donor and recipient were evaluated in detail. Graft loss was defined as the patient became dialysis-dependent or underwent second renal transplantation. Results: A total of 250 renal transplantations were done during the study period. 16.4% of total transplantations were cadaveric transplants. Recipients mean age was 38.5±11.64 yrs and donor mean age was 42.25 ±10.79 yrs. The majority of the recipients were male (72.4%) while female donors were predominant among living donors(59.3%). Mean graft survival time was 98.2 months (95% confidence interval [CI]:72.2-114.4). Mean patient survival time was 104.5 months (95% confidence interval [CI]:82.4-126.2). Conclusion: There is increasing no. of cadaveric renal transplants due to well established deceased donation programs in the state. Our patient and graft survival are comparable. Most of the immediate graft loss was due to acute rejection and late graft loss was due to chronic antibody-mediated rejection.


Assuntos
Transplante de Rim , Adulto , Feminino , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto , Humanos , Índia/epidemiologia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Centros de Atenção Terciária , Resultado do Tratamento
2.
Stem Cell Res Ther ; 12(1): 376, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215315

RESUMO

BACKGROUND: There is a huge controversy about whether xenograft or allograft in the "immune-privileged" brain needs immunosuppression. In animal studies, the prevailing sophisticated use of immunosuppression or immunodeficient animal is detrimental for the recipients, which results in a short lifespan of animals, confounds functional behavioral readout of the graft benefits, and discourages long-term follow-up. METHODS: Neuron-restricted neural progenitor cells (NPCs) were derived from human embryonic stem cells (ESCs, including H1, its gene-modified cell lines for better visualization, and HN4), propagated for different passages, and then transplanted into the brain of immunocompetent rats without immunosuppressants. The graft survivals, their cell fates, and HLA expression levels were examined over time (up to 4 months after transplantation). We compared the survival capability of NPCs from different passages and in different transplantation sites (intra-parenchyma vs. para- and intra-cerebroventricle). The host responses to the grafts were also investigated. RESULTS: Our results show that human ESC-derived neuron-restricted NPCs survive extendedly in adult rat brain parenchyma with no need of immunosuppression whereas a late-onset graft rejection seems inevitable. Both donor HLA antigens and host MHC-II expression level remain relatively low with little change over time and cannot predict the late-onset rejection. The intra-/para-cerebroventricular human grafts are more vulnerable to the immune attack than the intrastriatal counterparts. Prevention of graft hyperplasia by using hypoproliferative late passaged human NPCs further significantly extends the graft survival time. Our new data also shows that a subpopulation of host microglia upregulate MHC-II expression in response to the human graft, but fail to present the human antigen to the host immune system, suggestive of the immune-isolation role of the blood-brain barrier (BBB). CONCLUSIONS: The present study confirms the "immune privilege" of the brain parenchyma and, more importantly, unveils that choosing hypoproliferative NPCs for transplantation can benefit graft outcome in terms of both lower tumor-genic risk and the prolonged survival time without immunosuppression.


Assuntos
Transplante de Tecido Encefálico , Células-Tronco Neurais , Animais , Encéfalo , Rejeição de Enxerto , Sobrevivência de Enxerto , Xenoenxertos , Humanos , Ratos , Ratos Sprague-Dawley
3.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(6): 947-952, 2021 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-34238750

RESUMO

OBJECTIVE: To investigate the risk factors affecting the survival of parathyroid autograft following total parathyroidectomy combined with autologous sternocleidomastoid muscle transplantation (TPTX + AT) in patients on maintenance hemodialysis (MHD) complicated with secondary hyperparathyroidism (SHPT). OBJECTIVE: This retrospective study was conducted among the patients on maintenance hemodialysis with SHPT, who underwent successful parathyroidectomy and autotransplantation from January, 2010 to February, 2020 in our hospital. The clinical data and serum levels of calcium, phosphorus, intact parathyroid hormone, hemoglobin, and alkaline phosphatase (ALP) of the patients were collected. The enrolled patients were divided into survival group with bilateral forearm parathyroid hormone (iPTH) ratio > 1.5 and death group with a ratio < 1.5 at 2 weeks after surgery for comparison of the clinical data and perioperative indicators. The risk factors of postoperative parathyroid autograft survival were analyzed using logistic regression analysis. OBJECTIVE: A total of 87 patients were included in the study, among whom the graft survival rate after parathyroid transplantation was 78.16%. In both groups, serum levels of calcium, phosphorus, iPTH and ALP decreased and hemoglobin level increased significantly at 1 week and 1, 2, 3, 6 and 12 months after surgery (P < 0.01). Logistic regression analysis showed that serum ALP level was an independent risk factor for graft survival following parathyroid autotransplantation [OR=1.003, 95% CI: 1.001-1.005, P=0.004]. OBJECTIVE: TPTX+AT is a safe and effective treatment for SHPT, and parathyroid autografts are less likely to survive following parathyroid transplantation in patients with high preoperative level of ALP.


Assuntos
Sobrevivência de Enxerto , Paratireoidectomia , Cálcio , Humanos , Hormônio Paratireóideo , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Transplante Autólogo
4.
Int Ophthalmol ; 41(7): 2315-2328, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34117964

RESUMO

PURPOSE: To review the published literature on indications and outcomes of DSAEK/DSEK and DMEK for the treatment of failed penetrating keratoplasty. DESIGN: This is a systematic review and single-arm meta-analysis. METHODS: Literature searches were conducted in PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews. Prospective and retrospective studies reporting DSAEK/DSEK or DMEK after failed penetrating keratoplasty were included. Primary outcome measures are graft survival and detachment rates, as well as postoperative visual outcomes. RESULTS: A total of 25 studies with 970 patients/989 eyes were included, comprising 735 patients with 746 eyes which underwent DSAEK/DSEK surgery and 235 patients with 243 eyes which underwent DMEK surgery, all of them following a previously failed PK. There were no randomized controlled studies. In all of the DSAEK-PK studies, the graft failure rate was 18% (10%, 26%), the detachment rate was 15% (9%, 22%) and the rejection rate was 7% (3%, 12%) by the time of the last follow-up. And in all of the DMEK-PK studies, the graft failure rate was 14% (4%, 27%), the detachment rate was 42% (28%, 56%) and the rejection rate was 7% (2%, 16%). The mean visual acuity of the DSAEK-PK and DMEK-PK groups is 0.65 ± 0.18 and 0.43 ± 0.23 logMAR, respectively, at 6 months postoperatively. CONCLUSIONS: Endothelial keratoplasty for treatment of failed penetrating keratoplasty led to improved vision and graft clarity in most recipients. Though graft survival rates and rejection rates were comparable between the two groups, the DMEK-PK group showed better visual outcomes with higher detachment rate.


Assuntos
Doenças da Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Doenças da Córnea/cirurgia , Epitélio Posterior , Sobrevivência de Enxerto , Humanos , Ceratoplastia Penetrante , Estudos Prospectivos , Estudos Retrospectivos , Revisões Sistemáticas como Assunto
5.
Biomed Res Int ; 2021: 5554500, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34124245

RESUMO

Objective: We aimed to evaluate the advantages of preoperative digital design of skin flaps to repair fingertip defects during the COVID-19 pandemic. We combined digital design with a 3D-printed model of the affected finger for preoperative communication with fingertip defect patients under observation in a buffer ward. Methods: From December 2019 to January 2021, we obtained data from 25 cases of 30 fingertip defects in 15 males and 10 females, aged 20-65 years old (mean 35 ± 5 years). All cases were treated by digitally designing preoperative fingertip defect flaps combined with a 3D-printed model. Preoperative 3D Systems Sense scanning was routinely performed, 3-matic 12.0 was used to measure the fingertip defect area ranging from 1.5 cm × 3.5 cm to 2.0 cm × 5.0 cm, and the skin flap was designed. The flap area was 1.6 cm × 3.6 cm to 2.1 cm × 5.1 cm. CURA 15.02.1 was used to set parameters, and the 3D model of the affected finger was printed prior to the operation. Full-thickness skin grafts were taken from donor areas for repair. Results: No vascular crises occurred in any of the 25 cases, and all flaps survived. The postoperative follow-up occurred over 3-12 months. All patients were evaluated 3 months after operation according to the trial standard of hand function evaluation of the Chinese Hand Surgery Society. The results showed that 20 cases had excellent outcomes (80%), four cases had good outcomes (16%), and one case had a fair outcome (4%). The excellent and good rate was 96%. Conclusions: During the COVID-19 epidemic, fingertip defects were treated with preoperative digital design of fingertip defect flaps combined with 3D printing. Precision design saves surgery time and improves the success rate of surgery and the survival rates of skin flaps. In addition, 3D model simulations improve preoperative communication efficiency, and the personalized design improves patient satisfaction.


Assuntos
COVID-19/epidemiologia , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Pandemias , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Adulto , Idoso , COVID-19/psicologia , China/epidemiologia , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Impressão Tridimensional/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/psicologia , SARS-CoV-2/patogenicidade , Transplante de Pele/psicologia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Resultado do Tratamento , Cicatrização/fisiologia
7.
Biomed Res Int ; 2021: 5554500, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1263956

RESUMO

Objective: We aimed to evaluate the advantages of preoperative digital design of skin flaps to repair fingertip defects during the COVID-19 pandemic. We combined digital design with a 3D-printed model of the affected finger for preoperative communication with fingertip defect patients under observation in a buffer ward. Methods: From December 2019 to January 2021, we obtained data from 25 cases of 30 fingertip defects in 15 males and 10 females, aged 20-65 years old (mean 35 ± 5 years). All cases were treated by digitally designing preoperative fingertip defect flaps combined with a 3D-printed model. Preoperative 3D Systems Sense scanning was routinely performed, 3-matic 12.0 was used to measure the fingertip defect area ranging from 1.5 cm × 3.5 cm to 2.0 cm × 5.0 cm, and the skin flap was designed. The flap area was 1.6 cm × 3.6 cm to 2.1 cm × 5.1 cm. CURA 15.02.1 was used to set parameters, and the 3D model of the affected finger was printed prior to the operation. Full-thickness skin grafts were taken from donor areas for repair. Results: No vascular crises occurred in any of the 25 cases, and all flaps survived. The postoperative follow-up occurred over 3-12 months. All patients were evaluated 3 months after operation according to the trial standard of hand function evaluation of the Chinese Hand Surgery Society. The results showed that 20 cases had excellent outcomes (80%), four cases had good outcomes (16%), and one case had a fair outcome (4%). The excellent and good rate was 96%. Conclusions: During the COVID-19 epidemic, fingertip defects were treated with preoperative digital design of fingertip defect flaps combined with 3D printing. Precision design saves surgery time and improves the success rate of surgery and the survival rates of skin flaps. In addition, 3D model simulations improve preoperative communication efficiency, and the personalized design improves patient satisfaction.


Assuntos
COVID-19/epidemiologia , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Pandemias , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Adulto , Idoso , COVID-19/psicologia , China/epidemiologia , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Impressão Tridimensional/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/psicologia , SARS-CoV-2/patogenicidade , Transplante de Pele/psicologia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Resultado do Tratamento , Cicatrização/fisiologia
8.
Aging (Albany NY) ; 13(12): 16219-16228, 2021 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-34157682

RESUMO

More and more aged people are undergoing organ transplantation. Understanding aging effects on immunity will be helpful for post-transplantation care and adjustment of immunosuppressants for aged recipients. A mouse model, using C3H mice as donors and aged/young C57BL/10J mice as recipients, was employed to study aging effects on immunity. The results showed that frequency of myeloid-derived suppressor cells (MDSC) and level of TGF-ß was higher in aged mice than in young mice (4.4 ± 1.4% versus 1.6 ± 1.1%, p = 0.026 for MDSC; 21.04 ± 3.91 ng/ml versus 15.26 ± 5.01 ng/ml, p = 0.026 for TGF-ß). In vivo, skin allograft survived longer on the aged than on young mice (19.7 ± 5.2 days versus 11.9 ± 4.1 days, p = 0.005). When entinostat was applied to block MDSC, the survival of skin allografts on aged mice was shorten to 13.5 ± 4.7 days which was not different from the survival on young mice (p = 0.359). In conclusion, allogeneic immunity was different in aged from young mice in high frequency of MDSC and high serum level of TGF-ß. Blocking the function of MDSC reversed the low immunity in aged mice and caused skin allograft rejection similar to young recipients.


Assuntos
Envelhecimento/imunologia , Sobrevivência de Enxerto/imunologia , Transplante de Pele , Envelhecimento/sangue , Animais , Apresentação do Antígeno/imunologia , Citocinas/sangue , Citotoxicidade Imunológica , Estimativa de Kaplan-Meier , Teste de Cultura Mista de Linfócitos , Masculino , Camundongos Endogâmicos C3H , Camundongos Endogâmicos C57BL , Linfócitos T Reguladores/imunologia
9.
Transplant Proc ; 53(5): 1541-1547, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34074467

RESUMO

BACKGROUND: Acute kidney injury (AKI) is common after liver transplantation (LT). Induction with interleukin-2 receptor antagonists is often used as a "renal-sparing" strategy. The aim of this study was to assess this approach in a real-world setting in an LT center. METHODS: A retrospective cohort analysis of LTs between 2011 and 2018 was performed to assess the impact of a renal-sparing strategy using basiliximab in conjunction with mycophenolate mofetil and corticosteroids from day 0 post-LT along with delayed introduction of tacrolimus. This was compared with a group receiving tacrolimus, mycophenolate mofetil, and corticosteroids from the outset. RESULTS: The renal-sparing regimen was associated with significantly lower incidence of all-stage AKI at day 7 post-LT (36% vs 55%, P = .006) and less decline in renal function at 3 months (39% vs 57%, P = .01). No further significant differences in renal outcomes were observed at other time points on follow-up to 1 year post-LT. There was no significant difference in the incidence of acute cellular rejection, inpatient length of stay or graft survival. The decision to adopt a renal-sparing regimen was predominantly made on a clinically reactive basis within the first 24 hours post-LT in 77%, and was preordained in 23%. Cost-effectiveness analysis did not find evidence of a significant cost saving when using a renal-sparing strategy. CONCLUSION: This study provides real-world analysis of the use of a renal-sparing immunosuppression regimen in LT. Although improvements in incidence of AKI in the short term were demonstrated, this did not translate to cost savings or improved renal outcomes after 3 months.


Assuntos
Injúria Renal Aguda/prevenção & controle , Basiliximab/administração & dosagem , Imunossupressores/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Tacrolimo/administração & dosagem , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Corticosteroides/administração & dosagem , Adulto , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Imunossupressão/métodos , Incidência , Rim/efeitos dos fármacos , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
10.
Curr Opin Organ Transplant ; 26(4): 381-389, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34101665

RESUMO

PURPOSE OF REVIEW: To define recent changes and future directions in the practice of pancreas transplantation (PT). Two major events have occurred in the past 18 months: COVID-19 pandemic, and the first world consensus conference on PT. Several innovative studies were published after the consensus conference. RECENT FINDINGS: During COVID-19 pandemic PT activity decreased. COVID-19 in transplant recipients increases mortality rates, but data from kidney transplantation show that mortality might be higher in waitlisted patients.The world consensus conference provided 49 jury deliberations on the impact of PT on management of diabetic patients and 110 practice recommendations.Recent evidence demonstrates that PT alone is safe and effective, that results of simultaneous pancreas and kidney (SPK) remain excellent despite older recipient age and higher prevalence of type 2 diabetes, that use of hepatitis C virus (HCV)-positive donors into HCV-negative recipients is associated with good outcomes, and that use of sirolimus as primary immunosuppressant and costimulation blockade does not improve results of SPK. SUMMARY: COVID-19 pandemic and the first world consensus conference on PT were major events. Although COVID-19 pandemic should not reduce PT activity in the future, a major positive impact on both volume and outcomes of PT is awaited from the proceedings of the world consensus conference.


Assuntos
COVID-19/epidemiologia , Transplante de Pâncreas/tendências , SARS-CoV-2 , Conferências de Consenso como Assunto , Seleção do Doador , Sobrevivência de Enxerto/fisiologia , Humanos , Transplante de Rim/tendências , Transplante de Pâncreas/mortalidade , Transplantados
11.
Int J Mol Sci ; 22(11)2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34063776

RESUMO

Calcineurin inhibitors are highly efficacious immunosuppressive agents used in pediatric kidney transplantation. However, calcineurin inhibitor nephrotoxicity (CNIT) has been associated with the development of chronic renal allograft dysfunction and decreased graft survival. This study evaluated 37 formalin-fixed paraffin-embedded biopsies from pediatric kidney transplant recipients using gene expression profiling. Normal allograft samples (n = 12) served as negative controls and were compared to biopsies exhibiting CNIT (n = 11). The remaining samples served as positive controls to validate CNIT marker specificity and were characterized by other common causes of graft failure such as acute rejection (n = 7) and interstitial fibrosis/tubular atrophy (n = 7). MiRNA profiles served as the platform for data integration. Oxidative phosphorylation and mitochondrial dysfunction were the top molecular pathways associated with overexpressed genes in CNIT samples. Decreased ATP synthesis was identified as a significant biological function in CNIT, while key toxicology pathways included NRF2-mediated oxidative stress response and increased permeability transition of mitochondria. An integrative analysis demonstrated a panel of 13 significant miRNAs and their 33 CNIT-specific gene targets involved with mitochondrial activity and function. We also identified a candidate panel of miRNAs/genes, which may serve as future molecular markers for CNIT diagnosis as well as potential therapeutic targets.


Assuntos
Biomarcadores/metabolismo , Inibidores de Calcineurina/toxicidade , Sobrevivência de Enxerto/genética , Nefropatias/induzido quimicamente , Nefropatias/genética , Transcriptoma/genética , Biópsia/métodos , Inibidores de Calcineurina/uso terapêutico , Criança , Biologia Computacional/métodos , Perfilação da Expressão Gênica/métodos , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/genética , Humanos , Imunossupressores/uso terapêutico , Imunossupressores/toxicidade , Rim/efeitos dos fármacos , Rim/metabolismo , Transplante de Rim/efeitos adversos , MicroRNAs/genética , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/genética , Transplantados , Transplante Homólogo/métodos
12.
Zhonghua Wai Ke Za Zhi ; 59(6): 491-496, 2021 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-34102733

RESUMO

Objectives: To study the risk factors for massive intraoperative blood loss in children with biliary atresia who underwent liver transplantation for the first time,and to analyze their impacts on graft survival,hospital stay and postoperative complications. Methods: The data of 613 children with biliary atresia who underwent liver transplantation at Department of Pediatric Organ Transplantation,Tianjin First Central Hospital from January 2015 to December 2018 were collected and analyzed. There were 270 males and 343 females, aged 7.4 (3.9) months (range: 3.2 to 148.4 months), the body weight of the recipients were (7.8±3.5) kg (range: 4.0 to 43.3 kg).According to the 85th quad of estimated blood loss(EBL),they were divided into two groups:massive EBL group(96 cases) and non massive EBL group(517 cases). The age,height,weight and other factors between the two groups were analyzed and compared. Univariate Logistic regression and multiple stepwise regression were used to determine the risk factors of massive EBL. Then,the postoperative complications of the two groups,including portal vein thrombosis and portal vein anastomotic stenosis etc.,were analyzed and compared by chi square test. Kaplan Meier curve and log rank test were used to analyze the recipient and graft survival rate of the two groups. Results: During the study period,713 transplants were performed and 613 patients were enrolled in the study. Ninety-six patients(15.7%) had massive EBL,and the postoperative hospital stay was 21(16) days(range:2 to 116 days),the hospital stay of non-massive EBL group was 22(12)days(range:3 to 138 days)(U=24 224.0,P=0.32). Univariate Logistic regression analysis showed that the recipient's weight,Kasai portoenterostomy,platelet count,operation time and cold ischemia time were the risk factors of massive EBL during biliary atresia transplantation. Multiple regression analysis showed that cold ischemia time ≥10 hours,prolonged operation time(≥8 hours) and body weight<5.5 kg were important independent risk factors for massive EBL.The incidence of portal vein thrombosis,hepatic vein stenosis,intestinal leakage and pulmonary infection in patients with massive EBL were significantly higher than those without massive EBL(3.1% vs. 0.8%,9.4% vs. 2.1%,6.3% vs. 0.8%,30.2% vs. 20.1%,all P<0.05). The 3-year overall graft and recipient survival rate were significantly lower in patients with massive EBL than those without massive EBL(87.5% vs. 95.7%,P=0.001;84.4% vs. 95.4%,P<0.01,respectively). Conclusions: In children with biliary atresia who underwent liver transplantation for the first time,the effective control of intraoperative bleeding should shorten the operation time and reduce the cold ischemia time as far as possible,on the premise of ensuring the safety of operation. For children without growth disorder,the weight of children should be increased to more than 5.5 kg as far as possible to receive the operation. Reducing intraoperative bleeding is of great significance to the prognosis of children.


Assuntos
Atresia Biliar , Transplante de Fígado , Atresia Biliar/cirurgia , Criança , Feminino , Sobrevivência de Enxerto , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
13.
Trials ; 22(1): 414, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167567

RESUMO

BACKGROUND: Induction therapy with IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent in low immunological risk kidney transplant recipients. However, the role of IL2-RA in the setting of tacrolimus-based immunosuppression has not been fully investigated. AIMS: To compare different induction therapeutic strategies with 2 doses of basiliximab vs. no induction in low immunologic risk kidney transplant recipients as per KFSHRC protocol. METHODS: Prospective, randomized, double blind, non-inferiority, controlled clinical trial EXPECTED OUTCOMES: 1. Primary outcomes: Biopsy-proven acute rejection within first year following transplant 2. SECONDARY OUTCOMES: a. Patient and graft survival at 1 year b. eGFR at 6 months and at 12 months c. Emergence of de novo donor-specific antibodies (DSAs) TRIAL REGISTRATION: The study has been prospectively registered at clinicaltrials.gov (NTC: 04404127). Registered on 27 May 2020.


Assuntos
Transplante de Rim , Basiliximab , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Humanos , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tacrolimo
14.
Acta Cir Bras ; 36(5): e360503, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34161432

RESUMO

PURPOSE: As a classical xenotransplantation model, porcine kidneys have been transplanted into the lower abdomen of non-human primates. However, we have improved upon this model by using size-matched grafting in the orthotopic position. The beneficial aspects and surgical details of our method are reported herein. METHODS: Donors were two newborn pigs (weighting 5 to 6 kg) and recipients were two cynomolgus monkeys (weighting, approximately, 7 kg). After bilateral nephrectomy, kidneys were cold-transported in Euro-Collins solution. The porcine kidney was transplanted to the site of a left nephrectomy and fixed to the peritoneum. RESULTS: Kidneys transplanted to the lower abdomen by the conventional method were more susceptible to torsion of the renal vein (two cases). In contrast, early-stage blood flow insufficiency did not occur in orthotopic transplants of theleft kidney. CONCLUSIONS: Size-matched porcine-primate renal grafting using our method of transplanting tothe natural position of the kidneys contributes to stable post-transplant blood flow to the kidney.


Assuntos
Transplante de Rim , Transplantes , Animais , Sobrevivência de Enxerto , Rim/cirurgia , Macaca fascicularis , Nefrectomia , Suínos
15.
BMC Med Res Methodol ; 21(1): 127, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34154541

RESUMO

BACKGROUND: Kidney graft failure risk prediction models assist evidence-based medical decision-making in clinical practice. Our objective was to develop and validate statistical and machine learning predictive models to predict death-censored graft failure following deceased donor kidney transplant, using time-to-event (survival) data in a large national dataset from Australia. METHODS: Data included donor and recipient characteristics (n = 98) of 7,365 deceased donor transplants from January 1st, 2007 to December 31st, 2017 conducted in Australia. Seven variable selection methods were used to identify the most important independent variables included in the model. Predictive models were developed using: survival tree, random survival forest, survival support vector machine and Cox proportional regression. The models were trained using 70% of the data and validated using the rest of the data (30%). The model with best discriminatory power, assessed using concordance index (C-index) was chosen as the best model. RESULTS: Two models, developed using cox regression and random survival forest, had the highest C-index (0.67) in discriminating death-censored graft failure. The best fitting Cox model used seven independent variables and showed moderate level of prediction accuracy (calibration). CONCLUSION: This index displays sufficient robustness to be used in pre-transplant decision making and may perform better than currently available tools.


Assuntos
Transplante de Rim , Austrália , Sobrevivência de Enxerto , Humanos , Rim , Doadores de Tecidos
17.
Stud Health Technol Inform ; 281: 188-192, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042731

RESUMO

This paper investigates the clinical attributes that contribute to kidney graft failure following live and deceased donor transplantation using an association rule mining approach. The generated rules are used to analyze the distinctive co-occurrence of attributes for those with or without all-cause graft failure. Analysis of a kidney transplantation dataset acquired from the Scientific Registry of Transplant Recipients that included over 95000 deceased and live donor recipients over 5-years was performed. Using an association rule mining approach, we were able to confirm established risk factors for graft loss after live and deceased donor transplantation and identify novel combinations of factors that may have implications for clinical care and risk prediction post kidney transplantation. Using lift as the metric to evaluate association rules, our results indicate that advanced recipient age (i.e. over 60 years), end stage kidney disease due to diabetes, the presence of recipient peripheral vascular disease and recipient coronary artery disease have a high likelihood of graft failure within 5 years after transplantation.


Assuntos
Transplante de Rim , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Rim , Doadores Vivos , Fatores de Risco , Doadores de Tecidos , Transplantados , Resultado do Tratamento
18.
Curr Opin Ophthalmol ; 32(4): 331-337, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33989234

RESUMO

PURPOSE OF REVIEW: Immune rejection after corneal transplantation is a major risk for graft failure. We aim to summarize recent advances in the understanding and management of graft rejection. RECENT FINDINGS: Immune rejection remains the leading cause of graft failure in penetrating keratoplasty (PKP). While ABO blood type and sex match between donor and recipient may reduce rejection, human leucocyte antigens class II matching in a randomized study did not reduce the risk of rejection in high-risk PKP. Compared with PKP, deep anterior lamellar keratoplasty, descemet stripping automated endothelial keratoplasty, and descemet membrane endothelial keratoplasty have lower immune rejection rates of 1.7-13%, 5-11.4%, and 1.7-2.8%, respectively, based on long-term (5 years and more) studies. Whether immune rejection is a major risk factor for graft failure in these lamellar keratoplasties is unclear. While there have not been major advances in the systemic management of graft rejection, topical nonsteroid agents such as tacrolimus and anti-vascular endothelial growth factor have shown promise in high-risk cases. SUMMARY: Immune rejection remains the leading cause of graft failure in PKP. Lamellar keratoplasties have significantly lower rejection rates compared with PKP. The significance of rejection in the failure of lamellar grafts warrants further investigation.


Assuntos
Doenças da Córnea/cirurgia , Transplante de Córnea/efeitos adversos , Rejeição de Enxerto/imunologia , Imunidade Celular , Sobrevivência de Enxerto , Humanos , Fatores de Risco , Doadores de Tecidos
19.
BMC Med Res Methodol ; 21(1): 104, 2021 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-33992081

RESUMO

BACKGROUND: Tacrolimus is given post-kidney transplant to suppress the immune system, and the amount of drug in the body is measured frequently. Higher variability over time may be indicative of poor drug adherence, leading to more adverse events. It is important to account for the variation in Tacrolimus, not just the average change over time. METHODS: Using data from the University of Colorado, we compare methods of assessing how the variability in Tacrolimus influences the hazard of de novo Donor Specific Antibodies (dnDSA), an early warning sign of graft failure. We compare multiple joint models in terms of fit and predictive ability. We explain that the models that account for the individual-specific variability over time have the best predictive performance. These models allowed each patient to have an individual-specific random error term in the longitudinal Tacrolimus model, and linked this to the hazard of dnDSA model. RESULTS: The hazard for the variance and coefficient of variation (CV) loading parameter were greater than 1, indicating that higher variability of Tacrolimus had a higher hazard of dnDSA. Introducing the individual-specific variability improved the fit, leading to more accurate predictions about the individual-specific time-to-dnDSA. CONCLUSIONS: We showed that the individual's variability in Tacrolimus is an important metric in predicting long-term adverse events in kidney transplantation. This is an important step in personalizing the dosage of TAC post-transplant to improve outcomes post-transplant.


Assuntos
Rejeição de Enxerto , Isoanticorpos , Biomarcadores , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Humanos , Imunossupressores/efeitos adversos , Estudos Retrospectivos , Tacrolimo/efeitos adversos
20.
Ann Plast Surg ; 86(6): 701-706, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34002724

RESUMO

PURPOSE: To evaluate the effect of inactive form of platelet-rich plasma (PRP) at different injection time on the prefabricated flap viability in rabbits. METHODS: A thoracodorsal artery vascular bundle prefabricated flap was established on the back of 30 healthy male New Zealand white rabbits by 2 phases of operations. A total of 60 sides were randomly divided into the experimental side and the control side. The experimental side was injected with autologous inactive PRP around the thoracodorsal vascular bundle, and the control side was injected with the same amount of normal saline. According to preoperative (group A), intraoperative (group B), and postoperative (group C) injection of PRP, 30 rabbits were divided into 3 groups of 10 each. Histological and immunohistochemical observation, vascular density measurement, and lead oxide angiography were used to compare the differences in the survival of prefabricated flaps between the 3 groups of rabbits injected with inactive PRP at different injection time. RESULTS: The flap survival ratio, microvessels density, vascular endothelial growth factor and vascular endothelial growth factor receptor 2 expression of PRP injection side were significantly improved compared with the control side. In the comparison of 3 injection time groups, we found that group A and group B could achieve better results, and especially group B had the most significant effect on the revascularization and flap viability. CONCLUSION: Autologous inactive PRP can promote the survival of the prefabricated flap, and the intraoperative injection can significantly improve the survival rate of the prefabricated flap. It provides a theoretical guidance for obtaining a larger area of prefabricated axial flap in clinical practice.


Assuntos
Plasma Rico em Plaquetas , Fator A de Crescimento do Endotélio Vascular , Animais , Sobrevivência de Enxerto , Injeções , Masculino , Coelhos , Transplante de Pele , Retalhos Cirúrgicos
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