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1.
Transplant Proc ; 51(8): 2676-2682, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31477422

RESUMO

BACKGROUND: The hypothermic machine perfusion reduces delayed graft function after kidney transplant and allows, to some extent, predicting early graft function. However, it is difficult to identify exact perfusion criteria with which to exclude kidneys from transplant or modify post-transplant care. The aim of this study was to analyze whether renal resistance during the fourth hour of hypothermic machine perfusion is useful in the prediction of graft survival and acute rejection. PATIENTS AND METHODS: Data on pretransplant hypothermic machine perfusion parameters of 407 transplanted kidneys were available. Receiver operating characteristic curve analysis was performed to find an optimal cutoff value of ratio for predicting a higher risk class of considered group of patients. According to this, patients were divided into 2 groups: those who received kidneys with renal resistance lower than 0.19 mm Hg/mL/min (R1; n = 187) and those who received kidneys with renal resistance equal to or higher than 0.19 mm Hg/mL/min (R2; n = 220). Within R2, we additionally analyzed 2 subgroups: patients who received induction therapy (R2-Ind+; n = 124) and those who did not received induction therapy (R2-Ind-; n = 96). RESULTS: Acute rejection in R1 within 1 month post transplant was 2-fold lower compared with R2 and was 6.4% vs 13.1% (P = .03), respectively. One-year graft survival was higher in R1 compared with R2 and was 94.6% vs 88.5% (P = .03), respectively. Acute rejection in the R2-Ind+ subgroup within 1 month post transplant was 2.46-fold lower compared with the R2-Ind- subgroup and was 8% vs 19.7% (P = .01), respectively. CONCLUSION: Immunosuppression treatment after transplant should be adjusted to perfusion parameters.


Assuntos
Imunossupressão/métodos , Transplante de Rim , Rim/fisiopatologia , Preservação de Órgãos/métodos , Transplantes/fisiopatologia , Adulto , Função Retardada do Enxerto/fisiopatologia , Feminino , Rejeição de Enxerto/fisiopatologia , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Perfusão
2.
Transplant Proc ; 51(8): 2523-2526, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31473009

RESUMO

BACKGROUND: The need for donor pool expansion remains an important task for kidney transplantation. The aim of this study is the evaluation of primary nonfunction (PNF) from donation after circulatory death (DCD) kidneys. METHODS: Between 1996 and 2017, 100 kidney transplants from DCD donors were conducted in our department. We retrospectively analyzed PNF of kidney transplant recipients from DCD donors in terms of donors' and recipients' epidemiologic characteristics. RESULTS: Of 100 grafts, 95 recipients (95.0%) had discontinued hemodialysis at the time of hospital discharge. Only 5 recipients (5.0%) developed PNF. All 5 PNF recipients received a single graft from an expanded criteria donor (ECD). The mean donor age in the PNF group was 65.0 (SD, 6.2) years. Significant differences between the PNF group and discontinued dialysis group were found for donor age (P < .01) and for the use of ECD kidneys (P < .02). Nevertheless, no significant difference was found between groups for several factors: a history of hypertension and cerebrovascular events, terminal creatinine levels, and graft weight. CONCLUSION: The incidence of PNF from DCD kidneys was very low. Although ECD kidneys in older donors might be a significant risk factor for PNF, these findings suggest that DCD kidneys should be used more frequently for donor expansion.


Assuntos
Rejeição de Enxerto/epidemiologia , Transplante de Rim/efeitos adversos , Doadores de Tecidos/estatística & dados numéricos , Adulto , Idoso , Morte , Feminino , Rejeição de Enxerto/etiologia , Humanos , Incidência , Rim/fisiopatologia , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Transplantes/fisiopatologia , Resultado do Tratamento
3.
Transplant Proc ; 51(8): 2575-2581, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31474451

RESUMO

BACKGROUND: This study aimed to investigate the outcomes of kidney transplantation (KT) from deceased acute kidney injury (AKI) donors and analyzed the factors affecting these outcomes. METHODS: All patients who underwent KT from deceased donors at our institution from 1998 to 2016 were retrospectively reviewed. Recipients were divided into the AKI and non-AKI donor groups. We analyzed delayed graft function (DGF), serum creatinine levels at 1 month and 1 year after KT, cold ischemia time, donors' initial and terminal serum creatinine levels, Kidney Donor Profile Index, and patient and graft survival in each group. RESULTS: Of 181 recipients, 30 received kidneys from 21 AKI donors, whereas the remaining 151 received kidneys from donors without AKI. DGF more frequently developed in the AKI donor group than in the non-AKI donor group (40% vs 7.28%; P = .001). Allograft functions at 1 month and 1 year after KT did not differ between the AKI and non-AKI donor groups (1 month: P = .469; 1 year: P = .691). Factors affecting DGF were recipient weight and donor AKI. Recipient factors affecting graft function at 1 year were recipient height, length of hospital stay, serum creatinine levels at 1 month and 6 months, and biopsy-proven acute rejection. Older donor age was the only donor factor that affected graft function at 1 year. CONCLUSION: KT from deceased AKI donors showed a higher DGF rate but favorable patient and graft survival and graft functions. Donor AKI and recipient weight affected DGF, and only older donor age affected graft function at 1 year.


Assuntos
Lesão Renal Aguda , Função Retardada do Enxerto/epidemiologia , Função Retardada do Enxerto/etiologia , Transplante de Rim/métodos , Doadores de Tecidos , Adulto , Fatores Etários , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Homólogo , Transplantes/fisiopatologia
4.
Transplant Proc ; 51(8): 2520-2522, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31395361

RESUMO

We have adopted a modified method to resuscitate kidneys from donation after circulatory death (DCD) donors with the use of Euro-Collins (EC) solution instead of University of Wisconsin solution. This study aimed to evaluate kidney transplantation (KTx) outcomes of DCD procured with low-dose in situ perfusion using EC solution. PATIENTS AND METHODS: KTx was performed in 8 adults. Kidney grafts were procured following in situ perfusion with approximately 1 L of EC solution and preserved in the solution. The kidney donor profile index value was 88% ± 21%. The terminal creatinine level of the donors was 5.5 ± 3.4 mg/dL. Of the 8 donors, 6 experienced oligoanuria prior to graft procurement. RESULTS: The mean age of the recipients and the hemodialysis vintage were 50 ± 10 years and 161 ± 25 months, respectively. The warm and cold ischemic times were 8.3 ± 7.9 minutes and 8.7 ± 4.3 hours, respectively. All grafts functioned after a delayed graft function of 10.6 ± 6.9 days (2-25 days). There was neither immediate graft function nor primary nonfunction. The patient and graft survivals were both 100% with a terminal creatinine level of 1.3 ± .5 mg/dL. CONCLUSIONS: Kidney grafts procured from DCD donors with a high kidney donor profile index value demonstrated good renal function with an excellent midterm outcome. Low-dose in situ perfusion with EC solution is effective for the procurement of marginal kidney grafts from DCD donors under optimal conditions such as a relatively shorter preservation time.


Assuntos
Sobrevivência de Enxerto , Soluções Hipertônicas/administração & dosagem , Transplante de Rim/métodos , Preservação de Órgãos/métodos , Perfusão/métodos , Adulto , Isquemia Fria , Creatinina/análise , Morte , Função Retardada do Enxerto/etiologia , Feminino , Humanos , Rim/efeitos dos fármacos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Transplantes/efeitos dos fármacos , Transplantes/fisiopatologia , Resultado do Tratamento , Isquemia Quente
5.
Transplant Proc ; 51(6): 1785-1790, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399164

RESUMO

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


Assuntos
Circulação Extracorpórea/métodos , Hipotermia Induzida/métodos , Preservação de Órgãos/métodos , Perfusão/métodos , Fluxo Pulsátil , Morte , Feminino , Taxa de Filtração Glomerular , Glutationa Transferase/análise , Sobrevivência de Enxerto , Humanos , Rim/irrigação sanguínea , Rim/fisiopatologia , Transplante de Rim , Masculino , Taxa de Sobrevida , Doadores de Tecidos , Transplantes/irrigação sanguínea , Transplantes/fisiopatologia , Resultado do Tratamento
6.
Transplant Proc ; 51(7): 2312-2317, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400978

RESUMO

PURPOSE: The aim of this study is to determine the correlation between the predonation computed tomography (CT)-based calculated kidney volume and post-transplant renal function in recipients of renal transplants and to compare two different CT techniques. MATERIAL AND METHODS: The study group is comprised of 55 paired living kidney donor-recipients transplants. The total parenchymal renal volumes were calculated by using two CT-based techniques (3-dimensional renal volume [3DRV] and voxel-based volume calculation). Post-transplant creatinine and estimated glomerular filtration rate (eGFR) levels for the recipients at hospital discharge and sixth month were obtained. We tested the association with eGFR and creatinine by adjusting the renal volume to body weight and body mass index. For the creatinine levels above 1.5 mg/dL at discharge, a threshold value for renal volume-to-weight ratio on receiver operating characteristic curve (ROC) analysis and odds ratio (OR) were calculated. RESULTS: The renal volumes adjusted to weight were found to be moderately correlated with eGFR and creatinine levels at discharge (r = 0.51 and r = -0.54 for voxel-based calculation; r = 0.52 and r = -0.52 for 3DRV calculation, P < .001, respectively) and at sixth month (r = 0.55 and r = -0.58 for voxel-based calculation; r = 0.51 and r = -0.54 for 3DRV calculation, P < .001 respectively). A threshold value of 1.84 mL/kg was calculated for parenchymal volume-to-recipient weight ratio on ROC analysis (AUC±SE, 0.760 ± 0.078, P = .008). The likelihood of creatinine elevation above 1.5 mg/dL was found to be nine times greater for smaller renal volume-to-recipient weight ratios (OR = 9.6; 95% CI, 1.8-50.6) CONCLUSIONS: Predonation renal volume adjusted to recipient weight may estimate the renal function at discharge and 6 months after transplantation.


Assuntos
Tomografia Computadorizada de Feixe Cônico/estatística & dados numéricos , Transplante de Rim/métodos , Rim/patologia , Transplantes/patologia , Adulto , Tomografia Computadorizada de Feixe Cônico/métodos , Creatinina/análise , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Rim/fisiopatologia , Testes de Função Renal/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Tamanho do Órgão , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Transplantes/diagnóstico por imagem , Transplantes/fisiopatologia , Resultado do Tratamento
7.
Transplant Proc ; 51(6): 1673-1678, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307770

RESUMO

BACKGROUND: Previously, we showed that B-type natriuretic peptide (BNP) measured in the donor was related to cardiac performance after cardiac transplantation. The present study assesses the value of 3 biomarkers in the selection of donor hearts in a larger cohort. METHODS: Blood samples were prospectively obtained in 105 brain-dead patients scheduled for heart donation. BNP, soluble suppressor of tumorigenicity 2 (ST2), and troponin of heart donors were correlated with hemodynamic parameters early after transplantation as well as with the mortality of the recipients. RESULTS: A significant inverse relationship was found between donor BNP measured at the time of donation and recipient cardiac index and cardiac output at day 13 post-transplantation (r = -0.31, P = .005, and r = -0.34, P = .0016, respectively). Logistic regression analysis-including BNP, ST2, and troponin-showed that donor BNP was a predictor of a poor cardiac index (< 2.2 L/min/m2) in the recipient (P = .04). A donor BNP > 132 pg/mL has a sensitivity of 56% (95% confidence interval 21-86) and a specificity of 86% (95% confidence interval 77-93) to predict poor cardiac performance in the recipient. When the donor BNP is ≤ 132 pg/mL, the risk of a poor cardiac function in the recipient is very low (negative predictive value 94%). Mortality at 30 days was also correlated to donor BNP (r = 0.29, P = .0029). Long-term survival of the recipient was not correlated to the biomarkers measured in the donor. CONCLUSION: Donor BNP, but not donor ST2 or high-sensitivity troponin, provides information on the donor heart and early post-transplant performance, including 1-month mortality.


Assuntos
Morte Encefálica/sangue , Seleção do Doador/métodos , Transplante de Coração , Proteína 1 Semelhante a Receptor de Interleucina-1/sangue , Peptídeo Natriurético Encefálico/sangue , Troponina/sangue , Adulto , Biomarcadores/sangue , Débito Cardíaco , Feminino , Coração/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Doadores de Tecidos , Transplantes/fisiopatologia , Resultado do Tratamento
8.
Transplant Proc ; 51(6): 2022-2028, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303418

RESUMO

BACKGROUND: Extended periods of ex vivo lung perfusion (EVLP) lead to several inadvertent consequences including accumulation of lactate and increasing electrolyte concentrations in the perfusate. We sought to determine whether continuous hemodialysis (CHD) of the perfusate would be a suitable modality for improving ionic homeostasis in extended EVLP without compromising functional outcomes. METHODS: Twelve porcine lungs were perfused using EVLP for 24 hours. All lungs were ventilated with negative pressure ventilation. Lungs in the treatment group (n = 6) underwent continuous hemodialysis of the perfusate. Functional parameters, edema formation, and histopathologic analysis were used to assess graft function. Electrolyte and lactate profiles were also followed to assess the efficiency of hemodialysis. RESULTS: Lungs in both treatment and control groups demonstrated stable and acceptable oxygenation to 24 hours. Lungs demonstrated a decrease in compliance over time. There was no difference in oxygenation and compliance between groups. CHD-EVLP lungs had higher pulmonary vascular resistance and pulmonary artery pressures. Despite increased perfusion pressures, weight gain at both 11 and 23 hours was not different between groups. Perfusate sodium and lactate concentrations were significantly lower in the CHD-EVLP group. CONCLUSION: The addition of continuous hemodialysis to EVLP did not improve graft function up to 24 hours despite improved maintenance of perfusate composition.


Assuntos
Circulação Extracorpórea/métodos , Transplante de Pulmão/métodos , Perfusão/métodos , Diálise Renal/métodos , Transplantes/fisiopatologia , Animais , Feminino , Técnicas In Vitro , Pulmão/fisiopatologia , Sus scrofa , Suínos
9.
Transplant Proc ; 51(3): 647-650, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30979447

RESUMO

BACKGROUND: Inflammation, coagulation, and fibrinolysis are tightly linked together. Reperfusion after transient ischemia activates both neutrophils, coagulation, and fibrinolysis. Experimental data suggest that tissue plasminogen activator (tPA) regulates renal neutrophil influx in kidney ischemia and reperfusion injury. METHODS: In 30 patients undergoing kidney transplantation, we measured renal neutrophil sequestration and tPA release from blood samples drawn from the supplying artery and renal vein early after reperfusion. tPA antigen levels were measured using a commercial enzyme-linked immunosorbent assay kit. For each parameter, transrenal difference (Δ) was calculated by subtracting the value of the arterial sample (ingoing blood) from the value of the venous sample (outgoing blood). RESULTS: Positive transrenal gradients of tPA antigen occurred at 1 minute [Δ = 14 (3-46) ng/mL, P < .01] and 5 minutes [Δ = 5 (-3 to 27) ng/mL, P < .01] after reperfusion. At 5 minutes after reperfusion, a negative transrenal gradient of neutrophils was observed [Δ = -0.17 (-1.45 to 0.24) x 10E9 cells/L, P < .001]. At 1 minute after reperfusion, neutrophil sequestration into the kidney (ie, negative transrenal neutrophil count) correlated significantly with tPA release from the kidney (ie, positive transrenal tPA concentration), (R = -0.513 and P = .006). CONCLUSIONS: The findings suggest a proinflammatory role for tPA in ischemia and reperfusion injury in human kidney transplantation.


Assuntos
Transplante de Rim , Rim/fisiopatologia , Neutrófilos/metabolismo , Traumatismo por Reperfusão/metabolismo , Ativador de Plasminogênio Tecidual/metabolismo , Transplantes/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão/fisiopatologia
10.
BMC Nephrol ; 20(1): 39, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717699

RESUMO

BACKGROUND: The problem of organ shortage is an important issue in kidney transplantation, but the effect of kidney donation on AKI is unclear. The aim of this study was to investigate the impact of acute kidney injury (AKI) on post-transplant clinical outcomes for deceased donor kidney transplantation (DDKT) using standard criteria donors (SCDs) versus expanded criteria donors (ECDs). METHODS: Five-hundred nine KT recipients receiving kidneys from 386 deceased donors (DDs) were included from three transplant centers. Recipients were classified into the SCD-KT or ECD-KT group according to corresponding DDs and both groups were divided into the AKI-KT or non-AKI-KT subgroups according to AKI in donor. We compared the clinical outcomes among those four groups and investigated the interaction between AKI in donors and ECD on allograft outcome. RESULTS: The incidence of delayed allograft function was higher when the donors had AKI within SCD-KT and ECD-KT groups. In allograft biopsies within 3 months, chronic change was more significant in the AKI-ECD-KT subgroup than in the non-AKI-ECD-KT subgroup, but it did not differ between AKI-SCD-KT and non-AKI-SCD-KT group. AKI-ECD-KT showed higher risk for death-censored allograft failure than the other three groups and a significant interaction was observed between AKI in donors and ECD on the allograft outcome. CONCLUSIONS: The presence of AKI in ECDs significantly impacted the long-term allograft outcomes of kidney transplant recipients, but it did not in SCDs.


Assuntos
Lesão Renal Aguda/patologia , Função Retardada do Enxerto/etiologia , Seleção do Doador/normas , Transplante de Rim , Doadores de Tecidos , Transplantados , Transplantes/patologia , Lesão Renal Aguda/fisiopatologia , Adulto , Idoso , Cadáver , Função Retardada do Enxerto/epidemiologia , Função Retardada do Enxerto/fisiopatologia , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Transplantes/fisiopatologia , Resultado do Tratamento
11.
BMC Nephrol ; 20(1): 46, 2019 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736760

RESUMO

BACKGROUND: The magnitude of renal function recovery after kidney donation differs in donors with a heterogeneous background. Preoperative assessment of candidates with potentially unfavorable renal functional compensation is critical when baseline kidney function is marginal. We explored the significance of preserved kidney volume (PKV) and known preoperative risk factors for the prediction of unfavorable renal function compensation. METHODS: We enrolled 101 living donors for whom a 1-mm sliced enhanced computed tomography scan was performed preoperatively and clinical data could be collected up to 1 year after donation. The donors whose estimated glomerular filtration rate (eGFR) at 1 year after donation was 70% or higher of baseline eGFR were assigned to the "favorable renal compensation" group and the others to the "unfavorable renal compensation" group. RESULTS: Age, sex, and preoperative serum uric acid level were not significant predictors for "unfavorable renal compensation." Multivariable logistic regression analysis revealed that body mass index (BMI) and body surface area (BSA)-adjusted PKV were independent preoperative risk factors for "unfavorable renal compensation" (adjusted odds ratio, 1.342 and 0.929, respectively). Hypertension and preoperative eGFR were not independent predictors when adjusted with BMI and BSA-adjusted PKV. Receiver operative characteristic analysis revealed that the predictive equation with the two independent predictors yielded a good accuracy to detect donor candidates with unfavorable renal functional compensation (area under the curve = 0.803), and the optimal cut-off values were identified as 23.4 kg/m2 for BMI and 107.3 cm3/m2 for BSA-adjusted PKV. CONCLUSIONS: BMI and BSA-adjusted PKV may be useful to select candidates with potentially unfavorable renal function compensation before kidney donation.


Assuntos
Seleção do Doador/normas , Transplante de Rim , Rim/anatomia & histologia , Rim/fisiopatologia , Doadores Vivos , Transplantes/fisiopatologia , Adulto , Idoso , Área Sob a Curva , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Tamanho do Órgão , Período Pós-Operatório , Prognóstico , Curva ROC , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Ácido Úrico/sangue
12.
Knee Surg Sports Traumatol Arthrosc ; 27(2): 491-497, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30196436

RESUMO

PURPOSE: The purpose of this study was to evaluate the signal/noise quotient (SNQ) for graft maturation and the serial changes observed in the magnetic resonance imaging (MRI) findings after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using a hamstring tendon autograft at a minimum of 5 years after surgery. METHODS: Forty-five patients who underwent DB ACL reconstruction between 2007 and 2010 were included in this prospective study. All participants underwent postoperative MRI at 3 weeks and 3, 6, 9 and 12, 18, 24, 36, 48 and 50 months. The signal intensity (SI) characteristics of the reconstructed graft were evaluated on oblique axial proton density-weighted MR imaging (PDWI) perpendicular to the grafts. The signal/noise quotient (SNQ) was calculated to quantitatively determine the normalized SI. The SNQ of the AMB and PLB was evaluated separately. RESULTS: The mean SNQ of the AM bundle (AMB) continued to increase until 6 months after surgery (5.2 ± 1.2), and then gradually decreased and became well stabilized by 18 months (3.3 ± 0.5), after which it remained unchanged. On the other hand, the mean SNQ of the PL bundle (PLB) continued to increase until 9 months after surgery (6.2 ± 1.1), and then decreased incrementally and became well stabilized by 24 months (4.1 ± 0.5). The SI of PLB was significantly higher than that of AMB between 3 and 24 months (p = 0.04, 0.03, 0.01, 0.04, 0.02 and 0.03, respectively). CONCLUSIONS: These results indicate that at least 18 months is needed after ACL reconstruction to sufficiently restore the SI of the AMB, while at least 24 months are needed to for the PLB. The SI of the PLB was significantly higher than that of the AMB at 3-24 months after surgery, indicating that the PLB showed inferior graft maturity to the AMB until 24 months after surgery. For clinical relevance, the correct understanding of serial changes in graft maturation may potentially be used in decision-making regarding a return to sports. LEVEL OF EVIDENCE: Prospective case series, Level IV.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/reabilitação , Tendões dos Músculos Isquiotibiais/transplante , Articulação do Joelho/diagnóstico por imagem , Transplantes/diagnóstico por imagem , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Autoenxertos , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Período Pós-Operatório , Estudos Prospectivos , Transplante Autólogo , Transplantes/fisiopatologia , Adulto Jovem
13.
BMC Nephrol ; 19(1): 351, 2018 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-30537946

RESUMO

BACKGROUND: Contrast enhanced ultrasonography (CEUS) assessment of kidney allografts mainly focuses on graft rejection. However, studies on delayed graft function (DGF) without acute rejection are still lacking. The aim of this study was to build a time-intensity curve (TIC) using CEUS in non-immunological DGF to understand the utility of CEUS in early transplantation. METHODS: Twenty-eight patients in the short-term postoperative period (<14 days) were divided according to the need for dialysis (early graft function [EGF] and [DGF]) and 37 subjects with longer than 90 days follow-up were divided into creatinine tertiles. Time to peak [TTP] and rising time [RT were compared between groups. RESULTS: EGF and DGF were similar, except for creatinine. In comparison to the late group, medullary TTP and RT were shorter in the early group as well as the delay regarding contrast arrival in the medulla (in relation to cortex) and reaching the medullary peak (in relation to artery and cortex). In the late group, patients with renal dysfunction showed shorter temporal difference to reach medullary peak in relation to artery and cortex. CONCLUSIONS: Although it was not possible to differentiate EGF and DGF using TIC, differences between early and late groups point to blood shunting in renal dysfunction.


Assuntos
Meios de Contraste , Função Retardada do Enxerto/diagnóstico por imagem , Transplante de Rim/tendências , Transplantes/diagnóstico por imagem , Ultrassonografia Doppler/tendências , Adulto , Função Retardada do Enxerto/etiologia , Função Retardada do Enxerto/fisiopatologia , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Transplantados , Transplantes/fisiopatologia , Ultrassonografia Doppler/métodos
14.
Transplant Proc ; 50(10): 3088-3094, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577171

RESUMO

BACKGROUND: The management of a deceased donor in the intensive care unit before organ transplantation is important for the outcome of the recipient. Herein, we analyze the pre-transplant resuscitation factors managed before procurement that could influence graft function immediately after deceased-donor kidney transplantation (DDKT). METHODS: A total of 271 DDKTs performed at Seoul St. Mary's Hospital, Korea, from January 2009 to March 2016 were reviewed. We divided the patients into a delayed graft function (DGF) group and a non-DGF group, and compared postoperative outcomes between the 2 groups. We also analyzed the predisposing factors of DGF using multivariate analysis. RESULTS: A total of 36 cases developed DGF while 235 patients did not, and the demographic characteristics of the recipients in the two groups had no significant difference. Of the pre-transplant resuscitation factors, preoperative polyuria, the maximal levels of serum sodium and BUN, and transfer times were significantly higher in the DGF group (P < .001). In a multivariable analysis, preoperative polyuria (odds ratio 4.835, P = .036), elevated preoperative level of sodium (odds ratio 1.227, P = .001), and extended transfer times (odds ratio 1.001, P < .001) were the independent risk factors of the donor in pre-transplant resuscitation management associated with DGF. CONCLUSIONS: Polyuria, high levels of sodium before procurement, and prolonged transfer times are independent risk factors for DGF after a DDKT. Active intervention and early implementation of the intensivist can help in managing these factors effectively and thus ultimately improve graft function.


Assuntos
Função Retardada do Enxerto/etiologia , Transplante de Rim/métodos , Obtenção de Tecidos e Órgãos/métodos , Transplantes/fisiopatologia , Adulto , Idoso , Morte Encefálica/fisiopatologia , Feminino , Humanos , Rim/fisiopatologia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , República da Coreia , Ressuscitação/métodos , Fatores de Risco , Doadores de Tecidos , Resultado do Tratamento , Adulto Jovem
15.
Transplant Proc ; 50(10): 3698-3704, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577258

RESUMO

BACKGROUND: Utilization of donor hearts remains insufficient. In this observational study, we explored the rate and reasons of rejection of cardiac donors in 1 organ procurement organization. METHODS: Donors were enrolled in the study for 1 year, from October 5, 2014, through October 4, 2015. Data on demographics, medical history, and diagnostic tests were collected. We compared continuous variables between groups using a Mann-Whitney U test, and categorical variables using the χ2test. Multivariate logistic regression analysis was performed to identify factors predicting transplantation. RESULTS: Of 134 adult hearts, only 39.5% were transplanted. Moreover, almost half (46.9%) of non-transplanted hearts were normal by all data available. In 12 (31.5%) of all hearts, coronary artery disease was discovered by pathology, making them unusable for transplantation. Overall, 26 normal hearts (19.4%) were not accepted for transplantation. The most common abnormality of hearts not suitable for transplantation was a decreased left ventricular ejection fraction (LVEF). In about one-fifth of donors with low LVEF on the first echocardiogram, LVEF improved on a second echocardiogram. In a majority of cases with low LVEF, echocardiogram was never repeated. CONCLUSIONS: Almost 20% of normal donor hearts were not transplanted. Coronary artery disease was the most common abnormality in seemingly normal hearts. Coronary angiography should be performed more liberally in potential donors. Decreased LVEF was the most common reason for not using a heart. Since impaired LVEF may be reversible, repeated echocardiogram is encouraged in order to maximize the rate of transplantation.


Assuntos
Transplante de Coração/métodos , Doadores de Tecidos/provisão & distribução , Obtenção de Tecidos e Órgãos/normas , Transplantes/provisão & distribução , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obtenção de Tecidos e Órgãos/métodos , Transplantes/fisiopatologia
16.
Circ J ; 83(1): 232-238, 2018 12 25.
Artigo em Inglês | MEDLINE | ID: mdl-30393270

RESUMO

BACKGROUND: To obtain a saphenous vein graft (SVG) for coronary artery bypass grafting (CABG), the benefit of using a no-touch (NT) technique in vascular function has not been fully investigated. Methods and Results: The pathological and physiological functions of human SVGs with a NT technique to preserve the perivascular adipose tissue (PVAT) and ones obtained by using a conventional (CON) technique removing PVAT, were examined. Immunohistochemistry of the section of SVGs showed that the phosphorylation of endothelial nitric oxide synthase in the endothelium of the NT group was more responsive to vascular endothelial growth factor. A myograph of SVGs showed greater contraction with phenylephrine in the NT group. However, the strong contraction was eliminated in SVGs taken by electrocautery. In the 10 patients whose SVGs were taken without electrocautery, endothelial-dependent relaxation with bradykinin was apparently increased in the CON group more than in the NT group. Smooth muscle relaxation with nitroprusside was higher in the CON group at the lower concentrations; however, the relaxation became greater in the NT group at the high concentrations. Therefore, the effect of neutralizing PVAT-released factors in the both groups was further examined. After medium of NT and CON were exchanged in half, relaxation of SVGs was immediately restored in the NT group. CONCLUSIONS: The results suggest that the NT technique preserves the functions of vasoconstriction and relaxation. Also, the presence of PVAT-released vasoconstrictive factors was suspected.


Assuntos
Ponte de Artéria Coronária , Veia Safena/fisiopatologia , Transplantes/fisiopatologia , Vasoconstrição , Vasodilatação , Idoso , Idoso de 80 Anos ou mais , Endotélio Vascular/metabolismo , Endotélio Vascular/patologia , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Masculino , Óxido Nítrico/metabolismo , Veia Safena/metabolismo , Veia Safena/patologia , Transplantes/metabolismo , Transplantes/patologia
17.
Br J Haematol ; 182(5): 679-692, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29974948

RESUMO

Poor graft function (PGF) is a severe complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT). Murine studies have demonstrated that effective haematopoiesis depends on the specific bone marrow (BM) microenvironment. Increasing evidence shows that BM macrophages (MФs), which constitute an important component of BM immune microenvironment, are indispensable for the regulation of haematopoietic stem cells (HSCs) in the BM. However, little is known about the number and function of BM MФs or whether they directly interact with HSCs in PGF patients. In the current prospective case-control study, PGF patients showed a significant increase in classically activated inflammatory MФs (M1; 2·18 ± 0·11% vs. 0·82 ± 0·06%, P < 0·0001), a striking reduction in alternatively activated anti-inflammatory MФs (M2; 3·02 ± 0·31% vs. 21·89 ± 0·90%, P < 0·0001), resulting in a markedly increased M1/M2 ratio (0·82 ± 0·06 vs. 0·06 ± 0·002; P < 0·0001) in the BM compared with good graft function patients. Meanwhile, standard monocyte subsets were altered in PGF patients. Dysfunctional BM MФs, which were characterized by reduced proliferation, migration and phagocytosis, were evident in PGF patients. Furthermore, BM MФs from PGF patients with high tumour necrosis factor-α and interleukin 12 levels and low transforming growth factor-ß levels, led to impaired BM CD34+ cell function. In summary, our data indicate that an unbalanced BM M1/M2 ratio and dysfunctional MФs may contribute to the occurrence of PGF following allo-HSCT.


Assuntos
Medula Óssea/patologia , Microambiente Celular , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Macrófagos/patologia , Monócitos/patologia , Transplantes/fisiopatologia , Células da Medula Óssea/patologia , Movimento Celular , Proliferação de Células , Humanos , Fagocitose , Transplante Homólogo
18.
Transplant Proc ; 50(6): 1686-1690, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30056882

RESUMO

INTRODUCTION: The approach toward transplanting kidneys from expanded-criteria donors (ECDs) in Poland is largely site-dependent. The Kidney Donor Risk Index (KDRI) allows for obtaining a more precise characteristic of ECDs and further stratification into "better" and "worse" quality grafts. METHODS: Comparison of the incidence of delayed graft function (DGF) and biopsy-proven acute rejection (BPAR), median of hospitalization time and median of estimated glomerular filtration rate (eGFR) at 1 year after transplantation among kidney graft recipients (n = 468), divided by donor status (ECD/standard-criteria donor [SCD]) and KDRI value (I: 0.67-1.2, II: 1.21-1.6, III: 1.61-2.0, IV: 2.01-3.48). RESULTS: ECD kidneys have been transplanted to 32.47% of recipients. There were no ECD recipients in KDRI compartment I, 16.55% in compartment II, 79.22% in compartment III, and 100% in IV. In KDRI compartment II, DGF was diagnosed in 34.9% of SCDs and 56% of ECDs (P = .003), BPAR occurred in 7.8% of SCDs and 16% of ECDs (P = .073), median hospital stay was 12 days for SCDs and ECDs (P = 1), and eGFR was 50.7 mL/min for SCDs and 49.4 mL/min for ECDs (P = .734). In KDRI compartment III, DGF was diagnosed in 43.8% of SCDs and 49.2% of ECDs (P = .139), BPAR occurred in 6.3% of SCDs and 31.7% of ECDs (P = .001), median hospital stay was 10 days for SCDs and 12 days for ECDs (P = .634), and eGFR was 49.5 mL/min for SCDs and 45.2 mL/min for ECDs (P = .382). Among ECD recipients, DGF was diagnosed in 56.0%, 49.2%, and 47.7% of patients for KDRI compartments II, III, and IV respectively (P = .776); BPAR occurred in 16% (compartment II), 31.7% (compartment III), and 23.1% (compartment IV) (P = .273); the median hospital stay was 12 days (compartment II), 12 days (compartment III), and 12.5 days (compartment IV) (P = 1); and eGFR was 49.5 mL/min (compartment II), 45.4 mL/min (compartment III), and 36.1 mL/min (compartment IV) (P = .002). CONCLUSION: Assessment using both the ECD and KDRI systems allows for a more precise evaluation of prognosis and predicting complications among recipients.


Assuntos
Função Retardada do Enxerto/etiologia , Seleção do Doador/estatística & dados numéricos , Rejeição de Enxerto/etiologia , Transplante de Rim/efeitos adversos , Adulto , Idoso , Função Retardada do Enxerto/epidemiologia , Feminino , Taxa de Filtração Glomerular , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto , Humanos , Incidência , Rim/fisiopatologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Polônia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Transplantes/fisiopatologia , Resultado do Tratamento
19.
Transplant Proc ; 50(6): 1730-1732, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30056890

RESUMO

BACKGROUND: After kidney transplantation (KTx), donor- and recipient-dependent factors, as well as the immunosuppression protocol, may have an impact long-term graft function. The aim of this retrospective study was to identify and describe recipients from a single center who had their transplanted kidney survive for more than 20 years. METHODS: The database of KTx recipients was searched to find identify patients with a functioning kidney graft for >20 years. Clinical, demographic, and immunologic data were recorded and analyzed. Moreover, the Charlson Comorbidity Index was calculated. RESULTS: We identified 25 patients, with graft survival of 23.9 ± 3.2 years (maximum, 31.5 years), with following characteristics: age at time of transplantation 36.2 ± 11.9 years; median of 4 human leukocyte antigen (HLA) mismatches; low risk of rejection (panel-reactive antibodies [PRA] 0%); and 14 recipients had delayed graft function (DGF) and 9 had a single episode of acute rejection successfully treated with steroid pulses. In 24 cases there was a deceased donor. There was a predominance of males aged <54 years. At 1 year after KTx, serum creatinine was 1.36 ± 0.26 mg/dL. All recipients were given cyclosporine + azathioprine + prednisone as primary immunosuppression. The majority of recipients have continued to visit the clinic on an oupatient basis, with a most recent creatinine average of 1.5 ± 0.82 mg/dL. CONCLUSION: Very long-term kidney graft survival is most likely associated with a low risk of rejection (0% PRA pre-KTx), a relatively weak immunosuppression protocol, and optimal function at 12 months post-KTx.


Assuntos
Sobrevivência de Enxerto/fisiologia , Imunossupressão/métodos , Transplante de Rim/métodos , Sobreviventes/estatística & dados numéricos , Fatores de Tempo , Adulto , Creatinina/análise , Feminino , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Doadores de Tecidos , Transplantes/fisiopatologia , Resultado do Tratamento
20.
Laryngoscope ; 128(8): E272-E279, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29756207

RESUMO

OBJECTIVES/HYPOTHESIS: Current techniques for airway characterization include endoscopic or radiographic measurements that produce static, two-dimensional descriptions. As pathology can be multilevel, irregularly shaped, and dynamic, minimal luminal area (MLA) may not provide the most comprehensive description or diagnostic metric. Our aim was to examine the utilization of computational fluid dynamics (CFD) for the purpose of defining airway stenosis using an ovine model of tissue-engineered tracheal graft (TETG) implantation. STUDY DESIGN: Animal research model. METHODS: TETGs were implanted into sheep, and MLA was quantified with imaging and endoscopic measurements. Graft stenosis was managed with endoscopic dilation and stenting when indicated. Geometries of the TETG were reconstructed from three-dimensional fluoroscopic images. CFD simulations were used to calculate peak flow velocity (PFV) and peak wall shear stress (PWSS). These metrics were compared to values derived from a quantitative respiratory symptom score. RESULTS: Elevated PFV and PWSS derived from CFD modeling correlated with increased respiratory symptoms. Immediate pre- and postimplantation CFD metrics were similar, and implanted sheep were asymptomatic. Respiratory symptoms improved with stenting, which maintained graft architecture similar to dilation procedures. With stenting, baseline PFV (0.33 m/s) and PWSS (0.006 Pa) were sustained for the remainder of the study. MLA measurements collected via bronchoscopy were also correlated with respiratory symptoms. PFV and PWSS found via CFD were correlated (R2 = 0.92 and 0.99, respectively) with respiratory symptoms compared to MLA (R2 = 0.61). CONCLUSIONS: CFD is valid for informed interventions based on multilevel, complex airflow and airway characteristics. Furthermore, CFD may be used to evaluate TETG functionality. LEVEL OF EVIDENCE: NA. Laryngoscope, E272-E279, 2018.


Assuntos
Broncoscopia/estatística & dados numéricos , Fluoroscopia/estatística & dados numéricos , Hidrodinâmica , Imageamento Tridimensional/estatística & dados numéricos , Estenose Traqueal/diagnóstico por imagem , Animais , Broncoscopia/métodos , Fluoroscopia/métodos , Imageamento Tridimensional/métodos , Modelos Animais , Pico do Fluxo Expiratório , Ovinos , Estresse Mecânico , Engenharia Tecidual , Traqueia/diagnóstico por imagem , Traqueia/fisiopatologia , Traqueia/transplante , Estenose Traqueal/fisiopatologia , Transplantes/diagnóstico por imagem , Transplantes/fisiopatologia , Transplantes/transplante
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