International Journal of Organ Transplantation Medicine最新文献

Background: This study aims to propose an initial development of the FACT-Liver Transplant (FACT-LT) scale to assess the major physical and emotional concerns of patients before and after Orthotopic Liver transplant (OLT) due to acute and chronic liver failure and hepatocellular carcinoma.

Methods: The FACT-LT was developed in two phases. In Phase I, items were generated: 1) through interviews with 10 OLT experts and 15 candidates for or recipients of both oncological and non-oncological OLT which identified relevant topics; 2) from the FACIT item bank. In Phase II, a questionnaire to assess item frequency, applicability, and comprehension was administered to 20 OLT experts and, to assess item difficulty, embarrassment and content irrelevance, to 30 transplant recipients or candidate patients (15 oncological, 15 non-oncological).

Results: In Phase I, 44 items were formulated/reviewed, and 30 items were maintained. All the healthcare professionals interviewed rejected the recommendation to develop two different modules for cancer and non-cancer patients. In Phase II, the majority of the experts and patients expressed an overall satisfaction with the questionnaire, indicating that the items were relevant, comprehensible and not embarrassing (range 75% - 99%). The first version of the FACT-LT includes 28 items defining four QOL domains: 5 items relating to Physical Well-Being, 8 to Functional Well-Being, 13 to Emotional Well-Being, and 2 to Social/Family Well-Being.

Conclusion: The preliminary results obtained were promising; however further studies are needed, in order to proceed with a FACT-LT validation process.

Background: Liver re-transplantation (re-LT) represents the only treatment for patients with irreversible graft failure.

Objective: The aim of the current study was to describe the outcomes of both, patient and graft, after re- LT, at a high-volume referral center.

Methods: Our population consisted of patients, with liver disease, who underwent re-LT in our institution between January 1996 and December 2019.

Results: 49 patients met the inclusion criteria. The patient's overall survival (OS) for the first year was 85% (Confidence Intervals (CI) 71-92) and 70% at five years (CI 53-82). In our population, three (6.12%) patients presented loss of graft and were included again in the transplant list; of these, one agreed to a new transplant while the remaining two died. This gave us graft survival results similar to those obtained for the re-LT patient; 85% at one year (CI 71-92) and 70% at 5 years (CI 53-82).

Conclusion: Our study shows that re-LT is a valid and safe treatment for both early graft dysfunction and for transplanted patients who again present end-stage liver disease, showing a satisfactory long-term evolution, with parameters comparable to primary transplantation.

Background: Owing to the advancement in organ transplantation, treating an individual with organ failure in today's world has become possible. However, organ transplantation is lagging in the absence of adequate organ donations. Shortage of organs for transplantation is a challenge to developing countries like Nepal and developed countries like the USA and UK. Despite various efforts to increase the rate of organ donation, the problem persists. The primary reason for the failure to accomplish adequacy in organ do-nation is the immediate dependency on an available donor. On top of that, reluctance to decide on organ donation after death, regarded as an onerous moment, at least by the general public, has another impact on the subject. Some countries have shifted while some are planning to change from an informed consent system to a presumed consent system, in which if an individual does not make any decision during life-time, it is presumed that his/her organ can be removed for organ transplantation after death.

Objective: To perceive the perception of healthcare professionals of the tertiary care centre of eastern Nepal regarding the presumed consent system.

Methods: Purposive sampling of 221 health care professionals (Faculties, Nursing In-charges, Lab-technicians, and Radiology technicians) participated in the study.

Results: Most healthcare professionals (90.5%) support using a presumed consent system in Nepal and agree on considering the family's opinion in the decision-making for cadaveric organ donation.

Conclusion: Most healthcare professionals have shown their perception in favors of presumed consent to support the increasing organ donation rate.

Retinal degenerative diseases are a group of heterogeneous eye diseases that affect a significant percentage of the world's population, i.e., age-related macular degeneration (AMD), diabetic retinopathy, retinitis pigmentosa (RP), and glaucoma. Regenerative medicines look for novel therapies for severe injuries or chronic diseases, e.g., retina degeneration. Müller glia is the only retinal glia type with a common embryonic origin, with retinal neurons derived from the neural crest. Also, the lack of neurons in the retina does not automatically regenerate. Therefore, Müller glial cells, which make up about 5% of retinal cells, are a potent source for retinal regeneration. Following the retinal damage, Müller glial cells dedifferentiate and re-enter the cell cycle, producing multipotent progenitor cells. This feature leads to applying Müller glial cells in the regeneration of the retina. This study reviews this feature's molecular and clinical approaches, focusing on the critical signaling pathways, generation and transplantation methods, and clinical and sub-clinical challenges.

Background: Autophagy is an intracellular self-degradative homeostasis process which eliminates undesirable and harmful macromolecules and organelles. Autophagy is also involved in self-renewal and differentiation of induced pluripotent stem cell (iPSCs).

Objective: In this study, we investigated the expression profile of autophagy marker genes in human iPSCs during their differentiation induction toward insulin producing β-like cells.

Methods: Human iPSC line, R1-hiPSC1, was used for differentiation induction toward β-like cells. The mRNA expression of Nanog, OCT4 (pluripotency markers), SOX17, FOXA2 (endodermic markers), PTF1A, NKX6.1 (exocrine/endocrine determinants), and PDX1 were measured during differentiation stages. Autophagy was monitored by genes expression study of four autophagy markers, MAP1LC3B, BECN1, SQSTM1/P62 and ATG5, along with protein expression profile of LC3b-II during differentiation stages.

Results: The mRNA expression measurement of pluripotency, endoderm and exocrine/endocrine marker genes confirmed that hiPSCs skipped pluripotency, differentiated into endoderm, passed through the pancreatic lineage commitment stage and successfully generated insulin producing β-like cells. Expression profile of autophagy genes during differentiation stages indicated the decreased expression levels at the early stages (EB and MEI) and then increased at the definitive endoderm stages (DEI 1, DEI 2 and DE) followed by a subtractive pattern toward the end of differentiation. The results of protein expression of LC3b-II were consistent with gene expression data.

Conclusion: This study demonstrated the high contribution of key autophagy genes/proteins during the differentiation of hiPSC toward β-like cells. The enhanced autophagy levels were a prominent feature of early stages of differentiation and DE rather than the later stages.

Background: Decreased bone mineral density (BMD) is one of the complications of kidney transplantation, which is associated with many factors. However, the findings of relevant studies are inconsistent and contradictory.

Objective: To investigate the prevalence of BMD reduction and its associated factors in kidney transplant recipients.

Methods: All kidney transplant recipients (n=69), referred to Shahid Mostafa Khomeini Hospital in Ilam, southwest of Iran, were included in this study between 2016 and 2018. The BMD of the lumbar spine and femoral neck was examined using dual-energy X-ray absorptiometry. According to the Z-score and T-score, the patients were divided into two age groups: <50 years and >50 years. All patients' demographic characteristics, background variables, and laboratory parameters were evaluated. Descriptive statistics were measured, and binary and multinomial logistic regression analyses were performed.

Results: The overall prevalence of osteoporosis in the femur and lumbar spine was 38% and 32%, respectively. In patients aged <50 years, femoral head osteoporosis showed a significant relationship with the vitamin D level and sex. In patients aged >50 years, advancing age and duration of prednisolone consumption were associated with an increased risk of osteoporosis and osteopenia at the femoral neck (P<0.05). Besides, the duration of prednisolone use was associated with osteoporosis at the lumbar spine (RRR=1.02, P<0.05).

Conclusion: Various factors, including prednisolone consumption, affect BMD reduction in kidney transplant recipients. Regular monitoring of BMD, maximum reduction of prednisolone dose, training on the use of effective supplements, and other preventive and supportive measures can be helpful for this group.

Background: Years of research have well demonstrated the pivotal role the attached gingiva plays in maintaining of periodontal health.

Objective: This study aimed to compare the efficacy of two technics, amniotic allograft and free gingival graft (FGG), in improving the attached gingiva width (AGW) around the teeth.

Methods: In this randomized controlled clinical trial study, 28 patients all in need of increased AGW were randomly halved and assigned to a test group receiving the amniotic allograft and a control group treated by a palatal FGG. Following the operation, the mean AGW, graft shrinkage, and color match were assessed and photographed at various intervals (1, 2, 6, and 12 weeks). The level of pain was also evaluated based on the visual analog scale (VAS).

Results: The AGW was not significantly different between the two groups in 2, 6 and, 12 weeks postoperatively (P=0.17, 0.73, 0.76 respectively). The same applied to the amount of shrinkage between the two groups at the intervals (p=0.38, p=0.57 and p=0.52 respectively). The amniotic allograft group was superior (not significantly) in terms of the color match (p=0.59, p=0.31 and p=0.18 respectively). However, it was found to have significantly lower VAS pain scores than did the control group (p <0.05).

Conclusion: Application of the amniotic allograft could decrease the postoperative pain as well as discomfort and effectively increase the AGW. Therefore, given the drawbacks of FGG, the amniotic allograft can be considered as a viable alternative.

Background: Biliary complications are the leading cause of morbidity and mortality in patients undergo¬ing Liver Transplantation (LT). Post-biliary transplantation strictures (BSs) are a severe problem with a high risk of graft failure. However, management of these BSs has remained controversial, and consid¬erable variability has been reported in Percutaneous Transhepatic Radiological Interventions (PTRIs) related to broad differences in technical procedures.

Objective: This study aimed to evaluate the efficacy of percutaneous treatments in managing post-LT BSs in a center in Shiraz.

Methods: PTRIs including balloon dilatation, metallic stent, and internal or internal-external hand-made plastic stent insertion were done for 34 transplanted patients with BSs referring to the Interventional Radiology Unit of Shiraz Namazi Hospital. Technical success rate, patency rates, and complications were evaluated.

Results: The. In this study, 31 strictures were successfully treated without any significant difference between the anastomotic and non-anastomotic types of stricture (success rate: 91.2%). Based on the results, 12- , 24-, and 36-month primary patency rates were 90.1%, 84.5%, and 76.8%, respectively. The secondary patency rate was 100% at 12 and 24 months and 93.3% at 36 and 60 months. The rate of minor complica¬tions (mild cholangitis and hemobilia) was 6.4%, and no major complications were detected.

Conclusion: According to the findings, PTRI is an effective method for treating anastomotic and non-anas- tomotic strictures with a high success rate and low complications.

Background: The waiting list for heart transplants is a valuable data registry that would offer very useful information on the characteristics of patients who have various outcomes while waiting in the list.

Objective: The purpose of this study was to look at the prognosis of those waiting for heart transplants as well as the factors that increase mortality.

Methods: Advanced heart failure patients' demographic, clinical, hemodynamic, and echocardiographic results, as well as their prognosis, were retrieved from the national registry for heart transplantation between 2011 and 2018. The study population was defined and compared in four groups: 1) Death while awaiting HTX, 2) Death after HTX, 3) Alive without a transplant, 4) Transplanted and alive.

Results: The data of 207 patients [75% male, mean (SD) age of 34(10) years] were analyzed. The most common etiology of heart failure was idiopathic dilated cardiomyopathy. A total of 86 patients (41%) were successfully transplanted, with a median (IQR) time between listing and transplantation of 84 (30¬219) days, 54 patients (26.1%) were dead and 32% were still alive. The multivariate analysis showed right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and systolic blood pressure at the time of listing as independent predictors of death.

Conclusion: The study on HTX waiting list is very useful for both allocation strategies and administrative planning for patients with advanced heart failure by development of accurate models and scoring systems using predictors of death in the waiting list.

Background: In-utero xenotransplantation of stem cells in abnormal fetuses effectively treats several genetic illnesses.

Objective: The current research aimed to evaluate structural and morphological alterations in the liver of rabbit fetuses following xenotransplantation of human Wharton's jelly-derived mesenchymal stromal cells (hWJ-MSCs), using a stereological technique.

Methods: All hWJ-MSCs were isolated from the human umbilical cord, and their authenticity was established by flowcytometry and differentiation. At gestational day 14, the rabbits were anesthetized, and hWJ-MSCs were injected into the uteri of 24 fetuses. Twenty-two fetuses were born successfully. Ten rabbit liver specimens were prepared from injected fetuses including; eight rabbits on day three following birth and two rabbits on the 21st post-natal day. The non-injected fetuses were considered positive controls. The livers of the control and hWJ-MSCs-treated rabbits were fixed, processed, stained, and examined through stereological approaches.

Results: In the hWJ-MSCs-treated group, the mean liver weight and volume increased by 42% and 78% compared to the control group. The total volume of the hepatocytes increased by 63%, and that of sinusoids by three folds in the treated rabbits. The total volume of the central veins increased by 70%. The total number corresponding to hepatocytes in the experimental group increased by 112% compared to the rabbits in the control. The total volume of the hepatocyte nuclei in the experimental group increased by 117% compared to the rabbits in the control.

Conclusion: After xenotransplantation of human MSCs, host tissue microenvironments (here, the rabbit liver) were altered and these included quantitative factors corresponding to the liver tissue and hepatocyte morphometric indices.