International Journal of Organ Transplantation Medicine最新文献

Solid organ recipients have increased risk of malignancy in comparison with general population. Although post-transplant lymphoproliferative disorders are the second most common cancer in transplanted patients, primary CNS lymphoma is a rare presentation of these disorders. Among the wide range of neurologic complications in post- transplant period, some characteristics could be helpful for diagnosing of this disorder. Rarity of CNS lymphoma may lead to late diagnosis of this disease while early detection has utmost importance for better management of it. Here, we describe a heart recipient young woman with focal neurologic symptoms 14 months after transplantation and some features that could be helpful for on-time diagnosis.

Background: Use of AlloDerm™ is highly suggested for the treatment of deep burns and burn sequela reconstruction. Scar formation and contracture are recognized as long-term consequences of split-thickness skin autografting, which is applied for full-thickness burn injuries. Mature fibroblasts, in the absence of dermis, seem to secrete collagen in the reformed scar pattern.

Objective: To process AlloDerm™ from fresh allograft and use it as a dermal substitute for covering deep wounds in burn patients and evaluate its effectiveness.

Methods: In this case-series, 7 patients with deep burn wounds involving different locations on the body surface were exposed to combined AlloDerm™ (processed from fresh human allograft) with thin split thickness skin autograft on it. On the 5^th post-operative day, wound dressings were changed to evaluate the graft survival with the human acellular dermal matrix scaffold. To determine the skin profiles, follow-ups continued for at least 6 months.

Results: The results showed excellent graft take, good elasticity, acceptable thickness, and little contracture and scarring according to fix surgeon assessment in 6 patients. Graft rejection happened only in one patient with chronic electrical injury.

Conclusion: AlloDerm™ derived from cadaver skin and combination of it with thin split thickness skin auto grafting constitute a cost-effective and favorable option for the treatment of deep burn wounds in our center, considering the increased tendency of the population towards organ donation in the event of brain death.

Background: Despite the high regenerative capacity of skeletal muscle, volumetric muscle loss (VML) is an irrecoverable injury. One therapeutic approach is the implantation of engineered biologic scaffolds.

Objective: To investigate the simultaneous effect of high intensity interval training (HIIT) and the use of decellularized human amniotic membrane (dHAM) scaffolds on vascularization, growth factor, and neurotrophic factor gene expression, and muscle force generation in the tibialis anterior (TA) of rats after VML injury.

Methods: VML injury was created in the TA of 24 rats, which were randomly divided into two groups-12 animals with and 12 without the use of a dHAM scaffold. After injury, each group was further divided into two groups of 6 animals each-sedentary and HIIT. Blood vessels were visualized and counted by hematoxylin and eosin staining. The PowerLab converter assay was used to evaluate isometric contraction force. The relative expression of neurotrophic factors and growth factor genes was measured with reverse transcription PCR (RT-PCR).

Results: The number of blood vessels in the whole regenerating areas showed a significant difference in the dHAM-HIIT and dHAM-sedentary groups compared to the sedentary group without dHAM (p=0.001 and p=0.003, respectively). BDNF and GDNF mRNA levels in the dHAM-HIIT group were significantly (p<0.05) higher than those in other groups; NGF mRNA levels did not differ significantly among groups. Isometric contraction force in the dHAM-HIIT group was significantly (p=0.001) greater compared to the sedentary group without dHAM.

Conclusion: Combined use of dHAM scaffoldsand HIIT would improve the structure of the injured muscle during regeneration after VML by better vascular perfusion. HIIT leads to greater force generation and innervation by modulating neurotrophic factor synthesis in regenerating muscles.

Background: Laparoscopic live donor nephrectomy (LLDN) has become the standard of care and is popular among most of the transplant centers across the globe. Despite proven advantages of LLDN, some transplantation centers hesitate to start the program because of issues concerning donor safety and allograft function.

Objective: To discusses the main barriers for creating a successful LLDN program, strategies that allowed us to start a successful LLDN program along with the study results.

Methods: The donors undergoing LLDN from December 2016 to February 2018 were enrolled in the study and prospectively evaluated. LLDN were performed by two senior surgeons alternately with assistance by the laparoscopic urologist in all cases. Also, in the present study, two technical alterations were done in the standard surgical technique of transperitoneal LDN. The first important modification made was the use of two additional ports for use by laparoscopic urologists. The second modification involved dissection on both poles of the kidney before hilar dissection.

Results: A total of 112 transperitoneal LLDN were performed during the study period. The mean (range) of operation time was 117.5 (81-158) min; the ischemia time was 194 (171-553) sec. Only one patient needed conversion to open surgery. No other major peri-operative or posto-perative complications occurred. All kidney grafts were functioning well.

Conclusion: With proper planning, team approach, and few technical modifications, introduction of LLDN is safe and effective.

Background: Giardiasis is one of the opportunistic infections in immunocompromised patients, especially among organ transplant recipients.

Objective: This study aimed to investigate the prevalence of Giardia lamblia infection in children with heart transplantation.

Methods: A prospective cross-sectional study was conducted on 53 heart transplant recipients (aged 1-17 years). Transplant patients were on oral Trimethoprim/Sulfamethoxazole (TMP-SMX) from the first day of transplantation as a prophylaxis regimen. The prevalence of Giardia lamblia was evaluated on stool samples by phenotypic assay and polymerase chain reaction (PCR) method.

Results: Out of 53 patients studied, 11 (20.75%) had gastrointestinal symptoms, and 42 (79.25%) were asymptomatic cases. No significant difference was observed between patients with and without gastrointestinal symptoms regarding type of heart disorders (p=0.13). The overall prevalence of Giardia lamblia infection among heart transplant patients was 5.7% (n=3). Moreover, the frequency was different between gastrointestinal symptomatic and asymptomatic recipients (27.27% and 0%, respectively). All three patients whose stool exams were phenotypically positive for Giardia lamblia were confirmed with PCR. Out of three, two Giardia lamblia isolates were found to have genotype B, while one isolate had genotype A. All of the Giardia positive patients suffered from chronic diarrhea and anorexia. Cryptosporidium spp., Isospora belli and Blastocysts spp. were not found in these cases.

Conclusion: The incidence of Giardia lamblia infection in pediatric heart transplant patients is considerable and should be noted. A comprehensive guideline for the assessment of Giardia lamblia before and after transplantation is suggested.

Living donor hepatectomy is not without risks, and some complications can end up with serious morbidities if not timely diagnosed and appropriately managed. In this report, we described a very unusual but significant surgical problem in living liver donor surgery in which a significant narrowing occurred in the inferior vena cava after the closure of the stump of the right hepatic vein and inferior right hepatic vein close to the right hepatic vein together, and describe the cavoplasty technique used to repair this narrowing. To the best of our knowledge, the technique of solving this problem in living liver donors was described only once in literature, which was previously published by our team.

Background: Optimizing anesthetic management for the best possible outcome is essential in kidney transplantation (KT).

Objective: To evaluate the difference in grafted kidney function and early kidney transplant outcome when the pairs of donor-recipient were anesthetized with isoflurane compared to propofol.

Methods: Thirty-eight pairs of kidney transplant donor-recipient were anesthetized with isoflurane, and 22 pairs were anesthetized with propofol. Blood urea nitrogen (BUN), serum creatinine (SCr), estimated glomerular filtration rate (eGFR) were assessed in the preoperative period, on the first postoperative day, before discharge from the hospital, and 6 months after KT. Short-term (6 months) outcomes of KT were assessed by the incidence of delayed graft function, acute rejection episodes, and graft failure.

Results: There was no statistically significant difference between the two groups in the serial measurements of SCr, BUN, eGFR, and the early outcomes (6 months) after surgery. Interestingly, donor warm ischemic time in the propofol group was significantly longer than in the isoflurane group (4.05±1.02, 2.93±0.87 minutes, respectively) (p=0.001). Moreover, postoperative hospital stay in the propofol group were significantly shorter compared to the isoflurane group (9.63±2.96, 11.78±4.91 days, respectively) (p=0.02).

Conclusion: There were no significant differences in transplanted kidney function and the early outcome of kidney transplantation between the two study groups. However, earlier hospital discharge after surgery in the propofol group suggests that propofol may be a more appropriate anesthetic choice in these patients.

Background: Ischemia-reperfusion injury during transplantation can cause post-operative graft dysfunction.

Objective: To assess the efficacy of N-acetylcysteine in preventing hepatic ischemia-reperfusion injury and post-transplant outcomes.

Methods: In this retrospective study on pediatrics undergoing living-donor (from one of their parents) liver transplantation, N-acetylcysteine was administered to one group (n=20) after induction in the donors until graft harvest, and in the recipients during implantation, which was maintained for 19 hours. The second group (n=20) did not receive NAC. Early allograft dysfunction was determined in the presence of alanine aminotransferase or aspartate aminotransferase ≥2000 IU/L and bilirubin ≥10 mg/dL within the first 7 days, and an international normalized ratio ≥1.6 on day 7. Data were collected from a retrospectively maintained database.

Results: The incidence of post-reperfusion syndrome was lower in N-acetylcysteine group compared with the other group (5% vs. 30%, p=0.037). Serum creatinine level was significantly (p=0.04) different in the N-acetylcysteine group during the second post-operative week (0.14 vs. 0.15 mg/dL). There was no significant difference in the incidence of early allograft dysfunction (21% vs. 14%, p=0.327), and the survival rate (p=0.409).

Conclusion: Peri-operative infusion of N-acetylcysteine in both donor and recipient would effectively prevent post-reperfusion syndrome and renal insufficiency. However, it might not affect the early allograft dysfunction, ICU stay, and mortality. NAC increases the chance of re-operation due to non-surgical bleeding in the first post-operative day.

The inferior vena cava is the main organ of venous return from the lower extremities and abdominal organs to the right atrium. Congenital atresia of inferior vena cava is very rare. This anomaly can be surprising for transplant surgeons. The anomaly, if unknown, can cause procedural complications during interventional procedures or organ harvesting.

Background: Studies evaluating liver transplantation (LT) in hepatocellular carcinoma (HCC) in the Middle East have been scarce, mainly due to intricacy of this type of surgery.

Objective: In here we report our experiences with LT among patients with HCC cirrhosis.Methods: All patients who underwent LT with primary diagnosis of HCC older than 18 years old, during 2004 to 2019, were initially included in our study.

Results: Overall, 124 patients entered our study, among which majority were males (86.3%). Mean (SD) age of patients was 53.1±10.6 years old. Most common underlying liver diseases were HBV (55.6%) and HCV infections (12.1%). Mean MELD score of patients was 18±5.5. Child-Pugh score of most patients was class B (50%). Mean (SD) duration of hospitalization was 12.1±3.5 days. Patients were followed for a median of 32 (9, 62) months. The most common causes of death were recurrence of HCC (47.7%) and sepsis (34.1%). Median (IQR) duration to recurrence and death were 18 (4, 34) months and 17.5 (5.7, 44.5) months, respectively. One-year survival (89%, 86.4%, and 63.2%, respectively) (p=0.011) and one-year DFS (89%, 86.4%, and 57.9%, respectively) (p=0.001) was significant different between those who were selected based on the Milan, UCSF and extended criteria.

Conclusion: Our study provides valuable experiences on LT and HCC from one of the largest LT centers in the world. Accordingly, we found that the Milan criterion provides the best survival compared to the UCSF and our extended criteria for patient selection.