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Denosumab treatment for osteopenia or osteoporosis in heart transplant recipients: Effects and safety Denosumab治疗心脏移植受者骨质减少或骨质疏松:效果和安全性
Q4 Medicine Pub Date : 2022-09-01 DOI: 10.1016/j.tpr.2022.100103
Juan C. Uzquiano , Ana Alonso Méndez , Álvaro Juano Bielsa , María Dolores García-Cosío Carmena , Juan F. Delgado Jiménez , Paz Sanz-Ayán

Background

Osteoporosis is a prevalent complication in heart transplant population. Denosumab is a monoclonal antibody that inhibits bone resorption approved for the treatment of corticosteroid-induced osteoporosis and potentially useful in heart transplant recipients.

Objective

To describe the metabolic and densitometric effects of denosumab in these patients, as well as the adverse effects observed.

Methods

We performed a study of 9 transplant patients between 2014 and 2019 who were treated with denosumab for osteopenia or osteoporosis. All patients received postoperative calcium and vitamin D supplements. We measured the changes in densitometric and metabolic variables and compared them by Student's t-test.

Results

After therapy, bone mineral density (BMD) and Tscore at lumbar spine improved a mean of 0.0458 and 0.5000, respectively (p < 0.05). The mean increase of BMD was 6.09% at lumbar spine and 7.84% at femoral neck. There was a case of abrupt decrease of BMD at total hip. A decrease in magnesium levels was observed after a dose of denosumab (p < 0.05), which included 1 case of hypomagnesemia. There were 2 cases of hypophosphatemia, and none of hypocalcaemia. 77.78% of the patients had infections, one of them serious.

Conclusion

Denosumab was shown to improve BMD at lumbar spine and could be a valid alternative for the treatment of osteoporosis in heart transplant patients. The risk of hypocalcaemia could be minimized with calcium adjustment prior to starting treatment. More studies are needed to assess its effects and the risk of infections.

背景:骨质疏松症是心脏移植人群中常见的并发症。Denosumab是一种抑制骨吸收的单克隆抗体,被批准用于治疗皮质类固醇诱导的骨质疏松症,可能对心脏移植受者有用。目的描述地诺单抗在这些患者中的代谢和密度效应,以及观察到的不良反应。方法:我们对2014年至2019年期间接受denosumab治疗骨质减少或骨质疏松症的9例移植患者进行了研究。所有患者术后均补充钙和维生素D。我们测量了密度和代谢变量的变化,并通过学生t检验进行了比较。结果治疗后,腰椎骨密度(BMD)和Tscore平均分别改善0.0458和0.5000 (p <0.05)。腰椎BMD平均升高6.09%,股骨颈BMD平均升高7.84%。全髋关节骨密度突然下降1例。一剂denosumab (p <0.05),其中包括1例低镁血症。低磷血症2例,无低钙血症。77.78%的患者发生感染,其中1例为重症感染。结论denosumab可改善腰椎骨密度,是治疗心脏移植患者骨质疏松症的有效选择。在开始治疗前调整钙含量可以将低钙血症的风险降至最低。需要更多的研究来评估其影响和感染风险。
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引用次数: 1
Cardiopulmonary death donation 心肺死亡捐赠
Q4 Medicine Pub Date : 2022-09-01 DOI: 10.1016/j.tpr.2022.100104
Hassan Argani
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引用次数: 1
Pancreas transplantation from donors after cardiac death – The US experience 心脏死亡后捐赠者的胰腺移植——美国的经验
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.1016/j.tpr.2022.100099
Angelika C. Gruessner, Subodh J. Saggi, Rainer W.G. Gruessner

Introduction

Since the beginning of pancreas transplantation, the rate of donation after cardiac (or circulatory) death (DCD) accounts for only 3% of all transplants in the US. This is the result of perceived higher complication rates and overall worse outcome with DCD donors. Such misconceptions and an increased demand for deceased donor (DD) organs warrant a systematic review of the use of DCD compared with donation after brain death (DBD) pancreata to objectively assess DCD outcome after pancreas transplantation in the US.

Methods

All 22,160 DD pancreas transplants performed in diabetic patients between 1/1/2001 and 12/31/2020 were included in this analysis. To assess changes in outcomes, patient and graft survival was computed using the Kaplan-Meier method in 5-year intervals. Comprehensive univariate and multivariable comparisons of posttransplant complications and patient and pancreas and kidney graft survival between DCD and DBD pancreas transplants were performed to assess the donor impact.

Results

In the US over the past 20 years most DCD donors were used for simultaneous pancreas and kidney (SPK) transplants and less often for solitary pancreas transplants. DCD transplants never accounted for more than 4% per year of all pancreas transplants. A comparison of the pancreas donor risk index (pDRI) between DCD and DBD pancreata showed that the only distinguishing factor was DCD donation. SPK patient, pancreas, and kidney graft survival for DCD donors did not change significantly over time. One- and 3 -year DCD patient survival reached 96% and 93%, pancreas graft survival 90% and 84%, and kidney graft survival 96% and 91%, respectively. For the last decade, no differences in patient and graft survival between DCD and DBD donors were detected (P > 0.67). The relative risk for the use of a DCD donor was not increased (P > 0.6). Influential risk factors were older donor and recipient age as well as longer preservation times. Larger transplant center accepted DCD donors more frequently and showed better outcome. While the rate of early pancreas complications was the same for DCD vs. DBD transplants, delayed kidney graft function was significantly higher in DCD kidneys secondary to more long-distance shipping across the country. The multivariable analysis showed a 4-times higher rate in delayed graft function. Longer cold preservation time and older donor age further increased the risk of graft failure. The use of machine perfusion of the kidney graft reduced the relative risk of delayed graft function by 50%.

Summary

The use of DCD donor organs in pancreas transplantation is not associated with higher failure or complication rates in the US. A pancreas offer from a DCD donor should not be the sole reason to decline the organ for transplantation. Careful selection of specific donor and recipient factors, as well as advanced pr

自胰腺移植开始以来,心脏(或循环)死亡(DCD)后的捐赠率仅占美国所有移植的3%。这是由于DCD供者的并发症发生率较高,总体预后较差。这种误解和对死亡供体(DD)器官需求的增加,需要对DCD与脑死亡后捐赠(DBD)胰腺的使用进行系统回顾,以客观评估美国胰腺移植后DCD的结果。方法纳入2001年1月1日至2020年12月31日期间接受DD胰腺移植的22160例糖尿病患者。为了评估结果的变化,采用Kaplan-Meier方法每隔5年计算患者和移植物的生存期。综合单因素和多因素比较DCD和DBD胰腺移植术后并发症、患者和胰腺和肾脏移植存活率,以评估供者的影响。结果在过去的20年里,美国大多数DCD供体用于胰肾同时移植(SPK),很少用于单独胰腺移植。每年,DCD移植在所有胰腺移植中所占的比例从未超过4%。DCD和DBD胰腺供者风险指数(pDRI)的比较表明,DCD捐献是唯一的区分因素。DCD供者的SPK患者、胰腺和肾脏移植存活率随时间没有显著变化。DCD患者1年和3年生存率分别为96%和93%,胰腺移植生存率分别为90%和84%,肾脏移植生存率分别为96%和91%。在过去十年中,没有发现DCD和DBD供者在患者和移植物存活方面的差异(P >0.67)。使用DCD供体的相对风险没有增加(P >0.6)。影响危险因素是供体和受体年龄较大以及保存时间较长。较大的移植中心接受DCD供者的频率更高,结果也更好。虽然DCD与DBD移植的早期胰腺并发症发生率相同,但由于长途运输,DCD肾脏的移植功能延迟明显更高。多变量分析显示,延迟接枝功能的发生率提高了4倍。较长的冷保存时间和较大的供体年龄进一步增加了移植物失败的风险。使用机器灌注肾移植物可使移植物功能延迟的相对风险降低50%。在美国,在胰腺移植中使用DCD供体器官与更高的失败率或并发症发生率无关。DCD捐赠者提供的胰腺不应该是拒绝器官移植的唯一原因。仔细选择特定的供体和受体因素,以及先进的保存技术是获得良好结果的必要条件。
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引用次数: 2
L-arginine prevents ischemic injury in explanted rat intestinal regions in an ex vivo perfusion model 在离体灌注模型中,l -精氨酸可预防离体大鼠肠区缺血损伤
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.1016/j.tpr.2022.100096
Michele Finotti , Maria Barahona , Renee M. Maina , Taras Lysyy , Raghav Agarwal , Phillip Schmitt , Giorgio Caturegli , Chiara Di Renzo , Alessandro Anselmo , David Mulligan , John P. Geibel , Francesco D'Amico

Background

The small intestine is one of the most sensitive organs to ischemia. L-arginine has been shown to reduce damage from ischemia and reperfusion injury. We hypothesize that explanted intestinal segments from rats will demonstrate reduced susceptibility to ischemic injury when perfused with l-arginine.

Methods

45 small intestinal segments were harvested from male Sprague-Dawley rats and connected to an ex vivo intestinal perfusion device. Ischemic damage was induced by perfusing the extraluminal side with Ringer-HEPES buffer saturated with 100% N2. All segments were then perfused intraluminally with and without l-arginine. We conducted a set of experiments with intraluminal perfusion with both l-arginine and N-nitroarginine methyl ester (L-NAME), an inhibitor of the nitric oxide – arginine pathway. Control segments were perfused extraluminally under non-ischemic conditions and intraluminally with and without l-arginine. The intraluminal perfusate contained FITC-inulin, and the fluorescence signal of FITC-inulin was measured to calculate average fluid secretion, which directly corresponds to the extent of ischemic injury.

Results

Intestinal segments perfused with l-arginine had significantly decreased secretion over time in comparison to intestinal segments perfused without l-arginine (p<0.0001). Perfusion with L-NAME abrogated the protective effect of l-arginine.

Conclusion

Intraluminal perfusion with l-arginine reduced ischemic damage to harvested intestine.

小肠是对缺血最敏感的器官之一。l -精氨酸已被证明可减少缺血和再灌注损伤。我们假设大鼠肠段外植体在灌注l-精氨酸后对缺血性损伤的易感性降低。方法取雄性sd大鼠45段小肠,连接体外肠灌流装置。用饱和100% N2的Ringer-HEPES缓冲液灌注腔外侧诱导缺血性损伤。然后在腔内灌注和不灌注l-精氨酸。我们用l-精氨酸和n -硝基精氨酸甲酯(N-nitroarginine methyl ester, L-NAME)(一氧化氮-精氨酸途径的抑制剂)进行了一系列腔内灌注实验。对照节段在非缺血条件下和腔内灌注l-精氨酸和不灌注l-精氨酸。腔内灌注液中含有fitc -菊粉,通过测量fitc -菊粉的荧光信号计算平均体液分泌量,直接对应缺血损伤程度。结果与未灌注l-精氨酸的肠段相比,灌注l-精氨酸的肠段分泌随着时间的推移显著减少(p<0.0001)。L-NAME灌注消除了l-精氨酸的保护作用。结论l-精氨酸腔内灌注可减轻切除肠的缺血性损伤。
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引用次数: 1
Brain death hormone therapy and Graft survival: A systematic review of the literature 脑死亡激素治疗和移植物存活:文献的系统回顾
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.1016/j.tpr.2022.100098
Marzieh Latifi Dr. , Farzaneh Bagherpour , Habib Rahban Dr. , Elahe Pourhossein , Sanaz Dehghani Dr.

Introduction

During brain death, several events occur, including hormonal. metabolic and systemic changes. This systematic review aims to find the role of hormone therapy in cadaver donors and its impact on graft function and/or survival following solid organ transplantation.

Method and materials

Randomized clinical trials were reviewed to investigate the effects of hormone therapy on graft survival amongst brain death cases. studies from Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were identified and reviewed for this current work. Two reviewers independently rated the quality of the study. As a result, 18 studies met inclusion criteria and were included in this study.

Results

Over 2235 titles were retrieved from various search sources and 16 full papers were identified for possible inclusion. Trial sample sizes varied widely from 25 to 12,333 patients. Multiple therapy schemes were developed and applied for brain death donors. The first scheme simply involved applying Triiodothyronine, Dopamine, Immunosuppressive, Vasopressin and Desmopressin separately. The second scheme consisted of applying double hormone therapy using Methylprednisolone and Vasopressin simultaneously. Finally, triple hormone therapy was applied which included Methylprednisolone, Triiodothyronine and Arginine vasopressin.

Conclusions

Results from this systematic study indicated no significant effects on overall organ survival in recipients who received brain death hormone therapy. Thus, the potential effects of hormone therapy in brain death scenarios are still unknown and need further investigation.

在脑死亡过程中,会发生一些事件,包括激素。代谢和全身变化。本系统综述旨在发现激素治疗在尸体供体中的作用及其对实体器官移植后移植物功能和/或存活的影响。方法与材料回顾随机临床试验,探讨激素治疗对脑死亡患者移植物存活的影响。本文对Medline、Embase和Cochrane中央对照试验注册库(Central)的研究进行了识别和回顾。两位审稿人独立评估了研究的质量。结果有18项研究符合纳入标准,被纳入本研究。结果共检索到2235篇文献,其中16篇全文可被纳入。试验样本量从25人到12333人不等。多种治疗方案被开发并应用于脑死亡供体。第一种方案只是分别应用三碘甲状腺原氨酸、多巴胺、免疫抑制剂、加压素和去氨加压素。第二种方案包括同时使用甲强的松龙和加压素进行双激素治疗。最后采用甲强的松龙、三碘甲状腺原氨酸、精氨酸加压素三联激素治疗。结论本系统研究的结果表明,接受脑死亡激素治疗对受者的总体器官存活无显著影响。因此,激素治疗对脑死亡的潜在影响尚不清楚,需要进一步研究。
{"title":"Brain death hormone therapy and Graft survival: A systematic review of the literature","authors":"Marzieh Latifi Dr. ,&nbsp;Farzaneh Bagherpour ,&nbsp;Habib Rahban Dr. ,&nbsp;Elahe Pourhossein ,&nbsp;Sanaz Dehghani Dr.","doi":"10.1016/j.tpr.2022.100098","DOIUrl":"https://doi.org/10.1016/j.tpr.2022.100098","url":null,"abstract":"<div><h3>Introduction</h3><p>During brain death, several events occur, including hormonal. metabolic and systemic changes. This systematic review aims to find the role of hormone therapy in cadaver donors and its impact on graft function and/or survival following solid organ transplantation.</p></div><div><h3>Method and materials</h3><p>Randomized clinical trials were reviewed to investigate the effects of hormone therapy on graft survival amongst brain death cases. studies from Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were identified and reviewed for this current work. Two reviewers independently rated the quality of the study. As a result, 18 studies met inclusion criteria and were included in this study.</p></div><div><h3>Results</h3><p>Over 2235 titles were retrieved from various search sources and 16 full papers were identified for possible inclusion. Trial sample sizes varied widely from 25 to 12,333 patients. Multiple therapy schemes were developed and applied for brain death donors. The first scheme simply involved applying Triiodothyronine, Dopamine, Immunosuppressive, Vasopressin and Desmopressin separately. The second scheme consisted of applying double hormone therapy using Methylprednisolone and Vasopressin simultaneously. Finally, triple hormone therapy was applied which included Methylprednisolone, Triiodothyronine and Arginine vasopressin.</p></div><div><h3>Conclusions</h3><p>Results from this systematic study indicated no significant effects on overall organ survival in recipients who received brain death hormone therapy. Thus, the potential effects of hormone therapy in brain death scenarios are still unknown and need further investigation.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"7 2","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2451959622000075/pdfft?md5=942c8b41b306d96e2e6f6b5677e9df57&pid=1-s2.0-S2451959622000075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136515495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hemostasis caused by stent-graft insertion followed by graft removal for pancreas graft bleeding due to chronic rejection: A case report 慢性排斥反应导致胰腺移植出血,植入支架后取出支架止血1例
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.1016/j.tpr.2022.100095
Kohei Miura , Takashi Kobayashi , Hirosuke Ishikawa , Seiji Saito , Yasuo Obata , Yohei Miura , Koji Toge , Yuki Hirose , Taku Ohashi , Kazuyasu Takizawa , Jun Sakata , Masayuki Tasaki , Kazuhide Saito , Yoshihiko Tomita , Toshifumi Wakai

Introduction

Lethal symptoms due to graft rejection warrant rapid removal of the transplanted graft to save the patient's life. We report a case of massive pancreas graft bleeding due to chronic rejection that necessitated graft removal after hemostasis by stent graft insertion.

Case presentation

A 39-year-old woman underwent simultaneous pancreas-kidney transplantation for type I diabetes and chronic renal failure nine years ago. She suffered irreversible kidney damage from severe chronic rejection due to drug non-compliance. She was admitted to the emergency department for abdominal pain and bloody stools. She presented with signs of shock based on her vitals due to massive bleeding in the stool a day after hospitalization and required systemic management in the intensive care unit (ICU). Enhanced computed tomography (CT) scan revealed active bleeding from the duodenal portion of the pancreas graft. Hemostasis was achieved by inserting a stent graft into the right external iliac artery. The respiratory and circulatory status of the patient improved after the intervention, and she was transported to our hospital day after treatment. The graft was removed along with the part of the anastomosed intestine, which was reconstructed with a functional end-to-end anastomosis.

Conclusion

We encountered a patient with hemorrhagic shock due to bleeding from a rejected pancreas graft. The patient was successfully treated and saved using stent-graft hemostasis followed by graft removal. Clinicians and surgeons should be mindful of chronic rejection, which could lead to life-threatening hemodynamic complications.

移植排斥反应引起的致命症状需要迅速切除移植的移植物以挽救患者的生命。我们报告一例胰脏移植物因慢性排斥反应而大出血,需要在植入术止血后取出移植物。病例介绍:一名39岁女性,9年前因1型糖尿病和慢性肾衰竭接受了胰肾联合移植手术。由于药物不遵医嘱,她遭受了严重的慢性排斥反应,造成了不可逆的肾脏损害。她因腹痛和便血被送进急诊科。住院一天后,患者因大出血出现休克体征,需要在重症监护病房(ICU)进行全身治疗。增强计算机断层扫描(CT)显示活动性出血从十二指肠部分的胰腺移植。止血是通过在右髂外动脉内植入支架实现的。干预后患者呼吸循环状况好转,治疗后第1天送至我院。将移植物与吻合的部分肠一起移除,用功能性端到端吻合术重建。结论我们收治了一例因胰腺移植排斥出血而发生失血性休克的患者。通过支架-移植物止血和移植物切除,患者得到了成功的治疗和挽救。临床医生和外科医生应注意慢性排斥反应,这可能导致危及生命的血流动力学并发症。
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引用次数: 0
Extended Literature Review of the role of erythropoietin stimulating agents (ESA) use in the management of post renal transplant anaemia 对促红细胞生成素刺激剂(ESA)在肾移植后贫血治疗中的作用的扩展文献综述
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.1016/j.tpr.2022.100097
Iman Alshamsi

Background

: Anemia is known to impact quality of life and survival in both renal and non-renal patients. End stage kidney disease (ESKD) patient's survival substantially improves post transplantation. Observational studies have reported better patients and graft outcomes in non anemic renal transplant recipients. Anemia of chronic kidney disease (CKD) is frequently linked to erythropoietin deficiency. Patients with post-transplant anemia (PTA) represent a distinct subset of CKD population. The benefit of using erythropoietin stimulating agents (ESA) in PTA is not clearly defined.

Aim

: The aim of this extended literature review is to define the role of ESA use in improving hemoglobin (Hb) level and graft survival in patients with PTA.

Methods

: An extended literature review was done to identify randomized controlled trials (RCTs) with patients with PTA as the study population, the use of erythropoietin stimulating agents as the intervention, and the renal function and Hb level as the outcomes. The aim of this literature review is to delineate the role of using ESA in PTA. Medline, Google scholar, Scopus, and CINHAL data bases were searched and papers meeting the pre-set inclusion criteria were identified.

Results

: A total of 163 papers were identified. After screening the results, four papers met the inclusion criteria and were included for review. 2/4 papers recruited patients with early PTA, while 2/4 papers recruited patients with late PTA. The early PTA papers were not consistent in reporting the effect of ESA in improving renal outcomes. Both studies showed that using ESA had no additional benefit in anemia treatment. 2/4 studies looked at late PTA. The study designs were similar and the follow up period was 2-3 years. Both studies showed a better graft survival in the higher Hb group.

Conclusion

: In the case of early PTA, the benefit of using ESA is not clear. The two RCTs studying the effect of ESA in patients with late PTA showed that targeting higher Hb levels was associated with better graft function. The optimal Hb target and the utility of intravenous iron need further clarifications.

背景:已知贫血会影响肾脏和非肾脏患者的生活质量和生存。终末期肾脏疾病(ESKD)患者移植后生存率显著提高。观察性研究报告了非贫血性肾移植受者的患者和移植物预后较好。慢性肾脏疾病(CKD)贫血通常与促红细胞生成素缺乏有关。移植后贫血(PTA)患者是CKD人群中一个独特的子集。在PTA中使用促红细胞生成素(ESA)的益处尚未明确定义。目的:这篇扩展文献综述的目的是确定ESA在改善PTA患者血红蛋白(Hb)水平和移植物生存中的作用。方法:对以PTA患者为研究人群,以促红细胞生成素刺激药物为干预手段,以肾功能和Hb水平为结局的随机对照试验(rct)进行文献综述。这篇文献综述的目的是描述使用ESA在PTA中的作用。检索Medline、Google scholar、Scopus和CINHAL数据库,确定符合预设纳入标准的论文。结果:共筛选出163篇论文。经筛选结果,有4篇论文符合纳入标准,纳入综述。2/4的文献招募了早期PTA患者,2/4的文献招募了晚期PTA患者。早期的PTA论文在报道ESA对改善肾脏预后的影响方面并不一致。两项研究都表明,使用ESA在贫血治疗中没有额外的益处。2/4的研究着眼于晚期PTA。研究设计相似,随访2-3年。两项研究均显示高血红蛋白组的移植物存活率更高。结论:在早期PTA病例中,应用ESA的益处尚不明确。两项研究ESA对晚期PTA患者影响的随机对照试验显示,靶向较高的Hb水平与更好的移植物功能相关。最佳的血红蛋白靶点和静脉铁的效用需要进一步澄清。
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引用次数: 1
Cellular immunity in BK polyomavirus associated nephropathy following adult kidney transplantation 成人肾移植后BK多瘤病毒相关性肾病的细胞免疫
Q4 Medicine Pub Date : 2022-03-01 DOI: 10.1016/j.tpr.2022.100093
Laila Schneidewind , Uwe Grunwald , Desiree L. Dräger , Thomas Neumann , Jennifer Kranz , Oliver W. Hakenberg

Background

BK polyomavirus (BKPyV) is the most important polyomavirus affecting renal transplant recipients. BKPyV associated nephropathy (BKVAN) is seen in about 5% of renal transplant patients and can lead to graft loss in up to 50% of cases. Monitoring of specific immunity combined with viral load could be used to individually assess the risk of viral reactivation. However, cellular immunity and targeting the immune system have also the potential to be used in therapy development. Consequently, we performed a rapid review about cellular immune responses to summarize the evidence for planning new research on treatment. Additionally, we present an immunologically interesting case of BKVAN.

Methods

We performed a rapid review with a search in MEDLINE from 1971 to 2021. Additionally, we present an immunological interesting case of BKVAN.

Results

The literature search for original studies yielded 92 results. Finally, nine studies were considered, two of them were experimental studies, three retrospective case series and four prospective clinical trials. On the whole, there is evidence that virus-specific T cells could be used for monitoring of BKVAN, but also for therapy.

Conclusions

Cellular immune response to BKVAN is complex, but further prospective clinical studies, especially in virus-specific T cells are necessary.

背景dbk多瘤病毒(BKPyV)是影响肾移植受者最重要的多瘤病毒。BKPyV相关肾病(BKVAN)见于约5%的肾移植患者,可导致高达50%的移植肾丢失。特异性免疫监测结合病毒载量可用于单独评估病毒再激活的风险。然而,细胞免疫和靶向免疫系统也有可能用于治疗发展。因此,我们对细胞免疫反应进行了快速回顾,以总结计划新的治疗研究的证据。此外,我们提出了一个免疫学上有趣的BKVAN病例。方法在MEDLINE检索1971 - 2021年的文献,进行快速回顾。此外,我们提出了一个有趣的免疫学病例BKVAN。结果对原创性研究进行文献检索,得到92个结果。最终纳入9项研究,其中2项为实验研究,3项为回顾性病例系列,4项为前瞻性临床试验。总的来说,有证据表明,病毒特异性T细胞既可以用于监测BKVAN,也可以用于治疗。结论细胞对BKVAN的免疫反应是复杂的,但需要进一步的前瞻性临床研究,特别是在病毒特异性T细胞中的研究。
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引用次数: 0
Subclinical non-HLA AMR detection and monitoring with surveillance dd-cfDNA in a kidney transplant recipient 肾移植受者亚临床非hla AMR检测和监测dd-cfDNA
Q4 Medicine Pub Date : 2022-03-01 DOI: 10.1016/j.tpr.2022.100092
Erik L. Lum , Sabrina Lee , Jonathan Zuckerman , Suphamai Bunnapradist

Elevations in dd-cfDNA at the time of kidney allograft dysfunction are associated with an increased risk of rejection. The utility of such measurements in a stable allograft is unknown. Herein we present a case utilizing routine surveillance dd-cfDNA to detect subclinical active BANFF rejection with persistent elevations and biopsy evidence of ongoing injury despite treatments. Due to treatment failure she developed chronic allograft nephropathy within six months of transplantation. Surveillance and post treatment monitoring of dd-cfDNA may be useful early detection and monitoring of rejection in kidney transplant recipients and as a marker in future studies.

同种异体肾移植功能障碍时dd-cfDNA升高与排斥反应风险增加有关。这种测量在稳定的同种异体移植物中的效用尚不清楚。在此,我们报告了一个病例,利用常规监测dd-cfDNA检测亚临床活动性BANFF排斥反应,持续升高,活检证据表明,尽管治疗,仍存在持续损伤。由于治疗失败,她在移植后6个月内患上了慢性同种异体肾病。监测和治疗后监测dd-cfDNA可能有助于早期发现和监测肾移植受者的排斥反应,并在未来的研究中作为一个标记。
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引用次数: 0
Re-appropriation of a right anterior thoracotomy approach to portal-systemic bypass for liver transplantation in a patient with complete superior vena cava occlusion 完全性上腔静脉闭塞患者再次采用右前开胸入路行门静脉-全身搭桥进行肝移植
Q4 Medicine Pub Date : 2021-12-01 DOI: 10.1016/j.tpr.2021.100086
Justin A. Steggerda , Andre Y. Son , Marcos E. Pozo , Amit Pawale , Aaron S. Reynolds , Kush Desai , Daniel Galvez-Lima , Josh Herborn , Andre DeWolf , Daniela Ladner , Juan Carlos Caicedo , Nitin Katariya , Daniel Borja-Cacho

The utilization of venovenous bypass in liver transplantation (LT) has become less frequent and more center dependent over time. Unfortunately, this has left many transplant surgeons, particularly younger trainees, unfamiliar with the techniques and indications for its utilization. We present a case of LT in a patient with complete superior vena cava (SVC) occlusion prohibiting direct vascular access. A multi-disciplinary approach involving interventional radiology, anesthesiology, cardiac surgery, and transplant surgery, was used to diagnose, evaluate, and develop an operative plan for successful LT. In doing so, a novel approach to portosystemic bypass was utilized involving a right mini-thoracotomy with direct cannulation of the right atrium to gain central venous access and optimize venous return during LT. As a center that does not routinely use venovenous bypass, this multidisciplinary approach was crucial identifying the need for a rarely used technique for vascular access and performance of a successful LT.

随着时间的推移,静脉-静脉旁路在肝移植(LT)中的应用越来越少,越来越依赖于中心。不幸的是,这使得许多移植外科医生,特别是年轻的实习生,不熟悉其使用的技术和适应症。我们报告了一例完全性上腔静脉(SVC)闭塞,禁止血管直接进入的患者的LT。包括介入放射学、麻醉学、心脏外科和移植外科在内的多学科方法被用于诊断、评估和制定成功的ltt手术计划。为此,采用了一种新的门静脉搭桥方法,包括右小开胸和直接插管右心房,以获得中心静脉通路并优化ltt期间的静脉回流。这种多学科的方法至关重要,它确定了一种很少使用的血管通路技术的需求,并成功地完成了小血管移植。
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引用次数: 0
期刊
Transplantation Reports
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