Sarah Albilal, M. Shawaqfeh, Salwa Albusaysi, Lolwa Fetyani, Fai Alnashmi, Shaden D Alshehri, Nataleen A Albekairy, Amal Akhulaif, L. Alzahrani, Mariah Alwuhayde, A. Obaidat, Abdulkareem M. Al Bekairy
{"title":"Tacrolimus Trough Level Variation and Its Correlation to Clinical Outcomes and Consequences in Solid Organ Transplantation","authors":"Sarah Albilal, M. Shawaqfeh, Salwa Albusaysi, Lolwa Fetyani, Fai Alnashmi, Shaden D Alshehri, Nataleen A Albekairy, Amal Akhulaif, L. Alzahrani, Mariah Alwuhayde, A. Obaidat, Abdulkareem M. Al Bekairy","doi":"10.2147/trrm.s415385","DOIUrl":"https://doi.org/10.2147/trrm.s415385","url":null,"abstract":"","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45318662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: We conducted a survey on the status of patients after kidney transplantation infected with JC virus (JCV), at 108 Military Central Hospital (108MCH), Vietnam, combining research on the effects of JCV infection on transplanted kidney function and understanding the risk factors for JCV infection in kidney transplant recipients. Patients and Methods: A single-center cohort study was conducted in the period from March 2021 to July 2022, using a combination of retrospective and prospective methods, with longitudinal follow-up of 94 eligible kidney transplant patients who agreed to participate, at the Department of Nephrology and Dialysis, 108MCH, Vietnam. Patients undergo monthly health checks and have their blood and urine tested by a real-time PCR method, with TaqMan probes (BioRad, USA). If at least one of the two specimens (blood or urine sample) is positive for JCV (when JCV is quantified in blood or urine samples at >250 copies/mL), the patient is confirmed to have JCV infection in any part or tissue of the body. Factors of JCV infection, such as age, gender, donor source, and immunosuppressive therapy, along with demographic and clinical data and JCV infection status, were analyzed using multivariable Cox-regression analysis. The estimated glomerular filtration rate (eGFR) was selected as an indicator of kidney function, and the difference in eGFR between JCV-infected patients and non-infected patients was compared using the t -test. This study was approved by the Research Ethics Committee. Results: JCV was detected in 71.3% of kidney transplant patients. Differences in eGFR were observed between the JCV-infected and non-infected patient groups (64.47±25.70 and 70.89±28.80 mL/min/1.73 m 2 for each group; independent t -test; t =−6.079; p =0.00). Factors such as kidney donor (HR=0.086; 95% confidence interval [CI]: 0.008–0.936; p =0.04), tacrolimus trough level (HR=1.083; 95% CI: 1.069–1.097; p =0.00), mycophenolate dose (HR=1.002; 95% CI: 1.002–1.001; p =0.00) and prednisone dose (HR=1.001; 95% CI: 1.000–1.001; p =0.00) in the trio of immunosuppressants tacrolimus + mycophenolate mofetil (MMF) + prednisone (multivariable Cox-regression analysis) are potential risk factors for JCV infection in renal transplantation. JCV infection in kidney transplant patients lowers the eGFR, leading to decreased transplant kidney function (independent t -test, p =0.00). Conclusion: The level of JCV infection in kidney transplant patients in our study is quite high (71.3%). Using an immunosuppressive regimen that uses the trio of immunosuppressants tacrolimus + MMF + prednisone, and having a donor source element are potential risk factors for JCV infection in renal transplantation. The function of the transplanted kidney is reduced by JCV infection in kidney transplant patients in the short term. The timely diagnosis and treatment of JCV can ensure the stable and long-term function of transplanted kidneys in kidney transplant patients. initially to dete
目的：我们在越南108军事中心医院（108MCH）对肾移植后感染JCV的患者进行了调查，结合JCV感染对移植肾功能影响的研究和了解肾移植受者JCV感染的危险因素。患者和方法：在2021年3月至2022年7月期间，采用回顾性和前瞻性相结合的方法进行了一项单中心队列研究，对同意参与的94名符合条件的肾移植患者进行了纵向随访。患者每月接受健康检查，并使用TaqMan探针（美国BioRad）通过实时PCR方法对其血液和尿液进行检测。如果两个样本（血液或尿液样本）中至少有一个样本的JCV呈阳性（当血液或尿液样品中的JCV定量为>250拷贝/mL时），则确认患者在身体的任何部位或组织中感染了JCV。使用多变量Cox回归分析分析JCV感染的因素，如年龄、性别、供体来源和免疫抑制治疗，以及人口统计学和临床数据和JCV感染状况。选择估计的肾小球滤过率（eGFR）作为肾功能的指标，并使用t检验比较JCV感染患者和未感染患者之间的eGFR差异。这项研究得到了研究伦理委员会的批准。结果：肾移植患者JCV检出率为71.3%。在JCV感染和未感染患者组之间观察到eGFR的差异（每组64.47±25.70和70.89±28.80 mL/min/1.73 m 2；独立t检验；t=−6.079；p=0.00）。肾脏供体（HR=0.086；95%置信区间[CI]:0.08–0.936；p=0.04）、他克莫司谷水平（HR=1.083；95%CI:1.069–1.097；p=0.00，三种免疫抑制剂他克莫司+霉酚酸酯（MMF）+泼尼松（多变量Cox回归分析）中的霉酚酸酯剂量（HR=1.002；95%CI:1.002–1.001；p=0.00）和泼尼松剂量（HR=10001；95%CI:11.000–1.001，p=0.00）是肾移植中JCV感染的潜在危险因素。肾移植患者的JCV感染降低了eGFR，导致移植肾功能下降（独立t检验，p=0.00）。结论：我们研究的肾移植患者JCV感染水平相当高（71.3%），以及具有供体来源元素是肾移植中JCV感染的潜在风险因素。肾移植患者的JCV感染会在短期内降低移植肾的功能。及时诊断和治疗JCV可以保证肾移植患者移植肾的稳定和长期功能。首先确定肾移植术后患者感染JCV的原因和潜在风险因素，然后评估JCV在肾移植患者中的作用，并确定预防和治疗JCV的策略。在本研究中，年龄、性别、供体来源、免疫抑制治疗、人口统计学和临床数据等特征，以及JCV感染对移植肾功能的影响与JCV感染因素之间的相关性，以及JC病毒与免疫抑制剂量和免疫抑制药物水平之间的相关性，以期为肾移植患者适当调整免疫抑制方案提供参考。蛋白尿和免疫抑制剂的三联作用，以及他克莫司的浓度和MMF和泼尼松的剂量。在最后一步中，拟合的多变量Cox回归只显示了显著变量。供者来源（HR=0.086，p<0.05）、血尿（HR=1.405，p<0.01）、蛋白尿（HR=0.851，p<0.01），他克莫司谷值（HR=1.083，p<0.01）、MMF剂量（HR=1.002，p<0.01）和泼尼松剂量（HR=0.001，p<0.01）
{"title":"Kidney Transplant Recipients with JC Virus Infection Have Decreased Function of the Transplanted Kidney","authors":"Ho Trung Hieu, B. T. Sy","doi":"10.2147/trrm.s384595","DOIUrl":"https://doi.org/10.2147/trrm.s384595","url":null,"abstract":"Purpose: We conducted a survey on the status of patients after kidney transplantation infected with JC virus (JCV), at 108 Military Central Hospital (108MCH), Vietnam, combining research on the effects of JCV infection on transplanted kidney function and understanding the risk factors for JCV infection in kidney transplant recipients. Patients and Methods: A single-center cohort study was conducted in the period from March 2021 to July 2022, using a combination of retrospective and prospective methods, with longitudinal follow-up of 94 eligible kidney transplant patients who agreed to participate, at the Department of Nephrology and Dialysis, 108MCH, Vietnam. Patients undergo monthly health checks and have their blood and urine tested by a real-time PCR method, with TaqMan probes (BioRad, USA). If at least one of the two specimens (blood or urine sample) is positive for JCV (when JCV is quantified in blood or urine samples at >250 copies/mL), the patient is confirmed to have JCV infection in any part or tissue of the body. Factors of JCV infection, such as age, gender, donor source, and immunosuppressive therapy, along with demographic and clinical data and JCV infection status, were analyzed using multivariable Cox-regression analysis. The estimated glomerular filtration rate (eGFR) was selected as an indicator of kidney function, and the difference in eGFR between JCV-infected patients and non-infected patients was compared using the t -test. This study was approved by the Research Ethics Committee. Results: JCV was detected in 71.3% of kidney transplant patients. Differences in eGFR were observed between the JCV-infected and non-infected patient groups (64.47±25.70 and 70.89±28.80 mL/min/1.73 m 2 for each group; independent t -test; t =−6.079; p =0.00). Factors such as kidney donor (HR=0.086; 95% confidence interval [CI]: 0.008–0.936; p =0.04), tacrolimus trough level (HR=1.083; 95% CI: 1.069–1.097; p =0.00), mycophenolate dose (HR=1.002; 95% CI: 1.002–1.001; p =0.00) and prednisone dose (HR=1.001; 95% CI: 1.000–1.001; p =0.00) in the trio of immunosuppressants tacrolimus + mycophenolate mofetil (MMF) + prednisone (multivariable Cox-regression analysis) are potential risk factors for JCV infection in renal transplantation. JCV infection in kidney transplant patients lowers the eGFR, leading to decreased transplant kidney function (independent t -test, p =0.00). Conclusion: The level of JCV infection in kidney transplant patients in our study is quite high (71.3%). Using an immunosuppressive regimen that uses the trio of immunosuppressants tacrolimus + MMF + prednisone, and having a donor source element are potential risk factors for JCV infection in renal transplantation. The function of the transplanted kidney is reduced by JCV infection in kidney transplant patients in the short term. The timely diagnosis and treatment of JCV can ensure the stable and long-term function of transplanted kidneys in kidney transplant patients. initially to dete","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42605483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Skyler L Kanegi, George D Crane, K. Scott, E. Thomas
: Tacrolimus is a cornerstone immunosuppressant with high efficacy in preventing graft rejection in liver recipients. However, neurotoxic side effects such as posterior reversible encephalopathy syndrome (PRES) may occur. Patients often exhibit seizures, encephalopathy, headache, and hypertension. This case describes a 68-year-old female who received deceased donor liver transplantation and was started on an immunosuppressive regiment of tacrolimus which was adjusted to therapeutic trough. Graft function was preserved throughout post-operative course. The patient experienced a prolonged intubation period complicated by failed spontaneous breathing tests until post-operative day (POD) 8. From POD 8–16, the patient experienced dysphagia. From POD 13–16, the patient exhibited altered mental status and dysarthria. Throughout presentation of these symptoms, the patient had no radiographic findings, lab findings, or hypertension. On POD 15, tacrolimus was discontinued in favor of cyclosporine. By POD 17, the patient experienced complete resolution of her encephalopathy, dysphagia, and dysarthria. The patient was discharged on POD 24. This is the first known case of dysphagia and dysarthria as major presenting symptoms of tacrolimus toxicity. Discontinuing tacrolimus in favor of cyclosporine can successfully resolve a constellation of neurotoxic symptoms that do not fit a classic picture of PRES.
{"title":"A Unique Case of Tacrolimus-Induced Dysphagia and Dysarthria in the Absence of Diagnostic Findings","authors":"Skyler L Kanegi, George D Crane, K. Scott, E. Thomas","doi":"10.2147/trrm.s378778","DOIUrl":"https://doi.org/10.2147/trrm.s378778","url":null,"abstract":": Tacrolimus is a cornerstone immunosuppressant with high efficacy in preventing graft rejection in liver recipients. However, neurotoxic side effects such as posterior reversible encephalopathy syndrome (PRES) may occur. Patients often exhibit seizures, encephalopathy, headache, and hypertension. This case describes a 68-year-old female who received deceased donor liver transplantation and was started on an immunosuppressive regiment of tacrolimus which was adjusted to therapeutic trough. Graft function was preserved throughout post-operative course. The patient experienced a prolonged intubation period complicated by failed spontaneous breathing tests until post-operative day (POD) 8. From POD 8–16, the patient experienced dysphagia. From POD 13–16, the patient exhibited altered mental status and dysarthria. Throughout presentation of these symptoms, the patient had no radiographic findings, lab findings, or hypertension. On POD 15, tacrolimus was discontinued in favor of cyclosporine. By POD 17, the patient experienced complete resolution of her encephalopathy, dysphagia, and dysarthria. The patient was discharged on POD 24. This is the first known case of dysphagia and dysarthria as major presenting symptoms of tacrolimus toxicity. Discontinuing tacrolimus in favor of cyclosporine can successfully resolve a constellation of neurotoxic symptoms that do not fit a classic picture of PRES.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44135002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Stirnadel-Farrant, G. Mu, Selin Cooper-Blenkinsopp, R. Schroyer, K. Thorneloe, E. Harrison, S. M. Andrews
Purpose: A variety of definitions for delayed graft function (DGF) have been proposed, but none has consistently been shown to be superior for predicting long-term graft outcomes for kidney donation after circulatory death (DCD) transplantation. In this study, real-world clinical outcome data following DCD transplantation were explored to determine the value of various DGF definitions for predicting graft survival. Patients and Methods: Data from 4 centers registered in the UK-based National Health Service Blood and Transplant registry (2010 to mid-2015) were used to assess 4 definitions of DGF in this retrospective chart review study. Results: Depending on the definition used, the frequency of DGF ranged from 119/362 (32.9%) when DGF was determined with available registry data and based on a requirement for dialysis within 7 days post-transplantation, to 224/315 (71.1%) when based on failure to achieve a 10% fall in serum creatinine (SCr) versus baseline per 24 hours averaged over the first 72 hours. Patients without clinical DGF as determined by a physician upon chart review, or when defined as <30% reduction in baseline SCr within 7 days post-transplantation with or without dialysis, had significantly better graft survival probability 1 year (hazard ratio 2.08 and 4.48, respectively) and 5 years post-transplant, whereas serum creatinine level over the first 72 hours post-transplant was not predictive of graft survival at 1 year. Patients with clinical DGF upon physician chart review also had higher SCr, lower estimated glomerular filtration rate levels, and were dialyzed more (2.3 days) versus patients without (0.2 days). Conclusion: Delayed graft function, determined clinically or using a functional definition, is associated with poorer renal function and remains a useful predictor of graft survival at 1 year after DCD kidney transplantation. not have DGF by these definitions had better kidney function at 30 days and at 1 year following their transplant. In conclusion, DGF using these definitions may help to predict long-term outcomes after DCD kidney transplantation.
{"title":"Predictive Value of Delayed Graft Function Definitions Following Donation After Circulatory Death Renal Transplantation in the United Kingdom","authors":"H. Stirnadel-Farrant, G. Mu, Selin Cooper-Blenkinsopp, R. Schroyer, K. Thorneloe, E. Harrison, S. M. Andrews","doi":"10.2147/trrm.s320221","DOIUrl":"https://doi.org/10.2147/trrm.s320221","url":null,"abstract":"Purpose: A variety of definitions for delayed graft function (DGF) have been proposed, but none has consistently been shown to be superior for predicting long-term graft outcomes for kidney donation after circulatory death (DCD) transplantation. In this study, real-world clinical outcome data following DCD transplantation were explored to determine the value of various DGF definitions for predicting graft survival. Patients and Methods: Data from 4 centers registered in the UK-based National Health Service Blood and Transplant registry (2010 to mid-2015) were used to assess 4 definitions of DGF in this retrospective chart review study. Results: Depending on the definition used, the frequency of DGF ranged from 119/362 (32.9%) when DGF was determined with available registry data and based on a requirement for dialysis within 7 days post-transplantation, to 224/315 (71.1%) when based on failure to achieve a 10% fall in serum creatinine (SCr) versus baseline per 24 hours averaged over the first 72 hours. Patients without clinical DGF as determined by a physician upon chart review, or when defined as <30% reduction in baseline SCr within 7 days post-transplantation with or without dialysis, had significantly better graft survival probability 1 year (hazard ratio 2.08 and 4.48, respectively) and 5 years post-transplant, whereas serum creatinine level over the first 72 hours post-transplant was not predictive of graft survival at 1 year. Patients with clinical DGF upon physician chart review also had higher SCr, lower estimated glomerular filtration rate levels, and were dialyzed more (2.3 days) versus patients without (0.2 days). Conclusion: Delayed graft function, determined clinically or using a functional definition, is associated with poorer renal function and remains a useful predictor of graft survival at 1 year after DCD kidney transplantation. not have DGF by these definitions had better kidney function at 30 days and at 1 year following their transplant. In conclusion, DGF using these definitions may help to predict long-term outcomes after DCD kidney transplantation.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45443717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdulkareem M. Albekairy, M. Shawaqfeh, Shroug H Alharbi, Faisal Almuqbil, Mesfer A Alghamdi, Nataleen A Albekairy, S. Muflih, Abdulmalik A Alkatheri
Introduction: Cytomegalovirus infection is one of the opportunistic infections that occur within the first year of solid organ transplantation (SOT). Antiviral prophylaxis like valganciclovir is recommended for organ transplant recipients if the donors are seropositive. The study aims to assess the association between compliance with CMV prevention guidelines and the incidence of CMV infection post kidney and liver transplantation. Methods: A single-center, cross-sectional chart review study was conducted at a tertiary care facility. The study included patients with liver and/or kidney transplantation and received valganciclovir for CMV prevention. The primary endpoint is to determine the incidence of CMV post SOT. The secondary endpoint is to assess the association between compliance with the CMV prevention guidelines and the incidence of CMV infection. Descriptive statistics were used to report the incidence of CMVand logistic regression for risk factor comparisons. The study was approved by the Institutional Review Board. Results: A total of 493 patients had a mean age of 48.6 ± 15.3 years were included. For the primary endpoint, there were a total of 257 patients with CMV occurrence (52.1%). For the secondary endpoint, there was no statistically significant association between CMV incidence and starting CMV prophylaxis agent post-transplantation within 10 days post-transplant (p < 0.75) and duration of CMV prophylactic medications (p < 0.47). In this study, the cases of CMV disease that occurred within 3–6 months following completion of antiviral prophylaxis were in 28% of the patients. Other factors associated with increased risk of CMV infection were evaluated. Conclusion: We found about 28% of CMV infection cases occurred within 3–6 months following completion of antiviral prophylaxis. This was attributed to non-adherence to prophylaxis guidelines. The study has shown that there is a need for improvement in clinical practice. Future studies should address the optimal duration of the CMV prophylaxis. to identify the factors associated with the development of CMV among transplant patients. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were established. The statistical significance was set as α=0.05. All statistical analyses were performed using Statistical Package for Social Sciences version 24.0 (SPSS 24.0).
{"title":"Prophylaxis of Cytomegalovirus Infection in Solid Organ Transplantation, Retrospective Evaluation","authors":"Abdulkareem M. Albekairy, M. Shawaqfeh, Shroug H Alharbi, Faisal Almuqbil, Mesfer A Alghamdi, Nataleen A Albekairy, S. Muflih, Abdulmalik A Alkatheri","doi":"10.2147/trrm.s366213","DOIUrl":"https://doi.org/10.2147/trrm.s366213","url":null,"abstract":"Introduction: Cytomegalovirus infection is one of the opportunistic infections that occur within the first year of solid organ transplantation (SOT). Antiviral prophylaxis like valganciclovir is recommended for organ transplant recipients if the donors are seropositive. The study aims to assess the association between compliance with CMV prevention guidelines and the incidence of CMV infection post kidney and liver transplantation. Methods: A single-center, cross-sectional chart review study was conducted at a tertiary care facility. The study included patients with liver and/or kidney transplantation and received valganciclovir for CMV prevention. The primary endpoint is to determine the incidence of CMV post SOT. The secondary endpoint is to assess the association between compliance with the CMV prevention guidelines and the incidence of CMV infection. Descriptive statistics were used to report the incidence of CMVand logistic regression for risk factor comparisons. The study was approved by the Institutional Review Board. Results: A total of 493 patients had a mean age of 48.6 ± 15.3 years were included. For the primary endpoint, there were a total of 257 patients with CMV occurrence (52.1%). For the secondary endpoint, there was no statistically significant association between CMV incidence and starting CMV prophylaxis agent post-transplantation within 10 days post-transplant (p < 0.75) and duration of CMV prophylactic medications (p < 0.47). In this study, the cases of CMV disease that occurred within 3–6 months following completion of antiviral prophylaxis were in 28% of the patients. Other factors associated with increased risk of CMV infection were evaluated. Conclusion: We found about 28% of CMV infection cases occurred within 3–6 months following completion of antiviral prophylaxis. This was attributed to non-adherence to prophylaxis guidelines. The study has shown that there is a need for improvement in clinical practice. Future studies should address the optimal duration of the CMV prophylaxis. to identify the factors associated with the development of CMV among transplant patients. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were established. The statistical significance was set as α=0.05. All statistical analyses were performed using Statistical Package for Social Sciences version 24.0 (SPSS 24.0).","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47227709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To describe the method used locally in amniotic membrane preparation and preservation for ocular surface reconstruction. To report the indications, surgical techniques, outcome and complications of amniotic membrane transplant using the locally prepared tissue. To examine the safety and efficacy of this less commonly studied method in amniotic membrane banking technique. Patients and Methods: Dimethylsulphoxide (DMSO) was used for the preparation and preservation of the amniotic membrane. A retrospective study was done from 2005 to 2017 to examine the indications of amniotic membrane transplant. The surgical techniques used for different indications are described. Surgical outcome and complications are reported. Results: The prepared tissue was used for the surgical management of a variety of disorders related to the ocular surface. Over the 12 years period from 2005 to 2017, a total of 135 cases were done. The most common indications for amniotic membrane transplant were pterygium surgery (41%), non-healing corneal ulcer (24%), others (13%), corneal perforation (10%), chemical burn (7%), bullous keratopathy (3%) and conjunctival-corneal scarring (2%). The most common surgical procedures used were inlay, overlay and combination (sandwich) techniques. Success rates for this ocular structure restoration procedure were the highest when treating corneal ulcers (81%), followed by pseudophakic bullous keratopathy (75%), then corneal perforations (70%). The recurrence rate for pterygium with amniotic membrane transplant was 14%. The most common complication was repeat amniotic membrane transplant. There were no complications related to the banking technique. Conclusion: This method of preparation and preservation of amniotic membranes is safe and effective for ocular surface disorders. Amniotic membrane transplants have high success rates when treating, corneal ulcers, corneal perforations, pseudophakic bullous and epidermolysis bullosa.
{"title":"Amniotic Membrane Transplantation an Experience of a Locally Prepared Tissue","authors":"N. Al-Yousuf, Hasan Alsetri, E. Farid, S. George","doi":"10.2147/trrm.s336917","DOIUrl":"https://doi.org/10.2147/trrm.s336917","url":null,"abstract":"Purpose: To describe the method used locally in amniotic membrane preparation and preservation for ocular surface reconstruction. To report the indications, surgical techniques, outcome and complications of amniotic membrane transplant using the locally prepared tissue. To examine the safety and efficacy of this less commonly studied method in amniotic membrane banking technique. Patients and Methods: Dimethylsulphoxide (DMSO) was used for the preparation and preservation of the amniotic membrane. A retrospective study was done from 2005 to 2017 to examine the indications of amniotic membrane transplant. The surgical techniques used for different indications are described. Surgical outcome and complications are reported. Results: The prepared tissue was used for the surgical management of a variety of disorders related to the ocular surface. Over the 12 years period from 2005 to 2017, a total of 135 cases were done. The most common indications for amniotic membrane transplant were pterygium surgery (41%), non-healing corneal ulcer (24%), others (13%), corneal perforation (10%), chemical burn (7%), bullous keratopathy (3%) and conjunctival-corneal scarring (2%). The most common surgical procedures used were inlay, overlay and combination (sandwich) techniques. Success rates for this ocular structure restoration procedure were the highest when treating corneal ulcers (81%), followed by pseudophakic bullous keratopathy (75%), then corneal perforations (70%). The recurrence rate for pterygium with amniotic membrane transplant was 14%. The most common complication was repeat amniotic membrane transplant. There were no complications related to the banking technique. Conclusion: This method of preparation and preservation of amniotic membranes is safe and effective for ocular surface disorders. Amniotic membrane transplants have high success rates when treating, corneal ulcers, corneal perforations, pseudophakic bullous and epidermolysis bullosa.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45542948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nouf E AL-Otaibi, Abdulmalik S. Alotaibi, Nataleen A Albekairy, M. Shawaqfeh, Moawad Alotaibi, Shmeylan Alharbi, Abdulmalik A Alkatheri, Abdulkreem M Albekairy
{"title":"Assessment of Risk Factors Associated with Bone and Mineral Disease Post-Renal Transplantation: “The Experiences of Two Centers”","authors":"Nouf E AL-Otaibi, Abdulmalik S. Alotaibi, Nataleen A Albekairy, M. Shawaqfeh, Moawad Alotaibi, Shmeylan Alharbi, Abdulmalik A Alkatheri, Abdulkreem M Albekairy","doi":"10.2147/trrm.s338844","DOIUrl":"https://doi.org/10.2147/trrm.s338844","url":null,"abstract":"","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45838027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heidi Joyce, M. R. Taylor, Andrew Moffat, Miao Hong, D. Isaac, N. Fine, S. Greenway
Introduction: Interactions between our commensal microbes and immune system are well recognized but the impact of immunosuppression on this relationship is less well character-ized, particularly outside of the gastrointestinal tract. In this pilot case-control study, we examined microbial composition and inferred function in the saliva of patients after heart transplantation. Methods: Saliva samples were collected from 26 healthy adolescent and adult heart transplant patients and 27 healthy non-transplant controls. Bacterial DNA was isolated and the V3 and V4 regions of the 16S rRNA gene were sequenced. Measures of bacterial diversity and inferred function were calculated using the software packages DADA2, Phyloseq, QIIME, PICRUSt and STAMP. Results: Transplant patients were on average 51.6 ± 18.2 years of age and 8.6 ± 5.3 years post-transplant. Both alpha (p = 0.0009) and beta (p = 0.001) diversity differed significantly between the groups, and there were statistically significant changes (p < 0.01) in 101 individual functional pathways. Discussion: We conclude that the effects of chronic immunosuppression on bacterial composition and function in the oropharynx appear relatively subtle with no obvious ill effects on patient health. Full interpretation is limited by our lack of knowledge for many of the bacterial functional pathways. tract. We studied microbial composition and inferred function in the saliva of patients after heart transplantation compared to healthy non-transplant controls. Bacterial diversity differed significantly between the groups and there were statistically significant changes in multiple individual functional pathways. We conclude that immune suppression has broad but subtle effects on the oral microbiome.
{"title":"Changes in the Composition and Function of the Human Salivary Microbiome After Heart Transplantation: A Pilot Study","authors":"Heidi Joyce, M. R. Taylor, Andrew Moffat, Miao Hong, D. Isaac, N. Fine, S. Greenway","doi":"10.2147/trrm.s328467","DOIUrl":"https://doi.org/10.2147/trrm.s328467","url":null,"abstract":"Introduction: Interactions between our commensal microbes and immune system are well recognized but the impact of immunosuppression on this relationship is less well character-ized, particularly outside of the gastrointestinal tract. In this pilot case-control study, we examined microbial composition and inferred function in the saliva of patients after heart transplantation. Methods: Saliva samples were collected from 26 healthy adolescent and adult heart transplant patients and 27 healthy non-transplant controls. Bacterial DNA was isolated and the V3 and V4 regions of the 16S rRNA gene were sequenced. Measures of bacterial diversity and inferred function were calculated using the software packages DADA2, Phyloseq, QIIME, PICRUSt and STAMP. Results: Transplant patients were on average 51.6 ± 18.2 years of age and 8.6 ± 5.3 years post-transplant. Both alpha (p = 0.0009) and beta (p = 0.001) diversity differed significantly between the groups, and there were statistically significant changes (p < 0.01) in 101 individual functional pathways. Discussion: We conclude that the effects of chronic immunosuppression on bacterial composition and function in the oropharynx appear relatively subtle with no obvious ill effects on patient health. Full interpretation is limited by our lack of knowledge for many of the bacterial functional pathways. tract. We studied microbial composition and inferred function in the saliva of patients after heart transplantation compared to healthy non-transplant controls. Bacterial diversity differed significantly between the groups and there were statistically significant changes in multiple individual functional pathways. We conclude that immune suppression has broad but subtle effects on the oral microbiome.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41534463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bouchra Rezzouk, T. Bouattar, B. Belkadi, R. Razine, R. Bayahia, N. Ouzeddoun, L. Benamar, H. Rhou, N. Bouihat, A. Ibrahimi, M. Seffar, H. Kabbaj
Purpose: Despite the use of antiviral prophylaxis with valacyclovir, cytomegalovirus infection (CMV) can still occur in seropositive kidney transplant recipients. In this study, we aimed to assess the incidence of CMV DNAemia and its risk factors in Moroccan transplant recipients. Patients and Methods: Sixty kidney recipients with positive cytomegalovirus serostatus, receiving post-transplant prophylaxis were enrolled between 2013 and 2017. In total, 455 plasma samples were collected and tested for CMV DNAemia using PCR-based Abbott RealTime assays. Results: The incidence of CMV infection in seropositive patients was 63%. In patients with quantifiable DNAemia, the duration of CMV infection was significantly shorter than in those with detectable DNAemia (141.5 ± 96.9 vs 294.1 ± 112.6 days, P < 0.001). During prophylactic treatment, 14 of 30 patients (47.0%) experienced active replication with quantifiable DNAemia, whereas none of eight patients with detectable DNAemia did ( P = 0.017). Patients with symptomatic DNAemia were significantly younger than those without symptoms (28.8 ± 5.12 vs 38.1 ± 12.34 years, P = 0.007). The peak viral loads were significantly associated with viral disease (odds ratio: 3.39, 95% confidence interval: 1.21–9.53, P = 0.02). The duration of DNAemia (21.2 vs 13.4 days, P = 0.028) was significantly longer in symptomatic patients. Significantly higher rates of acute rejection were exclusively observed in recipients with disease (4/8, 50% vs 0/22, 0%, P = 0.003). Conclusion: Patients with high-level DNAemia were at an increased risk of progression to disease and acute rejection. Monitoring the viral load during the first year post-transplantation is essential, to support current preventive strategies. was statistically significant. Abbreviations: SD, standard deviation; HLA, human leukocyte antigen.
目的:尽管使用了伐昔洛韦抗病毒预防，巨细胞病毒感染(CMV)仍然可以发生在血清阳性肾移植受者。在这项研究中，我们旨在评估摩洛哥移植受者巨细胞病毒dna血症的发生率及其危险因素。患者和方法:在2013年至2017年期间，纳入了60例巨细胞病毒血清状态阳性且接受移植后预防治疗的肾受者。总共收集了455份血浆样本，并使用基于pcr的Abbott RealTime检测CMV dna血症。结果:血清阳性患者CMV感染发生率为63%。在可量化DNAemia患者中，CMV感染持续时间明显短于可检测DNAemia患者(141.5±96.9 vs 294.1±112.6天，P < 0.001)。在预防性治疗期间，30例患者中有14例(47.0%)经历了可量化dna血症的活跃复制，而8例可检测到dna血症的患者中没有一例(P = 0.017)。症状性dna血症患者明显比无症状者年轻(28.8±5.12岁vs 38.1±12.34岁，P = 0.007)。病毒载量峰值与病毒性疾病显著相关(优势比:3.39,95%可信区间:1.21 ~ 9.53,P = 0.02)。有症状患者的DNAemia持续时间(21.2天vs 13.4天，P = 0.028)明显更长。急性排斥反应发生率明显高于疾病受体(4/ 8,50% vs 0/ 22,0%， P = 0.003)。结论:高水平dna血症患者疾病进展和急性排斥反应的风险增加。在移植后的第一年监测病毒载量对于支持当前的预防策略至关重要。有统计学意义。缩写:SD，标准差;人白细胞抗原。
{"title":"Characteristics and Outcomes of Cytomegalovirus Infection in Seropositive Kidney Transplant Recipients in the Era of Antiviral Prophylaxis with Valacyclovir: A Single-Center Study in Morocco","authors":"Bouchra Rezzouk, T. Bouattar, B. Belkadi, R. Razine, R. Bayahia, N. Ouzeddoun, L. Benamar, H. Rhou, N. Bouihat, A. Ibrahimi, M. Seffar, H. Kabbaj","doi":"10.2147/TRRM.S278655","DOIUrl":"https://doi.org/10.2147/TRRM.S278655","url":null,"abstract":"Purpose: Despite the use of antiviral prophylaxis with valacyclovir, cytomegalovirus infection (CMV) can still occur in seropositive kidney transplant recipients. In this study, we aimed to assess the incidence of CMV DNAemia and its risk factors in Moroccan transplant recipients. Patients and Methods: Sixty kidney recipients with positive cytomegalovirus serostatus, receiving post-transplant prophylaxis were enrolled between 2013 and 2017. In total, 455 plasma samples were collected and tested for CMV DNAemia using PCR-based Abbott RealTime assays. Results: The incidence of CMV infection in seropositive patients was 63%. In patients with quantifiable DNAemia, the duration of CMV infection was significantly shorter than in those with detectable DNAemia (141.5 ± 96.9 vs 294.1 ± 112.6 days, P < 0.001). During prophylactic treatment, 14 of 30 patients (47.0%) experienced active replication with quantifiable DNAemia, whereas none of eight patients with detectable DNAemia did ( P = 0.017). Patients with symptomatic DNAemia were significantly younger than those without symptoms (28.8 ± 5.12 vs 38.1 ± 12.34 years, P = 0.007). The peak viral loads were significantly associated with viral disease (odds ratio: 3.39, 95% confidence interval: 1.21–9.53, P = 0.02). The duration of DNAemia (21.2 vs 13.4 days, P = 0.028) was significantly longer in symptomatic patients. Significantly higher rates of acute rejection were exclusively observed in recipients with disease (4/8, 50% vs 0/22, 0%, P = 0.003). Conclusion: Patients with high-level DNAemia were at an increased risk of progression to disease and acute rejection. Monitoring the viral load during the first year post-transplantation is essential, to support current preventive strategies. was statistically significant. Abbreviations: SD, standard deviation; HLA, human leukocyte antigen.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47304581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chollasak Thirapattaraphan, Prapatsorn Srina, Ampaipan Boonthai, N. Arpornsujaritkun, B. Sakulchairungrueng, W. Apinyachon, S. Treepongkaruna
Background: Pediatric liver transplantation (LT) has been accepted as a definitive treatment for end-stage liver disease. Pleural effusion is a common pulmonary complication following LT in children. The objectives of the study were to identify prevalence of post-LT pleural effusion, risk factors, and the impact on patients’ outcomes. Methods: A retrospective study was conducted in 107 pediatric patients who underwent LT at our center between March 2001 and June 2018. They were categorized into pleural effusion and non-pleural effusion groups. Preoperative and perioperative data, intraoperative findings, liver graft characteristics, and perioperative outcomes were compared between the two groups. Results: Post-LT pleural effusion occurred in 64 (59.8%) patients. There were more patients with PELD score ≥ 18 in the pleural effusion group (68.8 vs 48.8%, P =0.039). Other preoperative and perioperative data were not significantly different. The pleural effusion group had a higher rate of reoperation than non-pleural effusion group (55.6 vs 30.9%, P =0.013). Median oxygen dependence time, length of ICU and hospital stay were significantly longer in the pleural effusion group (18.5 vs 7.0, 10 vs 7 and 48 vs 34 days, respectively, P <0.05). However, mortality was not significantly different. Among the patients with pleural effusion, median time to extubation, oxygen dependence time, length of ICU and hospital stay were significantly longer in those who required therapeutic interventions than those without interventions (12 vs 3, 31 vs 10, 17 vs 8, and 60 vs 43 days, respectively, P <0.05). Conclusion: Pleural effusion following pediatric LT is common and its potential risk factor is PELD score at LT ≥ 18. Post-LT pleural effusion is associated with prolonged oxygen dependence time, ICU stay and hospital stay, particularly those who required therapeutic interventions.
{"title":"Risk Factors of Pleural Effusion Following Pediatric Liver Transplantation and the Perioperative Outcomes","authors":"Chollasak Thirapattaraphan, Prapatsorn Srina, Ampaipan Boonthai, N. Arpornsujaritkun, B. Sakulchairungrueng, W. Apinyachon, S. Treepongkaruna","doi":"10.2147/trrm.s276511","DOIUrl":"https://doi.org/10.2147/trrm.s276511","url":null,"abstract":"Background: Pediatric liver transplantation (LT) has been accepted as a definitive treatment for end-stage liver disease. Pleural effusion is a common pulmonary complication following LT in children. The objectives of the study were to identify prevalence of post-LT pleural effusion, risk factors, and the impact on patients’ outcomes. Methods: A retrospective study was conducted in 107 pediatric patients who underwent LT at our center between March 2001 and June 2018. They were categorized into pleural effusion and non-pleural effusion groups. Preoperative and perioperative data, intraoperative findings, liver graft characteristics, and perioperative outcomes were compared between the two groups. Results: Post-LT pleural effusion occurred in 64 (59.8%) patients. There were more patients with PELD score ≥ 18 in the pleural effusion group (68.8 vs 48.8%, P =0.039). Other preoperative and perioperative data were not significantly different. The pleural effusion group had a higher rate of reoperation than non-pleural effusion group (55.6 vs 30.9%, P =0.013). Median oxygen dependence time, length of ICU and hospital stay were significantly longer in the pleural effusion group (18.5 vs 7.0, 10 vs 7 and 48 vs 34 days, respectively, P <0.05). However, mortality was not significantly different. Among the patients with pleural effusion, median time to extubation, oxygen dependence time, length of ICU and hospital stay were significantly longer in those who required therapeutic interventions than those without interventions (12 vs 3, 31 vs 10, 17 vs 8, and 60 vs 43 days, respectively, P <0.05). Conclusion: Pleural effusion following pediatric LT is common and its potential risk factor is PELD score at LT ≥ 18. Post-LT pleural effusion is associated with prolonged oxygen dependence time, ICU stay and hospital stay, particularly those who required therapeutic interventions.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41729460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：