Pub Date : 2011-05-30DOI: 10.2174/1874418401105010044
M. Pompili, Valeria Abbate, E. Nicolardi, F. Ponziani, L. Riccardi, A. Gasbarrini, A. Grieco, A. Avolio, G. Rapaccini
During the past years, several therapeutic procedures have been proposed as bridging treatments in patients with hepatocellular carcinoma waiting for liver transplantation. Resective surgery, transarterial chemoembolization, radiofrequency thermal ablation and percutaneous ethanol injection are the most experienced, with the aim to decrease the rate of drop-out from LT waiting list, and the risk of HCC recurrence after transplant. Indeed, for patients within the Milan criteria, a time on waiting list exceeding 6-12 months is a known risk factor of tumor progression and drop out. For this reason, the application of bridging treatments in these patients might be reasonable and several studies in recent years have documented their usefulness to control tumor progression before the transplant. However, the favourable impact of these treatments on post-transplant patients' survival is still under investigation and the available studies provide controversial results. Bridging therapies have also been used for the downstaging of tumors exceeding the conventional "Milan criteria". Some recent data regarding multimodal sequential therapies seem to report promising results in terms of overall and disease-free survival of treated patients attaining effective downstaging before transplant.
{"title":"Bridge Treatments for HCC in the Waiting List for Liver Transplantation","authors":"M. Pompili, Valeria Abbate, E. Nicolardi, F. Ponziani, L. Riccardi, A. Gasbarrini, A. Grieco, A. Avolio, G. Rapaccini","doi":"10.2174/1874418401105010044","DOIUrl":"https://doi.org/10.2174/1874418401105010044","url":null,"abstract":"During the past years, several therapeutic procedures have been proposed as bridging treatments in patients with hepatocellular carcinoma waiting for liver transplantation. Resective surgery, transarterial chemoembolization, radiofrequency thermal ablation and percutaneous ethanol injection are the most experienced, with the aim to decrease the rate of drop-out from LT waiting list, and the risk of HCC recurrence after transplant. Indeed, for patients within the Milan criteria, a time on waiting list exceeding 6-12 months is a known risk factor of tumor progression and drop out. For this reason, the application of bridging treatments in these patients might be reasonable and several studies in recent years have documented their usefulness to control tumor progression before the transplant. However, the favourable impact of these treatments on post-transplant patients' survival is still under investigation and the available studies provide controversial results. Bridging therapies have also been used for the downstaging of tumors exceeding the conventional \"Milan criteria\". Some recent data regarding multimodal sequential therapies seem to report promising results in terms of overall and disease-free survival of treated patients attaining effective downstaging before transplant.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"5 1","pages":"44-49"},"PeriodicalIF":0.0,"publicationDate":"2011-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68073278","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}
Pub Date : 2011-05-18DOI: 10.2174/1874418401105010023
J. Mehta, J. Blake, C. Craddock
Amphotericin B is an important agent for the treatment of invasive fungal infections in immunocompromised patients because of its broad spectrum. However, its toxicities and the availability of alternative agents limit its application. Lipid-based formulations of amphotericin B, such as amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB), are less nephrotoxic and as effective as conventional amphotericin B. However, because of their similarities, choosing between the two formulations remains a challenge. The majority of prospective and retrospective comparative studies have shown equivalence in terms of efficacy although some subset analyses favor ABLC over L-AMB. While both drugs penetrate well in the reticuloendothelial system, ABLC gets concentrated in the lungs to a much greater extent. This may have clinical implications because the lungs are the commonest site of invasive fungal infections. L-AMB is associated with less infusion-related adverse effects and less nephrotoxicity than ABLC. ABLC has been shown to be more cost-effective than L-AMB, although this is affected by variable institutional contracts and pricing. The choice between the two drugs should be based upon due consideration of all these factors.
{"title":"Comparative Efficacy of Amphotericin B Lipid Complex and Liposomal Amphotericin B for the Treatment of Invasive Fungal Infections in HSCT Recipients and other Immunocompromised Patient Populations with Hematologic Malignancies: A Critical Review","authors":"J. Mehta, J. Blake, C. Craddock","doi":"10.2174/1874418401105010023","DOIUrl":"https://doi.org/10.2174/1874418401105010023","url":null,"abstract":"Amphotericin B is an important agent for the treatment of invasive fungal infections in immunocompromised patients because of its broad spectrum. However, its toxicities and the availability of alternative agents limit its application. Lipid-based formulations of amphotericin B, such as amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB), are less nephrotoxic and as effective as conventional amphotericin B. However, because of their similarities, choosing between the two formulations remains a challenge. The majority of prospective and retrospective comparative studies have shown equivalence in terms of efficacy although some subset analyses favor ABLC over L-AMB. While both drugs penetrate well in the reticuloendothelial system, ABLC gets concentrated in the lungs to a much greater extent. This may have clinical implications because the lungs are the commonest site of invasive fungal infections. L-AMB is associated with less infusion-related adverse effects and less nephrotoxicity than ABLC. ABLC has been shown to be more cost-effective than L-AMB, although this is affected by variable institutional contracts and pricing. The choice between the two drugs should be based upon due consideration of all these factors.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"15 1","pages":"23-29"},"PeriodicalIF":0.0,"publicationDate":"2011-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072837","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}
Pub Date : 2011-02-07DOI: 10.2174/1874418401105010008
B. Gali, D. Plevak, D. Nagorney, C. Rosen, J. Heimbach, R. Dierkhising, J. Findlay
Living donor liver transplantation (LD) has been implemented as an alternative to deceased donor transplantation (DD). We reviewed the perioperative course of recipients of LD and recipients of DD at our institution with specific aims to compare intraoperative events, early complication rates, resource utilization, and patient survival. Methods: Following Institutional Review Board (IRB) approval, the first forty LD cases were retrospectively matched by age, sex, and primary reason for transplant with controls that underwent DD between June 30, 2000 and January 25, 2005. Preoperative data, intraoperative variables, and immediate postoperative data were collected. Statistical analysis included signed rank test, McNemar's test, Wald statistics, and stratified Cox proportional hazards model. Results: Calculated Model for End Stage Liver Disease (MELD) scores were higher for DD (median 18 vs. 14 with p=0.04). Anesthesia time was longer in LD (median 7.1 vs. 6.5, p=0.02). Hospital length of stay (LOS) was higher in LD (median 12 vs. 8 days, P=0.002). Seven of the 40 (17%) LD were deceased at the time of data collection, as were four (10%) of the DD. Conclusions: Comparison of DD and LD at our institution revealed few significant differences in perioperative variables. LD may have more postoperative complications and longer hospital stays but similar patient survival.
{"title":"Perioperative Events in Living and Deceased Donor Liver Transplant Recipients: A Case Control Study","authors":"B. Gali, D. Plevak, D. Nagorney, C. Rosen, J. Heimbach, R. Dierkhising, J. Findlay","doi":"10.2174/1874418401105010008","DOIUrl":"https://doi.org/10.2174/1874418401105010008","url":null,"abstract":"Living donor liver transplantation (LD) has been implemented as an alternative to deceased donor transplantation (DD). We reviewed the perioperative course of recipients of LD and recipients of DD at our institution with specific aims to compare intraoperative events, early complication rates, resource utilization, and patient survival. Methods: Following Institutional Review Board (IRB) approval, the first forty LD cases were retrospectively matched by age, sex, and primary reason for transplant with controls that underwent DD between June 30, 2000 and January 25, 2005. Preoperative data, intraoperative variables, and immediate postoperative data were collected. Statistical analysis included signed rank test, McNemar's test, Wald statistics, and stratified Cox proportional hazards model. Results: Calculated Model for End Stage Liver Disease (MELD) scores were higher for DD (median 18 vs. 14 with p=0.04). Anesthesia time was longer in LD (median 7.1 vs. 6.5, p=0.02). Hospital length of stay (LOS) was higher in LD (median 12 vs. 8 days, P=0.002). Seven of the 40 (17%) LD were deceased at the time of data collection, as were four (10%) of the DD. Conclusions: Comparison of DD and LD at our institution revealed few significant differences in perioperative variables. LD may have more postoperative complications and longer hospital stays but similar patient survival.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"5 1","pages":"08-14"},"PeriodicalIF":0.0,"publicationDate":"2011-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072779","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}
Pub Date : 2011-02-04DOI: 10.2174/1874418401105010001
B. Sadeghi, H. Hägglund, M. Remberger, S. Al-Hashmi, Z. Hassan, M. Abedi‐Valugerdi, Moustapha Hassan
Graft versus host disease (GVHD) is the major limiting factor after Hematopoietic stem cell transplantation (HSCT). In this study, we report a HSCT-patient who developed arthritis 10-month after allogeneic sibling transplantation, treated with glucosamine-hydrochloride and developed severe acute GVHD within three weeks after the administration of glucosamine. Another HSCT-recipient with an increase in CD33+cells received one dose of donor lymphocyte infusion (DLI). Due to the lack of DLI and based on our experience from the first case, the patient was treated with glucosamine. No sign of relapse was observed in the second patient despite increased number of CD33+ for more than three years. The glucosamine effect was evaluated in seven individuals given the drug for four weeks. The effect of glucosamine treatment was examined by mixed-lymphocyte-reaction (MLR) and the levels of soluble IL-2 receptor (sIL- 2R), TNF-α and IFN-γ were determined. Glucosamine administration exhibited an enhancement in the allogeneic MLR and an increase in the serum levels of sIL-2R, but a decrease in the serum levels of inflammatory cytokines TNF-α and IFN-γ. We conclude that glucosamine may act as an activator of the immune system. In HSCT-patients, glucosamine-mediated immune activation might result in either beneficial or deleterious outcomes. Thus, precautions should be taken when glucosamine is prescribed to HSCT-patients.
{"title":"Glucosamine Activates T Lymphocytes in Healthy Individuals and may Induce GVHD/GVL in Stem Cell Transplanted Recipients","authors":"B. Sadeghi, H. Hägglund, M. Remberger, S. Al-Hashmi, Z. Hassan, M. Abedi‐Valugerdi, Moustapha Hassan","doi":"10.2174/1874418401105010001","DOIUrl":"https://doi.org/10.2174/1874418401105010001","url":null,"abstract":"Graft versus host disease (GVHD) is the major limiting factor after Hematopoietic stem cell transplantation (HSCT). In this study, we report a HSCT-patient who developed arthritis 10-month after allogeneic sibling transplantation, treated with glucosamine-hydrochloride and developed severe acute GVHD within three weeks after the administration of glucosamine. Another HSCT-recipient with an increase in CD33+cells received one dose of donor lymphocyte infusion (DLI). Due to the lack of DLI and based on our experience from the first case, the patient was treated with glucosamine. No sign of relapse was observed in the second patient despite increased number of CD33+ for more than three years. The glucosamine effect was evaluated in seven individuals given the drug for four weeks. The effect of glucosamine treatment was examined by mixed-lymphocyte-reaction (MLR) and the levels of soluble IL-2 receptor (sIL- 2R), TNF-α and IFN-γ were determined. Glucosamine administration exhibited an enhancement in the allogeneic MLR and an increase in the serum levels of sIL-2R, but a decrease in the serum levels of inflammatory cytokines TNF-α and IFN-γ. We conclude that glucosamine may act as an activator of the immune system. In HSCT-patients, glucosamine-mediated immune activation might result in either beneficial or deleterious outcomes. Thus, precautions should be taken when glucosamine is prescribed to HSCT-patients.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"5 1","pages":"01-07"},"PeriodicalIF":0.0,"publicationDate":"2011-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072769","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}
Pub Date : 2011-01-01DOI: 10.2174/1874418401105010015
Susanne L Lindell, Natascha Williams, Ilia Brusilovsky, Martin J Mangino
Main problem: The molecular basis of renal preservation injury is not well understood. Since mouse kidney transplantation models are not useful in this setting, a mouse Isolated Perfused Kidney (IPK) model was developed to take advantage of mouse genetic design capabilities for testing complex biological hypothesis regarding mechanisms of preservation injury in transplanted kidneys.
Methods: Mouse kidneys were recovered, preserved, and reperfused in-vitro with an acellular physiological crystalloid buffer containing hypo-physiological oncotic pressure. Outcome variables were measured to predict preservation injury. These included perfusate flow, vascular resistance, VO2, urine output, GFR, proteinuria, LDH release, and edema. The model was tested by subjecting mouse kidneys to cold storage in University of Wisconsin (UW) solution for 24, 48, or 72 hours (time-dependent preservation injury), cold storage in Euro-Collins Solution (solution dependent preservation injury), and exposure to prior warm ischemia (DCD dependent preservation injury).
Results: The model accurately predicted the qualitative and quantitative changes in the readouts based on known responses to preservation injury in kidney transplants in large animals and humans.
Conclusion: The mouse IPK accurately predicts many of the variables associated with renal organ preservation injury in the very early phases of reperfusion and may provide an attractive model for studying the molecular basis of renal preservation injury.
{"title":"Mouse IPK: A Powerful Tool to Partially Characterize Renal Reperfusion and Preservation Injury.","authors":"Susanne L Lindell, Natascha Williams, Ilia Brusilovsky, Martin J Mangino","doi":"10.2174/1874418401105010015","DOIUrl":"https://doi.org/10.2174/1874418401105010015","url":null,"abstract":"<p><strong>Main problem: </strong>The molecular basis of renal preservation injury is not well understood. Since mouse kidney transplantation models are not useful in this setting, a mouse Isolated Perfused Kidney (IPK) model was developed to take advantage of mouse genetic design capabilities for testing complex biological hypothesis regarding mechanisms of preservation injury in transplanted kidneys.</p><p><strong>Methods: </strong>Mouse kidneys were recovered, preserved, and reperfused in-vitro with an acellular physiological crystalloid buffer containing hypo-physiological oncotic pressure. Outcome variables were measured to predict preservation injury. These included perfusate flow, vascular resistance, VO<sub>2</sub>, urine output, GFR, proteinuria, LDH release, and edema. The model was tested by subjecting mouse kidneys to cold storage in University of Wisconsin (UW) solution for 24, 48, or 72 hours (time-dependent preservation injury), cold storage in Euro-Collins Solution (solution dependent preservation injury), and exposure to prior warm ischemia (DCD dependent preservation injury).</p><p><strong>Results: </strong>The model accurately predicted the qualitative and quantitative changes in the readouts based on known responses to preservation injury in kidney transplants in large animals and humans.</p><p><strong>Conclusion: </strong>The mouse IPK accurately predicts many of the variables associated with renal organ preservation injury in the very early phases of reperfusion and may provide an attractive model for studying the molecular basis of renal preservation injury.</p>","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"5 ","pages":"15-22"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7f/1b/nihms498293.PMC4056985.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32428298","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}
Pub Date : 2010-03-22DOI: 10.2174/1874418401004010005
R. Woodward, T. Page, A. Menclova, M. Schnitzler, D. Brennan
Background: Hyperlipidemia increases mortality and is common with kidney-disease. New-onset hyperlipidemia (NOHL) among patients wait-listed and after transplantation may impact costs and graft-survival of patients with kidney disease. Methods: Using the United States Renal Data System, we compared the costs to Medicare associated with or without NOHL in wait-listed patients in the second and first year pre-transplant and transplanted patients in the first and second year post-transplant. We also examined the impact on graft-survival of NOHL. Results: New onset hyperlipidemia was especially expensive when it occurred well before transplantation. When compared with individuals with no hyperlipidemia, patients with early onset hyperlipidemia cost an extra $15,228 in the two years before transplantation and an extra $14,673 in the two years following transplantation. As has been found in prior studies, patients without any NOHL had the worst graft survival rates. Conclusions: Although NOHL was associated with increased pre- and post-transplant costs, patients diagnosed with NOHL between the second year before and second year after transplantation experienced higher graft-survival rates than those without NOHL by 2-years post-transplantation. Prior studies attribute this relationship to inflammation and malnutrition, which result in lower cholesterol levels and worse outcomes.
{"title":"The Incidence and Cost of New Onset Hyperlipidemia Claims Among US Wait-Listed and Transplanted Renal Allograft Recipients~!2009-07-15~!2009-11-06~!2010-03-22~!","authors":"R. Woodward, T. Page, A. Menclova, M. Schnitzler, D. Brennan","doi":"10.2174/1874418401004010005","DOIUrl":"https://doi.org/10.2174/1874418401004010005","url":null,"abstract":"Background: Hyperlipidemia increases mortality and is common with kidney-disease. New-onset hyperlipidemia (NOHL) among patients wait-listed and after transplantation may impact costs and graft-survival of patients with kidney disease. Methods: Using the United States Renal Data System, we compared the costs to Medicare associated with or without NOHL in wait-listed patients in the second and first year pre-transplant and transplanted patients in the first and second year post-transplant. We also examined the impact on graft-survival of NOHL. Results: New onset hyperlipidemia was especially expensive when it occurred well before transplantation. When compared with individuals with no hyperlipidemia, patients with early onset hyperlipidemia cost an extra $15,228 in the two years before transplantation and an extra $14,673 in the two years following transplantation. As has been found in prior studies, patients without any NOHL had the worst graft survival rates. Conclusions: Although NOHL was associated with increased pre- and post-transplant costs, patients diagnosed with NOHL between the second year before and second year after transplantation experienced higher graft-survival rates than those without NOHL by 2-years post-transplantation. Prior studies attribute this relationship to inflammation and malnutrition, which result in lower cholesterol levels and worse outcomes.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68073292","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}
Pub Date : 2010-03-18DOI: 10.2174/1874418401004010001
R. Lingaraju, N. Blumenthal, J. Mendez, O. Hadjiliadis, Jimmy Lee, V. Ahya, J. Christie, R. Kotloff, A. Pochettino, D. Hadjiliadis
Background: Venous thromboembolism (VTE) is common after lung transplantation. We aimed to review our experience with VTE in lung transplant recipients, while paying attention to the use of sirolimus, a novel immunosuppressive agent that may have prothrombotic effects. Methods: A retrospective review of lung transplant recipients at the University of Pennsylvania from 2000 to 2006 was performed. Demographic data, acute and chronic rejection and survival were included. Clinically apparent VTE episodes and sirolimus utilization were noted. Results: 59/278 (21.2%) of patients developed VTE. There were no baseline differences in patients with and without VTE. Patients more than three months post-transplant had a higher rate of VTE on sirolimus vs. off (1.98% vs. 0.32% per month on vs. off sirolimus; p<0.001). Patients with VTE after lung transplantation had worse survival (p=0.001). Conclusions: VTE is a common complication after lung transplantation and patients with VTE have worse post-transplant survival. Sirolimus is associated with increased rate of VTE.
背景:静脉血栓栓塞(VTE)在肺移植术后很常见。我们的目的是回顾我们对肺移植受者静脉血栓栓塞的经验，同时关注西罗莫司的使用，西罗莫司是一种可能具有血栓前作用的新型免疫抑制剂。方法:对2000年至2006年在宾夕法尼亚大学接受肺移植的患者进行回顾性分析。包括人口统计数据、急性和慢性排斥反应和生存率。注意临床明显的静脉血栓栓塞发作和西罗莫司的使用。结果:59/278例(21.2%)患者发生静脉血栓栓塞。有静脉血栓栓塞和没有静脉血栓栓塞的患者没有基线差异。移植后超过3个月的患者服用西罗莫司的静脉血栓栓塞率高于停用西罗莫司(每月1.98% vs 0.32%);p < 0.001)。肺移植后静脉血栓栓塞患者生存率较差(p=0.001)。结论:静脉血栓栓塞是肺移植术后常见的并发症，且静脉血栓栓塞患者术后生存率较差。西罗莫司与静脉血栓栓塞率升高有关。
{"title":"Venous Thromboembolic Disease after Lung Transplantation: SpecialFocus on Sirolimus","authors":"R. Lingaraju, N. Blumenthal, J. Mendez, O. Hadjiliadis, Jimmy Lee, V. Ahya, J. Christie, R. Kotloff, A. Pochettino, D. Hadjiliadis","doi":"10.2174/1874418401004010001","DOIUrl":"https://doi.org/10.2174/1874418401004010001","url":null,"abstract":"Background: Venous thromboembolism (VTE) is common after lung transplantation. We aimed to review our experience with VTE in lung transplant recipients, while paying attention to the use of sirolimus, a novel immunosuppressive agent that may have prothrombotic effects. Methods: A retrospective review of lung transplant recipients at the University of Pennsylvania from 2000 to 2006 was performed. Demographic data, acute and chronic rejection and survival were included. Clinically apparent VTE episodes and sirolimus utilization were noted. Results: 59/278 (21.2%) of patients developed VTE. There were no baseline differences in patients with and without VTE. Patients more than three months post-transplant had a higher rate of VTE on sirolimus vs. off (1.98% vs. 0.32% per month on vs. off sirolimus; p<0.001). Patients with VTE after lung transplantation had worse survival (p=0.001). Conclusions: VTE is a common complication after lung transplantation and patients with VTE have worse post-transplant survival. Sirolimus is associated with increased rate of VTE.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"4 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2010-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68073280","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}
Pub Date : 2009-11-20DOI: 10.2174/1874418400903010026
R. Neff, R. Jindal, S. A. Whitworth, E. Falta, E. Elster, W. Nelson, K. Abbott, C. Yuan
Abstract : The differential diagnosis of heavy proteinuria presenting early after kidney transplantation has generally included de novo or recurrent glomerulonephritis (GN), whereas proteinuria is thought to be an unusual presentation of acute allograft rejection. We retrospectively analyzed the characteristics of 7 patients who presented with early (median 9 days post-transplant) heavy proteinuria with or without renal failure, in association with the development of new donor anti-HLA antibody. End Stage Renal Disease (ESRD) was due to primary GN in three patients. Mean proteinuria at presentation was 7.46 ? 2.44 gm/24 hours. Donor specific anti-HLA antibody was associated with each episode. Diffuse peritubular C4d staining was noted in three cases. Response to therapy with intravenous immunoglobulin G (IVIg) was good, with mean creatinine of 1.48 ? 0.13 mg% at last follow-up of 2-78 months with resolution of proteinuria, and no graft loss. Based on this series, we recommend screening for proteinuria post transplant in all allograft recipients, not only to detect de-novo or recurrent GN in the allograft, but also to detect antibody mediated rejection.
{"title":"Heavy Proteinuria as a Manifestation of Acute Allograft Rejection Presenting Early after Kidney Transplantation: A Retrospective, Single- Center Case Series","authors":"R. Neff, R. Jindal, S. A. Whitworth, E. Falta, E. Elster, W. Nelson, K. Abbott, C. Yuan","doi":"10.2174/1874418400903010026","DOIUrl":"https://doi.org/10.2174/1874418400903010026","url":null,"abstract":"Abstract : The differential diagnosis of heavy proteinuria presenting early after kidney transplantation has generally included de novo or recurrent glomerulonephritis (GN), whereas proteinuria is thought to be an unusual presentation of acute allograft rejection. We retrospectively analyzed the characteristics of 7 patients who presented with early (median 9 days post-transplant) heavy proteinuria with or without renal failure, in association with the development of new donor anti-HLA antibody. End Stage Renal Disease (ESRD) was due to primary GN in three patients. Mean proteinuria at presentation was 7.46 ? 2.44 gm/24 hours. Donor specific anti-HLA antibody was associated with each episode. Diffuse peritubular C4d staining was noted in three cases. Response to therapy with intravenous immunoglobulin G (IVIg) was good, with mean creatinine of 1.48 ? 0.13 mg% at last follow-up of 2-78 months with resolution of proteinuria, and no graft loss. Based on this series, we recommend screening for proteinuria post transplant in all allograft recipients, not only to detect de-novo or recurrent GN in the allograft, but also to detect antibody mediated rejection.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"50 1","pages":"26-30"},"PeriodicalIF":0.0,"publicationDate":"2009-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68073235","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}
Pub Date : 2009-08-27DOI: 10.2174/1874418400903010022
L. Sibulesky, C. Taner, Darrin L. Willingham, R. Satyanarayana, P. Peiris, M. Krishna, J. Miiller, J. Nguyen
Congenital portal vein agenesis, known as the Abernathy malformation, was first described in 1793. It is associated with focal nodular hyperplasia and adenomas due to abnormal hepatic regeneration secondary to abnormal or absent flow to the liver. We report a case of a 25-year-old Caucasian female with a complicated medical history including idiopathic membranoproliferative glomerulonephritis, hypertension, hyperlipidemia, Sweet's syndrome, acute febrile neutrophilic dermatosis, who incidentally was diagnosed with multiple liver nodules, the largest 14 cm in diameter, arising at the junction of the left and right hepatic lobes. She was also noted to have a congenital absence of the portal vein. There was no evidence of cirrhosis or portal hypertension. Liver function tests and - fetoprotein were within normal limits. A biopsy of the largest mass revealed hepatocellular adenoma. Because of the size, location, and multiplicity of the lesions, we elected to proceed with orthotopic liver transplantation. She subsequently underwent deceased donor liver transplantation using the piggyback technique. Despite dividing the portal vein shunt after completion of the caval anastomosis and minimizing the portal vein clamp time, her spleen spontaneously ruptured, for which splenectomy was performed. The patient did well postoperatively with good liver function.
{"title":"Orthotopic Liver Transplantation for Hepatic Adenoma in a Patient with Portal Vein Agenesis","authors":"L. Sibulesky, C. Taner, Darrin L. Willingham, R. Satyanarayana, P. Peiris, M. Krishna, J. Miiller, J. Nguyen","doi":"10.2174/1874418400903010022","DOIUrl":"https://doi.org/10.2174/1874418400903010022","url":null,"abstract":"Congenital portal vein agenesis, known as the Abernathy malformation, was first described in 1793. It is associated with focal nodular hyperplasia and adenomas due to abnormal hepatic regeneration secondary to abnormal or absent flow to the liver. We report a case of a 25-year-old Caucasian female with a complicated medical history including idiopathic membranoproliferative glomerulonephritis, hypertension, hyperlipidemia, Sweet's syndrome, acute febrile neutrophilic dermatosis, who incidentally was diagnosed with multiple liver nodules, the largest 14 cm in diameter, arising at the junction of the left and right hepatic lobes. She was also noted to have a congenital absence of the portal vein. There was no evidence of cirrhosis or portal hypertension. Liver function tests and - fetoprotein were within normal limits. A biopsy of the largest mass revealed hepatocellular adenoma. Because of the size, location, and multiplicity of the lesions, we elected to proceed with orthotopic liver transplantation. She subsequently underwent deceased donor liver transplantation using the piggyback technique. Despite dividing the portal vein shunt after completion of the caval anastomosis and minimizing the portal vein clamp time, her spleen spontaneously ruptured, for which splenectomy was performed. The patient did well postoperatively with good liver function.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"3 1","pages":"22-25"},"PeriodicalIF":0.0,"publicationDate":"2009-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68073124","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}
Pub Date : 2009-05-18DOI: 10.2174/1874418400903010014
V. Ibañez, E. Pareja, A. Serrano, V. Jj, Santiago Pérez, José D. Martín, F. Sanjuán, R. López, J. Mir
Cox's proportional hazard model or logistic regression model has been the classical mathematical approach to predict transplant results, but artificial neural networks may offer better results. In order to compare both methods, a logis- tic regression and a neural network model were generated to predict early transplant failure assessed at 90 days. Methods: Medical charts from 701 liver transplant patients were used as generation cohort, collecting variables from do- nor, recipient and operative data. The discrimination capacity of the models was measured through the area under their ROC curves. Models were validated by applying them to a second cohort of 170 patients (validation cohort), although af- terwards it was enlarged to 246 patients in order to increase statistical power. Results: For the generation sample, ROC curves were 75% for logistic regression and 96% for neural network (� 2 = 44,60. p<0,00001). Applied to the whole validation sample these values dropped to 68.7 % for logistic regression and 69.9 % for neural network (� 2 = 0.026. p: 0,87). However, when models where applied to the validation cohort in cumulative groups of 50 patients two aspects became evident: 1) predictions worsened for patients who were more distant in time from the generation cohort; 2) for the first hundred patients in validation cohort, neural network was clearly superior to logistic re- gression model (93 % vs 76 %; � 2 = 10.52. p:0,001). Conclusions: Our results suggest that, provided with the same information and for a limited period of time, neural net- works may offer better diagnostic performances than with logistic regression models.
{"title":"Predicting Early Transplant Failure: Neural Network Versus Logistic Regression Models","authors":"V. Ibañez, E. Pareja, A. Serrano, V. Jj, Santiago Pérez, José D. Martín, F. Sanjuán, R. López, J. Mir","doi":"10.2174/1874418400903010014","DOIUrl":"https://doi.org/10.2174/1874418400903010014","url":null,"abstract":"Cox's proportional hazard model or logistic regression model has been the classical mathematical approach to predict transplant results, but artificial neural networks may offer better results. In order to compare both methods, a logis- tic regression and a neural network model were generated to predict early transplant failure assessed at 90 days. Methods: Medical charts from 701 liver transplant patients were used as generation cohort, collecting variables from do- nor, recipient and operative data. The discrimination capacity of the models was measured through the area under their ROC curves. Models were validated by applying them to a second cohort of 170 patients (validation cohort), although af- terwards it was enlarged to 246 patients in order to increase statistical power. Results: For the generation sample, ROC curves were 75% for logistic regression and 96% for neural network (� 2 = 44,60. p<0,00001). Applied to the whole validation sample these values dropped to 68.7 % for logistic regression and 69.9 % for neural network (� 2 = 0.026. p: 0,87). However, when models where applied to the validation cohort in cumulative groups of 50 patients two aspects became evident: 1) predictions worsened for patients who were more distant in time from the generation cohort; 2) for the first hundred patients in validation cohort, neural network was clearly superior to logistic re- gression model (93 % vs 76 %; � 2 = 10.52. p:0,001). Conclusions: Our results suggest that, provided with the same information and for a limited period of time, neural net- works may offer better diagnostic performances than with logistic regression models.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"3 1","pages":"14-21"},"PeriodicalIF":0.0,"publicationDate":"2009-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68073115","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}
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