Transplantation proceedings最新文献

Despite several advances in living donor liver transplant (LDLT), many potential living liver donors cannot donate their organs to their relatives because of blood group incompatibility and unsuitable anatomy. Liver paired exchange (LPE) can be used to overcome incompatibilities between living donor-recipient pairs. In this study, we report the early and late results of three and five LDLTs performed simultaneously to initiate the more complex LPE program. By demonstrating that our center is capable of performing up to five LDLTs, we have taken an essential step for establishing a complex LPE program.

Introduction: Dickkopf wingless (Wnt) signaling pathway inhibitor-1 (DKK-1) is a potent antagonist of the WNT canonical signaling pathway. DKK-1 is a substance that exerts anabolic effects on bone and is also involved in vascular cell regulation. The study aimed to determine the relationship of DKK-1 with atherosclerosis as determined by carotid artery intima-media thickness (CA-IMT) and arterial stiffness (AS) as determined by brachial-ankle pulse wave velocity (baPWV) in renal transplant recipients (RTRs).

Methods: A total of 62 (62%) male and 38 (438%) female RTRs with a mean age of 44.22 ± 10.88 years were included in the study. RTRs were compared with 65 healthy individuals. CA-IMT measurement with ultrasonography was used as a marker of atherosclerosis. The presence of AS was detected with the baPWV device.

Results: Creatinine, CA-IMT, and baPWV were higher in the RTRs compared to the healthy subjects. No difference was determined between the two groups regarding log10 DKK-1. No difference was noted in the levels of CA-IMT and baPWV in patients with log10 DKK-1 > 3.83 pg/mL compared to patients with ≤3.83 pg/mL. Correlation and multivariate analyses showed no correlation between log10 DKK-1 and CA-IMT and baPWV.

Discussion: In RTRs, an increased development of atherosclerosis and AS was observed compared to healthy individuals. There was no difference in DKK-1 between the groups based on improved renal function. DKK-1 was not correlated with atherosclerosis and AS.

Background: The 8p11 myeloproliferative syndrome (EMS), a rare disorder characterized by translocations and interchanges at chromosome 8p11, is usually refractory to chemotherapy, and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is currently the only promising treatment for long-term remission. Among 14 translocation partners associated with EMS, t(1;8)(q25;p11) are very uncommon, with only four cases previously reported in peer-reviewed journals in English.

Case presentation: Here we report a 43-year-old man who presented with atypical peripheral T-cell lymphomas. Translocations between chromosomes 1q25 and 8p11 were detected during a bone marrow karyotype examination of 20 metaphases, and fluorescence in situ hybridization (FISH) revealed a positive rearrangement for the FGFR1 locus, confirming the diagnosis of EMS with t(1;8)(q25;p11). Despite rapid disease progression, he maintained remission for 27 months after admission due to aggressive chemotherapy combined with early allogeneic peripheral blood stem cell transplantation. We also conducted a literature review for 12 EMS patients treated with allo-HSCT who had rare karyotypes to better understand their clinicopathologic features and disease management.

Conclusion: we report the first case of EMS with t(1;8)(q25;p11) to have a favorable outcome after allo-HSCT. The encouraging results support the use of aggressive chemotherapy in conjunction with early allo-HSCT for EMS patients with t(1;8)(q25;p11).

Background: The aim of this systematic review and meta-analysis was to evaluate the effects of volatile anesthesia (VA) on early clinical outcomes in liver transplantation.

Methods: We searched electronic databases to identify relevant studies comparing VA to non-VA in liver transplant recipients. The primary outcome assessed was early allograft dysfunction (EAD), and secondary outcomes were postoperative peak liver function tests (LFT) including aspartate transaminase (AST) and alanine transaminase (ALT) levels, and hospitalization time.

Results: Six relevant studies involving 919 patients were analyzed. In meta-analysis of prospective studies, VA was associated with fewer incidence of EAD than non-VA (RR: 0.45; 95% CI: 0.25, 0.84; P = .012; I² = 0%; P_h = 0.334) but this association was not significant in meta-analysis of retrospective studies (OR: 0.83; 95% CI: 0.58, 1.19; P = .310; I² = 0%; P_h = 0.624). No significant difference in peak AST (SMD: -0.14 U/L; 95% CI: -0.65, 0.37 U/L; P = .594; I² = 69.9%; P_h = 0.036) and ALT (SMD: -0.16 U/L; 95% CI: -0.65, 0.33 U/L; P = .529; I² = 67.0%; P_h = 0.048) were found between VA and non-VA. The hospitalization time also did not differ between the two groups (SMD: -0.09 days; 95% CI: -0.29, 0.10 days; P = .350; I² = 0%; P_h = 0.864).

Conclusions: While there is potential protective effect of VA against EAD in liver transplant recipients, certainty remains low, whereas VA was not associated with postoperative LFT or hospitalization time.

Background: This was a retrospective study aimed at evaluating the efficacy of laparoscopic sleeve gastrectomy (LSG) as a strategy for weight loss in obese prospective voluntary kidney donors who were unable to achieve weight reduction through lifestyle changes.

Methods: This retrospective study included living kidney donors who underwent LSG as a strategy for weight loss in obese prospective voluntary kidney donors between 2012 and 2022. Prospective donors who were initially rejected due to obesity underwent LSG after pretransplantation evaluation. Changes in weight, body mass index (BMI), and laboratory parameters (hemogram, kidney function tests, liver function tests, fasting and postprandial glycemia, HbA_1c, and lipid profile measurements) were recorded before bariatric surgery and before nephrectomy.

Results: Of the 16 candidates who underwent LSG, one did not proceed with donor nephrectomy due to the intended recipient's death. Among the remaining 15 subjects, the average interval between bariatric surgery and donor nephrectomy was 165.95 ± 48.86 days. There was a significant decrease in BMI following bariatric surgery (P < .0001); the mean BMI before bariatric surgery was 40.94 ± 4.53 kg/m², and before nephrectomy, it was 30.91 ± 3.87 kg/m². The mean weight loss was 22.64 ± 5.75 kg.

Conclusion: This study supports LSG as an effective approach for obese individuals who are potential kidney donors to achieve weight loss, mitigate obesity-associated risks, and become successful kidney donors.

Background: Pediatric hematopoietic stem cell transplantation often results in pulmonary complications, yet limited data exist on pulmonary function in Thailand. This study aims to assess pulmonary function, investigating associated complications and identifying clinical factors linked to pre- and post-transplant pulmonary function defects.

Methods: In this retrospective cohort study, we focused on children aged 6-18 years who underwent hematopoietic stem cell transplantation between 1999 and 2020, ensuring accessible pulmonary function tests results.

Results: Among 48 patients, abnormal pulmonary function pre- and post-transplant (2-8 years) included a diffusion defect in 16.7% and 18.8%, a restrictive defect in 20.8% and 8.3%, and an obstructive defect in 4.2% and 10.4%, respectively. Pulmonary complications occurred in 16 patients (33.3%), including 15 infections and 1 case of bronchiolitis obliterans. While pretransplant pulmonary function defects were not significantly associated with specific characteristics, post-transplant pulmonary complications correlated with post-transplant pulmonary function defects (aOR = 4.11, 95% CI = 1.23-13.64, P = .02). Among the 6 patients with pre- and post-transplant follow-up, those with pulmonary complications showed a discernible decline in pulmonary function over time, while those without pulmonary complications remained stable or improved. However, the differences between these groups did not reach statistical significance (P = .13-.76).

Conclusions: Prevalent pulmonary function defects and complications in pediatric hematopoietic stem cell transplantation highlight the importance of close pulmonary function monitoring. Post-transplant pulmonary complications are associated with defects, suggesting a potential trend of a subsequent decline in lung function, warranting further prospective validation.

Introduction: This case report describes an elderly man experienced recurrent central serous chorioretinopathy (CSCR) for several years following a kidney transplant. Despite various treatments, his subretinal fluid was unexpectedly absorbed following hemodialysis after the loss of graft kidney function. Optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA) measures were taken. The patient has been followed for approximately 10 years.

Conclusion: Hemodialysis should be considered early if there is persistent and refractory serous retinal detachment despite reducing or discontinuing glucocorticoid therapy and in the presence of decreased glomerular filtration rate.

Hepatic artery pseudoaneurysm is a rare complication that may occur in the setting of liver transplantation and other traumatic instrumentation of the hepatobiliary system. This condition poses a significant morbidity and mortality risk and must be diagnosed and intervened upon emergently. Herein we present a case of hepatic artery pseudoaneurysm complicated by hemorrhagic shock in the setting of a post-liver transplant biliary leak. In this case, the patient was ultimately diagnosed via hepatic angiogram, treated with hepatic artery embolization, and required subsequent retransplantation. The objective of this case was to demonstrate the importance of maintaining a high clinical suspicion for hepatic artery pseudoaneurysm in the post-transplant setting, emphasize the use of computed tomography angiography as a primary diagnostic tool, and involving interventional radiology early in the treatment course.

Introduction: Hypercoagulability-related graft thrombosis is the leading cause of graft failure after simultaneous pancreas-kidney transplantation (SPK). Addressing this issue is crucial to improve the outcomes of SPK recipients. Thromboelastography (TEG) has been used to assess the coagulation profiles of SPK recipients. Recently, a new-generation TEG device, the TEG 6s Global Hemostasis System, was introduced. This device offers advantages over TEG 5000, including less frequent calibration requirements, ease of use, and reduced sensitivity to movement. We hypothesized that TEG 6s would enhance coagulation management in SPK.

Methods: We report two cases of Asian female SPK recipients in whom TEG 6s was used to assess coagulation status at six preset times during and after surgery.

Results: Preoperatively, both patients exhibited hypercoagulability on TEG 6s. Postoperative intravenous heparin was administered, and the dose was titrated based on the TEG 6s results. Vascular thrombosis was not observed in either patient. Detailed TEG 6s and standard laboratory test results are reported. This pilot study demonstrates that TEG 6s monitoring can effectively assess coagulation status in SPK recipients, aiding in optimal coagulation management and reducing the risk of thrombotic complications leading to graft loss. The TEG 6s facilitated real-time and accurate coagulation assessment, allowing for tailored anticoagulant therapy.

Conclusions: This is the first observational study to use TEG 6s in SPK recipients, indicating its potential benefits in improving patient outcomes. Further studies with larger sample sizes are warranted to validate these findings and establish comprehensive guidelines for using TEG 6s in SPK procedures.

Background: Partial nephrectomy (PN) is strongly recommended as nephron-sparing surgery for T1 renal tumors. Although there have been some reports of robot-assisted PN (RAPN) for solitary allograft renal tumors, only a few cases of RAPN for multifocal allograft renal tumors have been reported. Herein, we report a case of a patient who underwent RAPN for multifocal allograft renal cell carcinoma (RCCs).

Case presentation: A 77-year-old male was diagnosed with 24- and 15-mm lesions in the middle portion of a right iliac fossa renal allograft. RAPN was performed using a transperitoneal approach 22 years after the kidney transplantation. The allograft renal artery was clamped, and the tumors were resected. Pathological examination revealed clear-cell RCC with negative surgical margins. There were no perioperative complications, and kidney function did not significantly change during surgery.

Conclusion: RAPN is a feasible and effective treatment option for multiple allograft RCCs. The successful preservation of renal function coupled with minimal perioperative complications underscores the potential of RAPN. Our observations suggest that RAPN can be safely implemented in similar high-risk cases, offering a nephron-sparing alternative that might extend quality of life and reduce the need for dialysis in transplant recipients.