Transplantation proceedings最新文献

The field of vascularized composite allograft (VCA) transplantation has seen steady, rapid growth, with new innovations driving the evolution from experimental procedures to more standardized therapies. With this expansion comes challenges with graft allocation, preservation, and postoperative graft rejection. Here, we outline the first example of subzero nonfreezing (SZNF), supercooled storage of a whole rat hindlimb with orthotopic transplantation. Rat hindlimbs were procured, loaded, and supercooled for 48 hours at -4°C (n = 4), after which, they were recovered. The loading and recovery phase were performed using subnormothermic machine perfusion (SNMP) during which viability markers (glucose and oxygen consumption, lactate, and resistance) were tracked. Control limbs underwent static cold storage (SCS). After ex vivo validation, the model was piloted in a transplant model, comparing 48 hours of SZNF (n = 1), 48 hours of SCS (n = 1), and 72 hours of SCS (n = 1), which demonstrated no survival beyond postoperative day 4 in the SCS models, and survival until the end of study (postoperative day [POD] 28) in the SZNF model. This study demonstrates the promise of this model in future studies on long-term VCA preservation.

Background: Remote organ dysfunction is common after lung transplantation and might negatively affect the outcome. The local anesthetic ropivacaine was previously demonstrated to attenuate acute rejection after allogeneic lung transplantation in mice. We hypothesized that lung transplantation might result in detectable molecular signs of injury in kidneys and liver and that ropivacaine might attenuate this damage.

Methods: Organs from C57BL/6 mice undergoing allogeneic orthotopic single-lung transplantation were procured at postoperative day 5 and analyzed using Western blot and real-time quantitative polymerase chain reaction probing for Src protein tyrosine kinase, STAT3, and bax/bcl-2. During cold ischemia, the allograft had either been flushed with normal saline only or in combination with ropivacaine (1 µM). A nontransplanted group of animals served as the baseline controls.

Results: The allogeneic stimulus induced by transplantation led to an increase in Src-phosphorylation and STAT3-expression in the kidneys and livers of lung-transplanted mice compared to nontransplanted animals. Bax/bcl-2 as a marker of cellular apoptosis was not affected by the transplantation. In contrast to the findings in the transplanted lungs, the addition of ropivacaine did not have an effect on the examined markers of inflammation in the remote organs.

Conclusions: The observed increase in the inflammatory signaling provides first insight into a possible mechanism, by which remote organ dysfunction after lung transplantation might occur.

Objective: To assess the impact of long-term atorvastatin (ATO) therapy on reducing recipient inflammation and immune response, thus lowering the risk of chronic lung allograft dysfunction (CLAD) in lung transplant recipients. This study aimed to investigate the effects of ATO on overall survival, lung function recovery, and its influence on inflammatory factors alongside azithromycin (AZI) prophylaxis.

Methods: This retrospective single-center study included lung transplant recipients from January 2017 to December 2022. Patients who survival >1 year after lung transplantation and who were receiving AZI prophylaxis for >6 months were selected. Outcome measures involved pulmonary function assessments at various time points after AZI treatment, complete blood cell analysis, and inflammatory factor evaluations.

Results: The incidence of CLAD was significantly lower in the long-term ATO group compared with those not on ATO (P = .011). Long-term ATO treatment significantly delayed CLAD onset after lung transplantation (850 days vs. 630 days; P = .041), with patients showing notably enhanced lung function recovery within 6 months of AZI therapy compared with the non-ATO group. Neutrophil levels decreased in patients with CLAD, and interleukin-6 concentrations significantly decreased in the AZI + ATO group compared with the AZI group. Overall patient survival was significantly better in the AZI+ATO group than in the AZI group (P = .02).

Conclusion: In cases where CLAD develops despite AZI prophylaxis, long-term ATO treatment may lead to short-term improvements in lung function. It could also decrease inflammation levels in lung transplant recipients and enhance overall survival. The combination of AZI and long-term ATO therapy may be beneficial for CLAD prevention.

Objective: To analyze the functions and activities of the case manager nurse in the specialized practice of transplantation and heart failure.

Method: This systematic review is reported according to the PRISMA guidelines. Selected articles were subjected to a detailed critical reading and the evidence levels and recommendation grades of the Joanna Briggs Institute were verified. The field of documentation search was limited to the last 5 years.

Results: Health education provided by nursing is key in patients with heart failure and heart transplants. It must be evidence-based and focuses primarily on promoting self-care and adherence to therapy, although it includes other aspects such as recognition of signs and symptoms by the patient. Both activities are essential to prevent decompensations of heart failure, thus reducing hospital readmissions and mortality rates.

Conclusion: Nursing has an essential role in multidisciplinary programs for the care of heart failure and heart transplant patients. Case manager nurse role stands out for being cost effective, as well as for improving treatment compliance and reducing hospital stay and mortality rates. Nursing functions in this practice ensure continuity and coordination of care between the different health levels, increasing the patients' quality of life.

Objective: The study aims to investigate public opinion on opt-out organ donation registration in Saudi Arabia, addressing a gap identified in existing research that reveals varied attitudes and intentions among the population, as indicated by studies in Qatar and Saudi Arabia.

Methods: This study employed a secondary analysis approach, utilizing data from a cross-sectional survey conducted online among 1397 residents of Saudi Arabia. The survey utilized a GoogleTM form questionnaire adapted from a previous study in Qatar. The questionnaire comprised three sections, gathering socio-demographic information, assessing general awareness about organ donation, and exploring participants' agreement with opt-out consent and beliefs related to organ donation using the Theory of Planned Behaviour (TPB) model.

Results: Among the participants, 44.4% supported opt-out consent, with 25.7% females and 39.1% Saudi citizens. Females and diploma/graduation-level education were significantly associated with opt-out support (P < .001, P = .012, respectively). 98.06% of opt-out supporters were familiar with organ donation. 93.05% agreed to promote organ donation, 98.38% believed registration saves lives, and 81.91% were willing if family had no objections. 86.75% were ready with more information, and 85.78% if informed about their religion's perspective. 92.25% believed living and posthumous donation positively impact life after death. Concerns included inadequate care (33.44%) and bodily disfigurement (28.43%) postmortem. Majority felt healthy (45.56%) and appropriate in age for donation (57.67%). Among opt-out supporters, 20.84% expressed interest, 8.4% conveyed disinterest, while 36.34% remained undecided regarding organ donation registration.

Conclusion: The study reveals a considerable openness among Saudis toward adopting an opt-out organ donation system, suggesting a potential avenue for increased organ donation rates. While acknowledging cultural nuances, particularly familial influences, targeted interventions are vital to overcome specific barriers and ensure the successful implementation of an opt-out policy.

Cavoportal hemitransposition (CPHT) is a rarely performed treatment technique in liver transplantation in cases of extensive splanchnic thrombosis, in which the inferior vena cava of the recipient is used to perfuse the portal vein of the allograft. A case of a 65-year-old liver transplantation patient with an acutely thrombosed cavoportal anastomosis is presented. After unsuccessful medical treatment, recanalization was obtained with transfemoral catheter directed thrombolysis, angioplasty and stent placement. Although this type of treatment has been extensively documented for the management of portal anastomotic problems after orthotopic liver transplantation, data on its application in modified transplantation techniques including CPHT are rare. This technique provides a minimally invasive treatment option in CPHT patients with cavoportal anastomotic problems, who might otherwise require complex surgical repair or retransplantation.

Backgrounds: Evidence for C1q-fixing donor-specific antibodies (DSA) after chronic antibody-mediated rejection (CABMR) treatment is lacking. We investigated if C1q-DSA could predict therapy response in patients with biopsy-proven CABMR.

Material and methods: Twenty kidney transplant patients with late-onset DSA were enrolled. Patients with biopsy-proven CABMR received three plasma pheresis sessions, one dose of rituximab (375 mg/m²), and steroid pulse therapy. We monitored IgG-DSA, C1q-DSA, and renal graft function for >2 years post-CABMR treatment. Patients with C1q-DSA mean fluorescence intensity (MFI) decreased by less than 50% post-treatment were classified as C1q-nonresponders. We compared Banff classification scores (g, ptc, cg, c4d) before and 6 months after treatment.

Results: Fourteen (70%) of 20 patients were C1q-DSA positive. The MFIs of IgG-DSA and C1q-DSA before treatment were significantly higher in the C1q-DSA positive group than in the negative group, at 20,035 and 10,918 (P = .008) and 17,702 and 21 (P < .001), respectively. Fifteen patients (75%) were diagnosed with CABMR via biopsy, and 12 patients received rejection therapy. Five (41.7%) patients were C1q-responders and seven (58.3%) were C1q-nonresponders. The MFIs of C1q-DSA before treatment were not significantly different between the two groups (11,521 vs. 13,985). Renal graft function was stable after treatment in C1q-responders for 3 years. In contrast, renal graft function tended to deteriorate in C1q-nonresponders. Biopsy showed improvement in scores in 75% of C1q-responders while deterioration in scores in 42.9% of C1q-nonresponders.

Conclusions: C1q-DSA may be a good predictor of outcomes after CABMR treatment.

We present a challenging case of Epstein-Barr virus-related isolated small bowel post-transplant lymphoproliferative disorder (PTLD) in a pediatric heart transplant recipient presenting as recurrent gastrointestinal (GI) bleeding and subsequently a GI fistulous tract with associated intra-abdominal abscess. Diagnosis was not confirmed until exploratory laparoscopy was performed, with excision of the fistulous tract revealing evidence of PTLD on pathology. Early diagnosis of GI-PTLD remains a challenge, especially if isolated in the small intestine. Diagnosis may rely on positron emission tomography/ computed tomography scan (PET/CT) or invasive intervention to obtain appropriate tissue samples for pathology diagnosis.