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1.
T. Piskin B. Unal K. Kutluturk I.O. Yildirim B. Berktas S.M. Dogan J. Yagmur E.I. Coskun I. Turkcuoglu A. Beytur M. Sanli Y.Z. Colak G. Otlu H. Taskapan I. Sahin Y. Tabel U. Kayabas K. Sarac H.I. Toprak 《Transplantation proceedings》2017,49(3):460-463
Background
Kidney transplantation is the best treatment method for end-stage renal disease. Technically, left kidney transplantation is easier than right kidney, and the complication rates in the right are higher than the left kidney. We performed 28 kidney transplantations from 14 deceased donors between November 2010 and May 2016. Our aim was to share our outcomes and experiences about these 28 patients.Methods
We performed 182 kidney transplantations between November 2010 and May 2016. Fifty-four kidney transplantations were performed from deceased donors. Thirty-two of these were performed from 16 of the same donors. These 32 recipients' data were collected and retrospectively analyzed. We excluded the transplantations from two same-donors to their four recipients in this study. The remaining 28 recipients were included in the study.Results
The left and right kidney recipients' numbers were equal (14:14). The left kidney:right kidney rate was 11:3 in the first kidney transplantation recipient group; in the second kidney transplantation recipient group, the rate was 3:11. The difference was statistically significant (P = .002). We found no statistical differences for sex, mean age, and body mass index of recipients, total ischemic time of grafts, hospitalization times, creatinine levels at discharge time, and current ratio of postoperative complications of recipients (P > .05).Conclusions
There were no differences in the left or the right kidneys or in the first and the second kidney transplantations during the long follow-up period. 相似文献2.
S.M. Yeo Y. Kim S.S. Kang W.Y. Park K. Jin S.B. Park U.J. Park H.T. Kim W.H. Cho S. Han 《Transplantation proceedings》2017,49(5):997-1000
Background
Kidney re-transplantation is commonly considered to have a higher immunological risk than first kidney transplantation. Because of the organ shortage and increasing waiting lists, long-term outcomes of kidney re-transplantation are being studied. However, reports of re-transplantation outcomes are not common. We have reported our 30 years of experience with second kidney transplantations.Methods
Of 1210 kidney transplantations between November 1982 and August 2016 performed in our hospital, 105 were second kidney transplantations (2nd KT). Living donor KT was 44; deceased donor KT was 61.Results
Patient survival rates at 1, 5, and 10 years were 100%, 97.2%, and 90.7%, and graft survival rates were 97.0%, 94.6%, and 71.5%, respectively. The leading cause of graft failure in the 2nd KT was chronic rejection (60%). In addition, induction immunosuppressant, maintenance immunosuppressant, delayed graft function, and graft survival time at the 1st KT had a significant impact on graft survival time at the 2nd KT.Conclusions
Reasonable results in both patient survival and graft survival rates were found in the 2nd KT. Careful monitoring of immunologic risk is needed. 相似文献3.
M. Lejman K. Drabko B. Styka D. Winnicka M. Babicz I. Jaszczuk J.R. Kowalczyk 《Transplantation proceedings》2017,49(8):1903-1910
Background
In the light of an increasing number of hematopoietic stem cell transplantations and more frequent use of reduced-intensity conditioning as preparative regimens for hematopoietic stem cell transplantation, post-transplant cell chimera monitoring is considered a necessity.Methods
The quantitative fluorescence polymerase chain reaction method, along with the commercial AmpFSTR SGMPlus kit, was applied in research on hematopoietic chimeras.Results
The total of 102 patients who had undergone allogenic transplantations were investigated. Chimerism monitoring was commenced on the seventh day after transplantation and lasted up to 12 years in some cases, according to the instituted schedule.Conclusions
The kit has been shown to be fully sufficient for determining genetic profiles of recipients and donors and selecting informative markers. The method has been proven effective and satisfactory for assessing quantitative chimeras. 相似文献4.
Background
De novo gastric cancer is a rare complication of liver transplantation.Methods
Surgical treatments of 16 cases with different outcomes were reported in the English literature.Results
De novo gastric cancer (stage II) was diagnosed as the result of epi-gastric discomfort in a recipient 10 years after liver transplantation. The patient received chemotherapy alone and remained well for 26 months.Conclusions
De novo gastric cancer of liver transplantation recipients is a severe complication; early detection and relevant intervention will benefit these recipients. 相似文献5.
T. Unek T. Egeli M. Özbilgin A. Çelik K. Atilla C. Ağalar N.Ç. Arslan S. Karademir S. Bora H. Gülay Z.S. Derici İ. Astarcıoğlu 《Transplantation proceedings》2017,49(3):403-406
Introduction
Because of the shortage of organs available for transplantation, living related sequential transplantation with the use of liver and a kidney from the same donor has emerged as a reasonable therapeutic alternative. However, there is insufficient literature about the complications that living donors experience after simultaneous kidney and liver transplantations.Methods
From December 2001 to October 2009, 5 living donors provided simultaneous donation of livers and kidneys and 1 living donor donated first her kidney and then her liver. Demographic data of the donors and information concerning the surgery and postoperative observation were collected prospectively.Results
All of the donors were female. The median age was 27.5 (range, 19–36) years. Indications requiring the simultaneous transplantation of livers and kidneys were primary hyperoxaluria type 1 (PH1) in 5 potential recipients and cirrhosis due to chronic hepatitis B infection and idiopathic chronic renal insufficiency in 1 potential recipient. Four recipients underwent right hepatectomy (segments 5–8) and right nephrectomy; 1 recipient underwent left hepatectomy (segments 2–4) and right nephrectomy; and 1 recipient underwent left lobectomy (segments 2–3) and right nephrectomy. There were no complications except in 1 donor (postoperative ileus). No donor developed hypertension or microalbuminuria.Conclusions
With the right indications, appropriate preoperative evaluation, meticulous surgical technique, proper postoperative care, and long-term close monitoring to minimize morbidity and mortality risks, liver and kidney donation from the same donor can be considered for simultaneous kidney and liver transplantation. 相似文献6.
M. Kono J. Hasegawa S. Wakai A. Ishiwatari Y. Abe M. Endo T. Sakoma K. Miyake T. Tokumoto K. Tanabe H. Shirakawa 《Transplantation proceedings》2017,49(5):1183-1186
Background
Sarcoidosis is a chronic systemic disease that is characterized by the formation of noncaseating granuloma and whose etiology is unclear. It is unclear whether patients with sarcoidosis are suitable organ donors.Case
We treated a 56-year-old woman with pulmonary sarcoidosis who donated her kidney. She was previously in good health and was diagnosed with pulmonary sarcoidosis during her preoperative examination. Because she presented with no symptoms and was otherwise in good condition, donor nephrectomy was performed.Results
Baseline biopsy examination showed no evidence of sarcoidosis. One year after transplantation, both the donor and the recipient had not developed kidney dysfunction or recurrence of sarcoidosis.Conclusion
This is a rare case in which a patient with pulmonary sarcoidosis donated a kidney for transplantation, and both the recipient and the donor were clinically healthy. A patient with sarcoidosis and no kidney lesion can donate a living kidney, because transplantation appears to be safe for both the recipient and the donor. 相似文献7.
R. Pery E. Shaharabani B. Gazer M. Gutman D. Rosin 《Transplantation proceedings》2017,49(10):2378-2380
Background
Kidney graft torsion and subsequent acute kidney injury is a rare yet potentially devastating complication of intraperitoneal kidney transplant. We report a case of this elusive diagnosis and describe kidney salvage by using laparoscopic fixation.Case Report
A 49-year-old male patient presented with multiple episodes of anuric acute kidney injury 16 months after an uneventful combined orthotopic liver and kidney transplantation. After a thorough investigation, a diagnosis of kidney torsion was made, and the patient was urgently operated. Upon surgery, a complete torsion of a viable kidney was found. Laparoscopic fixation was achieved by using an absorbable mesh “pocket.” The patient has experienced no similar episodes in the subsequent year.Conclusions
Nephrologists and surgeons should be aware of this rare complication. Prompt diagnosis and operative repair are crucial to save the graft. Prophylactic nephropexy should be considered in all intraperitoneal transplantations. 相似文献8.
Objectives
In renal transplant recipients, the risk of developing bladder cancer and rate of diagnosis of advanced staged bladder cancer are generally higher than the general population. Also, it is more challenging to treat renal transplant recipients than the regular patient population. We aimed to evaluate the efficacy and safety of radical cystectomy (RC) and urinary diversion with ileal conduit in renal transplant recipients.Methods
We identified 2 patients with prior history of renal transplantation who underwent RC and ileal conduit urinary diversion for bladder cancer. Preoperative clinical and demographic data were presented and outcomes were assessed.Results
The RC and ileal conduit urinary diversion were performed in the first patient 56 months after renal transplantation and in the second patient 64 months after renal transplantation. Clinical staging was high-grade T2 transitional cell cancer of the bladder for patient 1 and T2 with pure squamous cell cancer of the bladder for patient 2. No perioperative or postoperative complication and no graft dysfunction occurred in either patient.Conclusion
Our experience demonstrated that RC with ileal conduit reconstruction in renal transplant recipients is safe and feasible. 相似文献9.
T. Inoue M. Saito S. Narita K. Numakura H. Tsuruta A. Maeno N. Tsuchiya S. Satoh T. Habuchi 《Transplantation proceedings》2017,49(8):1786-1790
Objectives
Using a strategy of placing a surgical drain after kidney transplantation, the duration of a lymphatic fluid leakage and prevalence of a symptomatic lymphocele were retrospectively analyzed. The risk factors for persistent lymphatic fluid leakage or asymptomatic lymphocele were evaluated using multivariate analysis to estimate the origin of the lymphatic fluid leakage.Materials and methods
Patients with persistent lymphatic fluid leakage and symptomatic lymphocele were defined as those with lymphatic fluid drainage >50 mL for more than 15 days and those who required a percutaneous drainage of the lymphocele, respectively.Results
Persistent lymphatic fluid leakage and symptomatic lymphocele were observed in 40 (16.4%) and 10 (4.1%) of a total of 244 patients, respectively. The maximum durations of lymphatic fluid drainage from the initial drain tube and the second drainage of the symptomatic lymphocele were 48 and 28 days, respectively. Anastomosis of the graft artery to the external iliac artery was an independent risk factor to predict persistent lymphatic fluid leakage or symptomatic lymphocele after kidney transplantation (odds = 2.597, P = .008).Conclusion
The findings of the study suggest that the lymphatic fluid originates from the recipient's iliac lymph trunk rather than from the graft kidney. 相似文献10.
Background
When assessing the cost of transplants in Japan, earlier studies have been limited to case series that investigated inpatient cost alone. Few studies have evaluated total cost, which includes inpatient, outpatient, and pharmaceutical costs, or compared costs before and after transplantation. Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), we investigated the total cost of major transplantation and contributing factors.Methods
We analyzed the cost and complications of patients who underwent a cadaveric renal transplantation (CRT), living renal transplantation (LRT), living-donor liver transplantation (LDLT), allogeneic bone marrow transplantation, autologous bone marrow transplantation, allogeneic peripheral blood stem cell transplantation, or autologous peripheral blood stem cell transplantation (auto-PBSCT) from April 2009 to March 2010.Results
The highest total cost of the month of transplantation was 4.95 million yen (JPY) for LDLT. Among renal transplantations, the cost of CRT was higher than LRT (3.69 vs 3.55 million JPY). Recipients of auto-PBSCT complicated by graft-versus-host disease, urinary tract infection, sepsis, or pneumonia had a significantly higher average total cost during the month of transplantation and the 2 following months than patients without it, as well as statistically longer total treatment days.Conclusions
In Japan, almost all medical services are covered by national health insurance, and the Japan government has begun to allow the use of the NDB for research activities. This is the first study to use the NDB to analyze the cost of transplantation, with technical and institutional limitations. 相似文献11.
R. Leal H. Pinto A. Galvão L. Rodrigues L. Santos C. Romãozinho F. Macário R. Alves M. Campos A. Mota A. Figueiredo 《Transplantation proceedings》2017,49(4):783-786
Introduction
Rehospitalization early post–kidney transplant is common and has a negative impact in morbidity, graft survival, and health costs. Infection is one the most common causes, and identifying the risk factors for early readmission due to infectious complications may guide a preventive program and improve outcome. The aim of this study was to evaluate the incidence, characterize the population, and identify the risk factors associated with early readmission for infectious complications post–kidney transplantation.Methods
We performed a retrospective cohort study of all the kidney transplants performed during 2015. The primary outcome was readmission in the first 3 months post-transplant due to infectious causes defined by clinical and laboratory parameters.Results
We evaluated 141 kidney transplants; 71% of subjects were men, with an overall mean age of 50.8 ± 15.4 years. Prior to transplant, 98% of the patients were dialysis dependent and 2% underwent pre-emptive living donor kidney transplant. The global readmission rate was 49%, of which 65% were for infectious complications. The most frequent infection was urinary tract infection (n = 28, 62%) and the most common agent detected by blood and urine cultures was Klebsiella pneumonia (n = 18, 40%). The risk factors significantly associated with readmission were higher body mass index (P = .03), diabetes mellitus (P = .02), older donor (P = .007), and longer cold ischemia time (P = .04). There were 3 graft losses, but none due to infectious complications.Conclusion
There was a high incidence of early rehospitalization due to infectious complications, especially urinary tract infections to nosocomial agents. The risk factors identified were similar to other series. 相似文献12.
A. Ministro T. Ferreira L. Batista A. Santana N. Alves J. Guerra J. Fernandes e Fernandes 《Transplantation proceedings》2017,49(4):906-912
Background
Vascular complications after kidney transplantation may cause allograft loss. Here, we describe 2 patients with extrarenal mycotic pseudoaneurysm after kidney transplantation.Patients
Patient 1 was a 54-year-old man who developed pseudoaneurysm 60 days after transplantation, and patient 2 was a 48-year-old woman who was diagnosed with a pseudoaneurysm 5 months after transplantation.Results
Patient 1 had a deceased-donor kidney transplant with end-to-side external iliac arterial anastomosis that was reconstructed 8 days after transplantation owing to rupture and major bleeding. At 60 days after transplantation, he had high serum creatinine level and Doppler ultrasonography showed a pseudoaneurysm of the arterial graft anastomosis and postanastomotic renal artery stenosis. Treatment included surgical excision of the pseudoaneurysm, vascular reconstruction, and fluconazole, with mycologic culture of the resected pseudoaneurysm showing Candida albicans. Patient 2 developed nondisabling intermittent claudication at 5 months after kidney transplantation, with a pseudoaneurysm subsequently observed on Doppler ultrasonography and computerized tomographic angiography. Treatment included renal artery thrombectomy and common iliac bypass to the hilar donor renal artery with inverted ipsilateral long saphenous vein. Operative samples showed C albicans, and she was treated with fluconazole. Both patients had satisfactory outcomes, and both kidney allografts were preserved.Conclusions
Extrarenal mycotic pseudoaneurysms after kidney transplantation require a high index of suspicion for early diagnosis, and preservation of the kidney graft may be achieved with the use of surgical treatment and antifungal therapy. 相似文献13.
Z. Wu S. Zhang L. Zhou J. Cai J. Tan X. Gao Z. Zeng D. Li 《Transplantation proceedings》2017,49(7):1656-1658
Objective
To investigate the thromboembolism induced by blood-mediated inflammatory reactions against infused cells during the clinical application of stem cells.Methods
Two patients with renal transplantation and chronic kidney disease, respectively, experienced thromboembolism after umbilical cord mesenchymal stem cell (UCMSC) infusion. The clinical manifestations and the laboratory test results were collected and analyzed.Results
The patients received stem cell infusion through the peripheral veins and presented with a swollen and painful forearm postinfusion. Doppler ultrasound showed venous clots at the proximal end of the puncture site. Urokinase and warfarin were used for thrombolytic therapy. The swelling and pain were relieved and cured.Conclusion
Safety concerns are still a primary hurdle for stem cell therapy, and thromboembolism as a critical complication should be prevented appropriately. 相似文献14.
Jonathan Robinson John I. Shin James E. Dowdell Calin S. Moucha Darwin D. Chen 《The Journal of arthroplasty》2017,32(8):2370-2374
Background
Impact of gender on 30-day complications has been investigated in other surgical procedures but has not yet been studied in total hip arthroplasty (THA) or total knee arthroplasty (TKA).Methods
Patients who received THA or TKA from 2012 to 2014 were identified in the National Surgical Quality Improvement Program database. Patients were divided into 2 groups based on gender. Bivariate and multivariate analyses were performed to assess associations between gender and patient factors and complications after THA or TKA and to assess whether gender was an independent risk factor.Results
THA patients consisted of 45.1% male and 54.9% female. In a multivariate analysis, female gender was found to be a protective factor for mortality, sepsis, cardiovascular complications, unplanned reintubation, and renal complications and as an independent risk factor for urinary tract infection, blood transfusion, and nonhome discharge after THA. TKA patients consisted of 36.7% male and 62.3% female. Multivariate analysis revealed female gender as a protective factor for sepsis, cardiovascular complications, and renal complications and as an independent risk factor for urinary tract infection, blood transfusion, and nonhome discharge after TKA.Conclusion
There are discrepancies in the THA or TKA complications based on gender, and the multivariate analyses confirmed gender as an independent risk factor for certain complications. Physicians should be mindful of patient's gender for better risk stratification and informed consent. 相似文献15.
A.A. Rahnemai-Azar M. Penna S.D. Morrison S.C. Rayhill L. Sibulesky K.A. Muczynski R. Bakthavatsalam 《Transplantation proceedings》2017,49(8):1960-1962
Background
Complicated diverticulitis after transplantation occurs in as many as 3.5% of cases and carries a 25% mortality rate. Diagnosis of complicated diverticulitis in this population can be challenging because of abnormal presentations caused by immunosuppression. Only 4 cases of fistulization after kidney transplantation are described in the literature; none occurred after simultaneous pancreas-kidney transplant.Methods
We present a first case of a coloduodenovesical fistula in a patient 9 years after simultaneous pancreas-kidney transplant. The patient presented with intermittent episodes of elevated creatinine and recurrent urinary tract infection. The presence of fistula was strongly suspected in cystoscopy, but, despite extensive investigation, a fistula tract could not be identified.Results
The patient ultimately underwent surgical exploration for positive cystoscopy examination, continuation of urinary complaints, and presence of multiple colonic diverticula in computed tomography scan. At surgical exploration, a fistula track was identified between the sigmoid colon and duodenal stump of the pancreas allograft. Subsequently, sigmoidectomy, bladder repair, and enteric conversion of the pancreas transplant were performed.Conclusions
Complications of diverticulitis should be considered in organ transplant recipients presenting with recurrent urinary infection and elevated creatinine, and surgical exploration might be indicated even if unable to well-define the fistula tract. 相似文献16.
W.Y. Park S. Han B.S. Choi C.W. Park C.W. Yang Y.-S. Kim J.I. Kim I.S. Moon B.H. Chung 《Transplantation proceedings》2017,49(5):1033-1037
Background
This study investigated the prevalence of osteoporosis and the risk factors for its progression in kidney transplant recipients (KTRs).Methods
Dual energy X-ray absorptiometry was used to prospectively measure changes in bone mineral density (BMD) before kidney transplantation (KT) and 1 year after transplantation in 207 individuals. We also analyzed the risk factors of osteoporosis progression during this period.Results
Prior to KT, the mean BMD score (T-score of the femur neck area) was ?2.1 ± 1.2, and the prevalence of osteoporosis was 41.5% (86/207). At 1 year post-transplantation, the mean BMD score significantly decreased to ?2.3 ± 1.1 (P < .001), and the prevalence of osteoporosis increased to 47.3% (98/207; P = .277). The BMD score worsened over the study period in 69.1% (143/207) of patients, improved in 24.1% (50/207), and showed no change in 6.8% (14/207). Minimal intact parathyroid hormone (iPTH) improvement after KT was found to be an independent risk factor of osteoporosis progression.Conclusions
This study demonstrates progressive loss of BMD after KT and sustained secondary hyperparathyroidism might influence the progression of osteoporosis. 相似文献17.
P. Mendogni A. Palleschi D. Tosi I. Righi M. Montoli F. Damarco L.C. Morlacchi L. Santambrogio M. Nosotti L. Rosso 《Transplantation proceedings》2017,49(4):682-685
Introduction
Lung transplantation is considered a therapeutic option in selected patients affected by end-stage pulmonary disease. The mortality on the waiting list is mainly attributed to the shortage of the donor pool available for transplantation. There are various strategies to overcome this shortage; one of them is lobar transplantation.Methods
The aim of the current study was to analyze the outcome of lobar lung transplantation from deceased donors in our Lung Transplant Center. Overall survival, perioperative mortality and morbidity, problem on bronchial anastomosis, and chronic rejection were prospectively recorded in a 5-year time-frame.Results
From November 2010 to October 2015, we performed 100 lung transplantations; 6 of which (6%) were lobar transplantations from deceased donors. Three recipients were on an emergency list due to preoperative extracorporeal support. The causes of lobectomy leading to lobar transplantation were: size mismatch (3), iatrogenic vascular damage (2), and chronic atelectasis (1). One patient died 5 months after surgery for sepsis; and 5 patients were alive at the study end (median follow-up: 17.5 months). Prevalence of grade 3 primary graft dysfunction at 72 hours was 50%. One patient developed bronchial stenosis. No cases of chronic rejection were recorded.Conclusions
Lobar transplantation can be considered a valid tool to overcome the donor pool shortage in selected cases; such a technique has proved particularly useful in critically ill patients who were scheduled in an emergency transplant program. 相似文献18.
Akira Yoshiyama Takeshi Morii Michiro Susa Hideo Morioka Eisuke Kobayashi Naofumi Asano Tomoaki Mori Ukei Anazawa Itsuo Watanabe Katsuhito Takeuchi Yu Kushima Takayuki Aoyagi Shoichi Ichimura 《Journal of orthopaedic science》2017,22(5):924-930
Background
Surgical treatment for renal cell carcinoma metastases can be an effective modality for improving survival and patients' quality of life. However, it is often difficult to decide on the optimal surgical approach due to the lesion's high vascularity and uncertainty regarding postoperative performance status and survival.Patients and methods
Blood loss, postoperative performance status, overall survival, postoperative complication and related risk factors for surgical treatment were analysed in 61 renal cell carcinoma patients with bone metastases.Results
Pelvic location and impending/pathological fracture in the metastatic lesion were both significant risk factors for increased blood loss. An unresectable primary lesion and poor preoperative performance status were independent risk factors for poor postoperative performance status. A shorter duration from the discovery of primary lesion to bone metastasis, the number of metastases, and unresectable primary lesion were independent risk factors for shorter survival. Postoperative complications were identified in 15 cases (24.6%).Conclusion
The preoperative prediction of intraoperative blood loss, performance status and survival in renal cell carcinoma patients with bone metastases may be possible based on the risk factors identified in this study. 相似文献19.
K.-M. Chan C.-H. Cheng T.-H. Wu C.-F. Lee T.-J. Wu H.-S. Chou W.-C. Lee 《Transplantation proceedings》2017,49(10):2324-2326
Background
Currently, pancreas transplantation has been a promising strategy to restore long-term normoglycemia as well as to improve life quality for patients with insulin-dependent diabetes mellitus (DM). However, the discrepancy between the number of organs needed and the number donated for transplantation is always enormous. Under a setting of scarce organ donations, we examined our limited experience of pancreas transplantation.Methods
A retrospective review of pancreas transplantations was performed with the use of data from the Taiwan Organ Registry and Sharing Center and the Ministry of Health and Welfare. Pancreas transplantations in the Organ Transplantation Institute of Chang Gung Memorial Hospital also were reviewed.Results
At present, there are 5 medical centers approved for pancreas transplantation in Taiwan. Overall, a total of 156 pancreas transplantations were performed from 2005 to the end of 2016; only 9 of them were performed in the Organ Transplantation Institute of Chang Gung Memorial Hospital. Although the number of organ donations is rising, pancreas transplantation numbers remain low. More than 20 pancreas transplantations were performed in 2016, yet there remained a total of 111 patients registered on the wait list for pancreas transplantation at the end of this study. Thus the gap between organ donation and transplantation is still vast.Conclusions
With continuing improvements in Taiwanese health policies and public education regarding organ transplantation, organ donation rates have risen steadily in recent years. Moreover, quality control and continuing evolution in organ transplantation is crucial to ameliorate the difficult situation of pancreas transplantation and other solid organ transplantation in the context of low levels of donation. 相似文献20.
E.C. Ataide S.R. Perales M.G. Silva F.C. Filho A.C. Sparapani P.F. Latuf Filho R.S.B. Stucchi J. Vassallo C.A.F. Escanhoela I.F.S.F. Boin 《Transplantation proceedings》2017,49(4):858-862