共查询到20条相似文献，搜索用时 31 毫秒
1.
M.F. Chedid H.R. Bosi A.D. Chedid M.R. Alvares-da-Silva I. Leipnitz T.J.M. Grezzana-Filho M.J. Reis G.M. Filho A.J. Ghissi P.R. Neto A. de Araujo S. Arruda A.B. Lopes M.T. Michalczuk A.N. Backes C.D.P. Kruel C.R.P. Kruel 《Transplantation proceedings》2017,49(4):848-851
Background
There are only 4 prior studies reporting on outcomes of liver transplantation (LT) using Institutes Georges Lopez-1 (IGL-1) preservation solution. Detection of negative predictors of LT using IGL-1 may help finding strategies to protect selected recipients at higher risk of graft failure and death.Methods
Review of all consecutive adult patients who underwent a first whole-graft LT using IGL-1 at authors' institution from 2013 to 2016. Primary end point was graft failure within the first 90 postoperative days (PODs). Graft losses due to any cause (including all deaths with a functioning graft) were recorded as graft failures.Results
Of all 100 patients included in this study, 37 were women; median age was 58 years (range 18–71). There were 12 graft losses during the first 90 PODs (including 3 cases of primary nonfunction of the liver allograft), and 10 of the 12 graft losses occurred on first 30 PODs. All 12 patients who experienced graft loss (including 1 patient who underwent liver retransplantation) died within the first 90 PODs. Of the total 100 patients, 14 experienced biliary complications. Univariate analysis revealed prolonged warm ischemic time (WIT) as the only predictor of 90-day graft failure (odds ratio = 23.5, confidence interval = 1.29–430.18, P = .03). The cutoff by receiver operating characteristic curve for WIT was 38 minutes (area under the curve = 0.70). Positive predictive value for WIT >38 minutes was 94.3%.Conclusions
LT using IGL-1 can be performed safely. Similar to prior reports on LT using other preservation solutions, prolonged WIT was associated with adverse outcomes. 相似文献2.
T. Ito T. Kenmochi N. Aida K. Kurihara A. Kawai T. Ito 《Transplantation proceedings》2018,50(10):3249-3254
Preceding solo kidney transplantation for type 1 diabetes with end-stage renal failure is controversial because of less pancreatic graft survival in pancreas transplantation after kidney transplantation (PAK) than in simultaneous pancreas and kidney transplantation (SPK).
Methods
To study the effectiveness of preceding solo kidney transplantation for type 1 diabetes with end-stage renal failure, comparative retrospective analysis was performed between SPK (n = 232) and PAK (n = 39) that were performed until December 2016.Results
At 1, 3, and 5 years, pancreatic graft survival in SPK was 87.5%, 86.4%, and 82.8%, respectively, and 87.1%, 65.0%, and 49.1%, respectively, in PAK, which showed lesser long-term graft survival than SPK. Because 10 cases out of 16 (62.5%) failed into pancreatic graft loss with rejection in PAK, which was about 3 times more than in SPK, control of rejection is very important; rejection episodes were decreased by rabbit antithymocyte globulin induction resulting in improved graft survival. Five-year patient survival was 88.0% in SPK and 96.6% in PAK.Conclusion
Considering patient survival, preceding solo kidney transplantation for type 1 diabetes with end-stage renal failure should be performed if a donor is available. 相似文献3.
M.A. Zaouali A. Panisello A. Lopez E. Folch C. Castro-Benítez R. Adam J. Roselló-Catafau 《Transplantation proceedings》2017,49(4):765-769
Background
Sirtuin 1 (SIRT1) is a nicotinamide adenine dinucleotide +–dependent histone deacetylase that regulates various pathways involved in ischemia-reperfusion injury (IRI). Moreover, high-mobility group box 1 protein (HMGB1) has also been involved in inflammatory processes during IRI. However, the roles of both SIRT1 and HMGB1 in liver preservation is poorly understood. In this communication, we evaluated the potential relationship between SIRT1 and HMGB1 in steatotic and non-steatotic liver grafts preserved in Institute Georges Lopez solution (IGL-1) preservation solution enriched or not enriched with trimetazidine (TMZ).Methods
Steatotic and non-steatotic livers were preserved in IGL-1 preservation solution (24 hours, 4°C), enriched or not enriched with TMZ (10 μmol/L), and then submitted to ex vivo reperfusion (2 hours; 37°C). Liver injury (AST/ALT) and function (bile output, vascular resistance) were evaluated. SIRT1, HMGB1, autophagy parameters (beclin-1, LC3B), PPAR-γ, and heat-shock protein (HO-1, HSP70) expression were determined by means of Western blot. Also, we assessed oxidative stress, mitochondrial damage (glutamate dehydrogenase), and TNF-α levels.Results
Elevated SIRT1 and enhanced autophagy were found after reperfusion in steatotic livers preserved in IGL-1+TMZ when compared with IGL-1. However, these changes were not seen in the case of non-steatotic livers. Also, HO-1 increases in the IGL-1 + TMZ group were evident only in the case of steatotic livers, whereas HSP70 and PPAR-γ protein expression were enhanced only in non-steatotic livers. All reported changes were consistent with decreased liver injury diminution, ameliorated hepatic function, and decreased TNF-α and HMGB levels. In addition, the oxidative stress and mitochondrial damage were efficiently prevented by the IGL-1 + TMZ use.Conclusions
SIRT1 is associated with HMGB1 decreases and increased autophagy in steatotic livers, contributing to increased tolerance to cold IRI. 相似文献4.
Background
Heart-lung transplantation is a well-established therapeutic modality for concomitant end-stage heart and lung failure. With growing organ scarcity, the rates of these transplants are declining, and center experience is waning.Methods
With over 35 years of experience performing heart-lung transplantation, we describe our procurement protocol herein, as well as offer suggestions to avoid potential pitfalls in order to ensure technical excellence in harvesting these valuable grafts.Results
Procurement issues most commonly arise with organ preservation and inadvertent damage to structures that are difficult to fully visualize.Conclusions
En-bloc heart-lung procurement can be taught effectively and safely to trainees with an emphasis on avoiding common pitfalls that may compromise graft function. 相似文献5.
S. Miyagi K. Shimizu K. Miyazawa W. Nakanishi Y. Hara K. Tokodai C. Nakanishi S. Satomi M. Goto M. Unno T. Kamei 《Transplantation proceedings》2017,49(10):2315-2317
Objective
Graft injuries sometimes occur and may cause complications such as the leakage of pancreatic secretions, which is often lethal. We report our experience of a case of successful simultaneous pancreas-kidney transplantation using injured pancreas graft.Patients and methods
The recipient was a 57-year-old woman with type 1 diabetes mellitus, and the donor was a 30-year-old man with a brain injury. In the donation, the pancreas parenchyma, splenic artery, and gastroduodenal artery were injured iatrogenically. We therefore reconstructed these arteries using vessel grafts and then performed simultaneous pancreas-kidney transplantation.Results
Five days after transplantation, we noted a high titer of amylase in the ascites; therefore, we performed an urgent laparotomy. The origin of the amylase was the injured pancreatic parenchyma, and continued washing and drainage were carried out. We reconstructed the duodenojejunostomy using the Roux-en-Y technique to separate the passage of food from the pancreas graft to prevent injury to other organs due to exposure to pancreatic secretions. Thereafter, we inserted a decompression tube into the anastomosis thorough the blind end of the jejunum. Finally, we inserted 3 drainage tubes for lavage. Following this procedure, the patient recovered gradually and no longer required hemodialysis and insulin therapy. She was discharged from our hospital 56 days after transplantation.Conclusion
The restoration of the injured graft was possible by management of pancreatic secretions and use of the donor's vessel grafts. Shortage of donors is a problem throughout the world; thus, it is important to use injured grafts for transplantation if possible. 相似文献6.
J.J. Salamanca-Bustos E. Gomez-Gomez J.P. Campos-Hernández J. Carrasco-Valiente J. Ruiz-García F.J. Márquez-López L. Zurera-Tendero M.J. Requena-Tapia 《Transplantation proceedings》2018,50(2):587-590
Introduction
Ureter stenosis in renal transplantation patients is a relatively frequent complication that negatively conditions graft evolution. The use of ureteral stents is a valid treatment alternative to the use of double-J catheters in patients for whom surgery is not contemplated or after surgical recurrence. We present our initial experience with five patients treated using this technique.Materials and Methods
We describe a total of five patients with ureteral stenosis after renal transplantation who were treated using ureteral stent model UVENTA (Taewoong Medical, Seoul, Korea) in our center. The median follow-up was 18 months (range, 4 to 38 months). We describe the clinical history of patients and previous treatments on ureteral stenosis. The technical procedure of placement is described. The clinical course is analyzed by measurement of renal function and imaging tests, as well as post-stent complications. Survival of the renal graft is evaluated.Results
The procedure could be completed in all patients without complications. The technique was effective in all patients, with correction of creatinine value and hydronephrosis during the renal ultrasound test. One patient suffered a urinary tract infection episode associated with the use of the ureteral stent. One patient suffered the loss of the renal graft secondary to the development of cryoglobulins. One hundred percent of the ureteral stents are functioning as of the writing of this article.Conclusions
In renal transplantation patients with ureter stenosis, metallic stents are a useful technique with low morbidity and associated complications. 相似文献7.
X. Wang X. Zhang T. Men Y. Wang H. Gao Y. Meng J. Wang 《Transplantation proceedings》2018,50(1):48-52
Background
The increase in the prevalence of end-stage renal disease in developed countries and the shortage of deceased donors have made it necessary to increase the graft pool by means of several strategies, such as living donation, non–heart-beating organ donors, and expanded-criteria donors. This study aimed to assess the short-term outcomes of donor kidneys with small (≤3.5 cm) renal cell carcinoma (sRCC) and to evaluate the possibility of using marginal kidneys in renal transplantation.Methods
Patients undergoing nephrectomy for sRCC who agreed to donate their kidneys were enrolled in the study. Seven dialysis patients aged 27-54 years agreed to undergo transplantation with sRCC kidneys. All of the transplantations were performed in Shandong Province Qianfoshan Hospital from May 2012 to March 2017. The function of transplanted kidneys was evaluated after surgery by testing and comparing parameters such as creatinine clearance rate, delayed graft function, and tumor recurrence.Results
The graft function of the transplanted kidneys was recovered to normal in all of the 7 patients who received sRCC kidneys. The latest serum creatinine levels before publication ranged from 59 to 102 μmol/L in the 7 recipients (normal range of serum creatinine: men, 54-106 μmol/L; women, 44-97 μmol/L). No tumor recurrence was noted 31-58 months after surgery in the recipients.Conclusions
According to short-term follow up (3-5 years), kidney transplantation in selected patients can be considered for kidneys having small incidental tumors. The use of marginal organs, such as those with sRCC, can increase the donor pool for kidney transplantation. 相似文献8.
M. Üstün E. Alçı S. Budak H.B. Demir C. Yucel S. Şen M. Yilmaz H. Töz 《Transplantation proceedings》2018,50(10):3445-3448
Introduction
Renal transplantation is undoubtedly considered the best renal replacement therapy. Graft nephrectomy can be performed in patients with renal transplantation because of complications associated with the failed graft. We aimed to retrospectively investigate the characteristics of patients who underwent graft nephrectomy.Materials and Methods
Between January 2000 and November 2013, the records of 757 patients who had renal transplantation in Ege University Faculty of Medicine Hospital Nephrology-Transplantation outpatient clinic were examined. Sixty-four patients who underwent graft nephrectomy were included in the study. Patients were divided into 2 groups according to the timing of graft nephrectomy. The group of 30 patients who underwent graft nephrectomy in the first 56 days after the renal transplantation was referred to as the “early group” and the group of 34 patients who underwent graft nephrectomy after 56 days was referred to as “late group.”Results
In our study, we found the body mass index to be significantly higher in those with early graft loss (P = .02). We found that there was a difference between the groups in terms of sex (P = .012). When the mortality and morbidity rates after graft nephrectomy were examined, mortality was observed in 3 of the 64 patients in the study and morbidity in 1 patient.Conclusion
According to our study, the body mass indices and ages of the subjects who need early graft nephrectomy are higher. However, male sex was significantly more prevalent in patients who underwent graft nephrectomy in the late period compared with the early period. 相似文献9.
M. Yilmaz T.Ö. Sezer O. Kir A. Öztürk C. Hoşcoşkun H. Töz 《Transplantation proceedings》2017,49(3):486-489
Background
Anti–T-lymphocyte globulins (ATG) are most commonly used as induction agents in kidney transplantation (KT). In this study, we investigated the use of ATG as induction therapy in deceased-donor KT.Methods
Among 152 deceased-donor KT recipients transplanted between January 2009 and December 2003, 147 with exact data were enrolled in this study. Delayed graft function was defined as dialysis requirement after KT. Greater than 10% panel-reactive antibody (PRA) was considered as positive. Total ATG (rATG-Fresenius) dosage and induction duration was evaluated. Mean age was 45 ± 10 years; 91 patients were male and 56 patients were female. Class I and class II PRA-positive patient numbers were 20 (13.6%) and 17 (11.5%), respectively. Pre-transplant dialysis vintage was 108 ± 63 months. Mean donor age was 42 ± 17, and cold ischemia time was 16 ± 5 hours. Eighty-nine patients (60%) had delayed graft function and needed at least one session of hemodialysis after transplantation. Cumulative ATG-F dosage was 676 ± 274 mg. The mean ATG-F cumulative dosage was 10.6 ± 3.8 mg/kg. At the end of first year, mean creatinine and proteinuria levels were 1.4 ± 1.0 mg/dL and 0.3 ± 0.4 g/d, respectively.Results
Mean follow-up time was 32 ± 20 months. During follow-up, there were 14 graft failures and 11 patients died. Patient survival for 1 and 2 years were 93% and 92.3%, respectively. Death-censored graft survival rates for 1 and 2 years were 94.8% and 90.8%, respectively.Conclusions
ATG-F induction provides acceptable graft and patient survival in deceased-donor KT. ATG-F infusion is well tolerated. Infection rates seem to be acceptable compared with all transplantation populations. 相似文献10.
M. Iglesias M. Ramírez-Berumen P. Butrón J. Alberú-Gómez F. Salazar-Hernández J. Macias-Gallardo R.P. Leal-Villalpando J. Zamudio-Bautista V. Acosta L. Jauregui A. Hernández-Campos V. Espinosa-Cruz J. Vázquez-Lamadrid J. González-Sánchez J. Cuellar-Rodriguez J.G. Sierra-Madero R. Gaytan-Cervantes S. Contreras-Barbosa M. Mayorquin-Ruiz 《Transplantation proceedings》2018,50(3):950-958
Background
The function reported after arm transplantation is deemed beneficial relative to the marked disability that upper arm amputation causes.Objective
We report a 51-year-old man with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 75.83 who underwent bilateral arm transplantation in October 2015.Procedure
The right arm was transplanted at the glenohumeral joint level, including transplantation of the humeral head, joint capsule, and rotator cuff ligaments and tendons. Additionally, neurorrhaphies were performed at the origin of the terminal branches of the brachial plexus, including the axillary and musculocutaneous nerves. Therefore, this was considered a total arm transplantation. The left arm was transplanted at the transhumeral level, with complete transplantation of the biceps and triceps brachii, and terminolateral neurorrhaphy of the donor musculocutaneous nerve to the receptor radial nerve. A maintenance triple immunosuppression scheme was administered, with tacrolimus levels kept at 10 ng/mL.Results
At 18 months post-transplantation, the intrinsic musculature in the left hand showed electrical registry, DASH score was 67.5, Carroll test score was 28 in both extremities, Hand Transplant Score System was 67.5 in the right extremity and 77.5 in the left extremity, and Short Form-36 score was 96.1. The patient was healthy, with restored body integrity. He could lift medium-sized weightless objects, eat and go to the bathroom by himself, drink liquids with bimanual grasp, swim, dress almost independently, and drive.Conclusion
The functional evolution of the patient was similar to previously reported transplanted arms, even though the right arm transplant involved the glenohumeral joint and axillary and musculocutaneous nerve repair. 相似文献11.
M.R. González-Sánchez P.A. Cascales-Campos J.J. López-Espín B. Febrero J.A. Pons A. Vargas Acosta J. Ros F. Sánchez-Bueno R. Robles L. Sáenz P. Ramírez P. Parilla 《Transplantation proceedings》2018,50(2):640-643
Background
In recent years, several studies have shown that the age of the donor may be related to an increase in the occurrence of biliary complications (BCs), which remain the main cause of morbidity after liver transplantation. This study analyzed the type and management of these BCs, the impact of BCs on graft and patient survival rates, and the influence of some characteristics of donors and recipients on BC appearance in patients transplanted with donors 75 years of age or older.Patients and Methods
From 2003 to 2016, 100 liver transplantations with donors 75 years of age or older (15.6%) were performed in our hospital. The data were compared with a control group of 400 patients with younger donors (case-control 1:4 per chronology).Results
The BC rate in the group of patients transplanted with organs from elderly donors was 18%, compared to 21.5% in the control group. Specifically, in the immediate post-transplantation period, 14% of the elderly donor group and 13.8% of the control group presented some BCs, with no statistically significant differences in the incidence, type, and treatment of BCs between the two groups. The occurrence of BCs was not a factor associated with graft and patient survival rates. In the global population, donor death by cerebral vascular accident and male donors have influenced the occurrence of BCs.Conclusions
The advanced age of the donor has not influenced BC rates after transplantation. 相似文献12.
M. Szymczak P. Kaliciński G. Kowalewski M. Markiewicz-Kijewska D. Broniszczak H. Ismail M. Stefanowicz A. Kowalski J. Rubik I. Jankowska B. Piątosa J. Teisseyre R. Grenda 《Transplantation proceedings》2018,50(7):2140-2144
Combined liver-kidney transplantation (CLKT) is a rare procedure in pediatric patients in which liver and kidney from 1 donor are transplanted to a recipient during a single operation. The aim of our study was to analyze indications and results of CLKT in children.
Materials and Methods
Between 1990 and 2017 we performed 722 liver transplantations in children; we performed 920 kidney transplantations in children since 1984. Among them, 25 received CLKT. Primary diagnosis was fibro-polycystic liver and kidney disease in 17 patients, primary hyperoxaluria type 1 in 6 patients, and atypical hemolytic uremic syndrome-related renal failure in 2 children. Age of patients at CLKT was 3 to 23 years (median 16 years) and body mass was 11 to 55 kg (median 35.5kg). All patients received whole liver graft. Kidney graft was transplanted after liver reperfusion before biliary anastomosis. Cold ischemia time was 5.5 to 13.3 hours (median 9.4 hours) for liver transplants and 7.3 to 15 hours (median 10.4 hours) for kidney transplants. In 8 patients X-match was positive. We analyzed posttransplant (Tx) course and late results in our group of pediatric recipients of combined grafts.Results
Tx follow-up ranged from 1.5 to 17 years (median 4.5 years). Two patients died: 1 patient with oxalosis lost renal graft and died 2.6 years after Tx due to complications of long-term dialysis, and 1 died due to massive bleeding in early postoperative period. Twelve patients were transferred under the care of adult transplantation centers. Six patients were dialyzed after CLKT due to acute tubular necrosis, and time of kidney function recovery was 10 to 27 days in these patients. In 1 patient with aHUS, renal function did not recover. In children with oxalosis, hemodialysis was performed for 1 month after Tx as a standard, with the aim to remove accumulated oxalate. Primary immunosuppression consisted of daclizumab or basiliximab, tacrolimus, mycophenolate mofetil, and steroids. Acute rejection occurred in 4 liver and 3 kidney grafts. One patient required liver retransplantation due to hepatitis C virus recurrence and 2 patients required kidney retransplantation. Two patients required dialysis.Conclusions
CLKT in children results in low rate of rejection and high rate of patient and graft survival. 相似文献13.
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14.
D. Kamińska M. Łukaszewski N. Kozera K. Kościelska-Kasprzak D. Bartoszek O. Mazanowska W. Goździk P. Chudoba P. Zaleska A. Lepiesza M. Klinger 《Transplantation proceedings》2018,50(6):1919-1921
Previously transplanted highly sensitized patients experience problems with subsequent transplantation. It is also difficult to provide optimal hemodynamic conditions during successive kidney transplantation in heart transplant recipients.
Patient and methods
We present a case of a 56-year old patient with end-stage renal failure after heart transplantation performed 21 years ago and hemodialyzed using arteriovenous fistula. The patient had 69% panel-reactive antibodies, had been on the active waiting list since 2013, and presented 335 positive crossmatches with deceased donors. He also positively crossmatched with a potential living donor. Detailed examination of anti-HLA antibodies revealed the absence of IgG donor-specific antibodies and negative crossmatch with dithiothreitol-treated serum. The transplantation from his wife was performed with positive crossmatch after 4 plasma exchanges and thymoglobulin induction. Because sympathetic and parasympathetic denervation of the transplanted heart and the presence of arteriovenous fistula induced volume overload of the right heart, we used central venous pressure (CVP) and the PiCCO2 for postsurgical assessment of cardiac output.Results
Monitoring, like CVP and other static exponents of preload obtained by PICCO (extravascular lung water, global end-diastolic volume index) as well as the dynamic parameters obtained by PiCCO2 (pulse pressure variation, stroke volume variation), was not sensitive enough to describe recipient volume status. The immediate graft function was observed, and after 11 months satisfactory estimated glomerular filtration rate is noted with the absence of donor-specific antibodies.Conclusion
The history of heart transplantation with existing arteriovenous fistula makes clinical tools such as continuous cardiac output monitoring and CVP parameter inadequate for describing the hemodynamic situation. The high level of panel-reactive antibodies and positive crossmatch possibly caused by IgM antibodies do not have to withdraw the recipient from kidney transplantation. 相似文献15.
16.
K. Jędrzejko R. Kieszek M. Kwapisz M. Nita M. Durlik A. Kwiatkowski 《Transplantation proceedings》2018,50(6):1726-1729
Background
It has been determined that there are about 25% patients with renal allograft failure on the waiting lists.Methods
We analyzed 406 patients who received a kidney graft from 2013 to 2015 in a single center. The analysis resulted in 33 pairs of patients: for one recipient in the pair it was the first transplantation and for the other it was the second or a subsequent one. Graft and patient survival, graft function, delayed graft function episodes, primary nonfunction, and acute rejection episodes were analyzed to assess the outcome of kidney retransplantation. The follow-up period was 2 years.Delayed graft function was observed in both groups (P = .3303).Results
Although in the second group there were twice as many episodes of acute rejection than in the first group (8 to 4), the results are not statistically significant (P = .1420). Primary graft dysfunction was observed only in the second group. Five patients who had lost their kidney graft during the follow-up period were observed in the second group. The probability of graft loss in the second group was as follows: 3% on the day of the transplantation, 12% after 3 months, and 15% after 13 months. All of the patients survived during the 2-year follow-up period. A similar estimated glomerular filtration rate was observed in dialysis time in both groups.Conclusion
There are no statistically significant differences in kidney graft function between patients with the first transplantation and those with the repeat one. Good kidney transplantation results are attainable in both groups. It seems that retransplantation is the best treatment option for patients with primary graft failure. 相似文献17.
E. Ferreira J. Costa C. Romãozinho L. Santos F. Macário C. Bastos R. Alves A. Figueiredo 《Transplantation proceedings》2017,49(4):770-776
Background
Organ shortage has prompted the use of expanded-criteria donors (ECDs). Our objective was to compare long-term outcomes of kidney transplants from ECDs with those from concurrent standard-criteria donors (SCDs). In addition, we evaluated variables associated with graft survival in both groups.Methods
We retrospectively reviewed all 617 deceased-donor kidney transplantations performed from 2005 to 2009 in our department. The population was divided according to donor status into ECD or SCD. Patients were followed until 5 years after transplantation, death, graft failure, or loss to follow-up.Results
We transplanted 150 deceased-donor kidneys from ECDs and 467 from SCDs. ECD were older, more frequently women, had a lower pre-retrieval glomerular filtration rate, and more frequently died due to cerebrovascular accident. ECD recipients were older, presented a lower proportion of black race, more frequently were on hemodialysis, and presented a higher rate of first kidney transplants. Mean glomerular filtration rate was consistently lower in the ECD group. Patient and graft survivals were lower in the ECD group, but statistical significance was present only in graft survival censored for death with a functioning graft at 3 years and graft survival noncensored for death with a functioning graft at 5 years. Younger recipient ages, longer time on dialysis, acute rejection episodes, and glomerular filtration rate at 1 year after transplantation were independent risk factors for lower graft survival.Conclusions
Transplantation with the use of ECD kidneys provide quite satisfactory patient and graft survival rates despite their poorer long-term outcomes. 相似文献18.
G.S. Wu Q.C. Zhao Z.S. Li Y. Wu W.Z. Wang M.B. Li H. Shi M. Wang D.L. Chen J.Y. Zheng X. Wang D.M. Fan 《Transplantation proceedings》2017,49(1):232-236
Background
Antibody-mediated rejection (ABMR) has recently surfaced as a potential form of graft dysfunction after intestinal transplantation.Methods
We present a case of an intestinal transplant recipient who developed late-onset ABMR 12 years after living-donor transplantation. An 18-year-old male recipient with a history of extensive intestinal resection secondary to acute bowel volvulus exhibited an excellent baseline immune profile for transplantation, including ABO-identical and HLA-haploidentical to the donor; a negative cross-match with a panel reactive antibody of 3.0%.Results
Post-transplantation immunosuppression consisted of tacrolimus, mycophenolate mofetil (MMF), and prednisone within the first year, followed by tacrolimus and MMF in the second year, and maintenance with tacrolimus monotherapy thereafter. The recipient experienced a single episode of indetermined acute cellular rejection 3 months after transplantation. Since then, he did not require any parenteral nutrition and had completely reintegrated with society. Twelve years later, the patient developed persistent diarrhea associated with transplant biopsy diffuse C4d deposition and circulating donor-specific antibodies. After the use of rituximab and intravenous immunoglobulin, the recipient stabilized 17 years after transplantation with complete recovery of intestinal mucosal damage.Conclusion
Late-onset ABMR can emerge after transplantation and must be considered a possible cause of graft dysfunction in long-term intestinal transplantation survivors. 相似文献19.
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20.
M. Özbilgin T. Ünek T. Egeli C. Ağalar S. Ozkardesler F. Obuz H. Ellidokuz S. Karademir İ. Astarcıoğlu 《Transplantation proceedings》2017,49(3):566-570