Current Issue : January-March Volume : 2026 Issue Number : 1 Articles : 6 Articles
Background: Patient survival after liver transplantation is lower in donor–recipient race mismatched patients for indications other than primary sclerosing cholangitis. Objectives: To determine if survival is lower after liver transplantation in donor–recipient race mismatched recipients with primary sclerosing cholangitis. Methods: The Organ Procurement and Transplantation Network database was analyzed for deceased donor adult liver transplant recipients with primary sclerosing cholangitis. Graft and patient survival by donor–recipient race were estimated using Kaplan–Meier survival method and compared using the log-rank test. Multivariable analysis was performed using Cox regression. Results: From 2002 to 2018, 5-year patient survival in White (n = 2223) and Black recipients (n = 491), was 89.8% and 87.1%, respectively. Five-year patient survival for the donor–recipient pairs, White–White (n = 1622), Black–Black (n = 110), Black–White (n = 335), and White–Black (n = 314) was 90.8%, 91.1%, 87.1%, and 86.0%, respectively, p = 0.026. In multivariable analysis, 5-year patient mortality was higher in Black recipients of White donors [HR 1.69, 95% CI 1.16, 2.45], compared to White recipients of White donors. Conclusions: Five-year patient mortality after deceased donor liver transplantation for primary sclerosing cholangitis is higher in Black recipients who received livers from White donors compared to matched White donors and recipients....
Background and Objectives: Early allograft dysfunction (EAD), defined as suboptimal initial graft function following liver transplantation (LT), is a serious complication associated with increased post-LT morbidity and mortality. This study aimed to evaluate the impact of EAD on clinical outcomes and to identify associated risk factors. Materials and Methods: Ninety-three patients who underwent LT between July 2015 and August 2024 were retrospectively analyzed. EAD was defined by the presence of one or more of the following criteria: total bilirubin ≥ 10 mg/dL or international normalized ratio ≥ 1.6 on postoperative day 7, and alanine or aspartate aminotransferase levels > 2000 IU/L within the first 7 days. Results: EAD occurred in 20 patients (21.5%). Patients with EAD exhibited significantly lower graft survival (p < 0.01) and patient survival (p = 0.03) compared with those without EAD. EAD was an in-dependent risk factor for both graft survival (p = 0.021) and patient survival (p = 0.027). Acute liver failure (odds ratio [OR], 6.228; 95% confidence interval [CI], 1.179–32.906; p = 0.031), donor age (OR, 1.051; 95% CI, 1.008–1.096; p = 0.020), and warm ischemic time (OR, 1.048; 95% CI, 1.001–1.098; p = 0.046) were identified as significant predictors of EAD development. Conclusions: EAD adversely affects both graft and patient survival following LT. Recipient clinical status, donor age, and intraoperative conditions should be carefully considered to minimize the risk of EAD....
Matrix metalloproteinase type 9 (MMP-9), which cleaves collagen type IV in basal membranes, has been associated with the progression of chronic kidney disease. The objective of the present study was to evaluate the characteristics of donors, recipients, induction therapies, and allograft function on MMP-9 transcripts from mononuclear cells in kidney transplant recipients. Transcripts were determined in peripheral blood mononuclear cells from 67 incident renal transplant recipients eight days post-transplant using quantitative real-time PCR and quantified using the ΔΔCq method. Median MMP-9 transcripts were 6.1 (IQR, 1.5 to 66.5, N = 4) in AB0-incompatible donor transplants; 3.2 (IQR, 2.0 to 16.9, N = 17) in living donor transplants; and 4.2 (IQR, 2.3 to 9.2, N = 46) in deceased donor transplants (p = 0.8). Importantly, renal transplant recipients who were treated with thymoglobulin had significantly higher median MMP-9 transcripts compared to all other induction therapies (14.5; IQR, 2.8 to 31.9, N = 10; vs. 3.5, IQR, 2.2 to 8.8, N = 57; p = 0.01). Median MMP-9 transcript levels were similar in recipients with delayed allograft function and immediate allograft function (8.86; IQR, 5.29 to 11.57, N = 7; vs. 3.4; IQR, 2.35 to 9.49, N = 60; p = 0.245). Induction therapy with thymoglobulin causes significantly higher MMP-9 transcripts in peripheral blood mononuclear cells, probably indicating an increased inflammatory response....
Background: Patient blood management (PBM) strategies have been shown to significantly reduce the use of blood products and enabled surgical procedures to be carried out safely without the need for transfusions. This evidence has raised questions about the possibilities of the “extreme” application of PBM strategies for complex surgical interventions, such as organ transplants, even in patients in whom it is not possible to proceed with transfusion. The aim of this scoping review was to identify and describe the current evidence available in the medical literature on the transplant of the four main solid organs: kidney, heart, liver, and lung in patients declining blood transfusions. Methods: A comprehensive literature search was conducted using PubMed from January 2000 to February 2025. Only articles reporting cases, case series, population samples, or comparative studies describing solid organ transplantation without the use of blood components were included. The results are presented separately for each solid organ. Results: Kidney: Nine studies were included, seven of which reported case reports or case series of kidney or kidney–pancreas transplants, and two articles were comparative studies. Liver: Nine studies reported bloodless liver transplants, eight were case reports or case series, and one was a comparative observational study. Heart: Five studies were included, four of which were case reports of heart transplants; in addition there was a comparative study describing eight heart transplants without the use of blood components to 16 transfusable transplant patients. Lung: Five studies reporting lung transplant without transfusion were reported, four of which were case reports performed in the absence of deaths, and two of which were bilateral. Furthermore, there was an article describing two single lung transplants without the use of blood components compared to ten transfusable transplant patients. Conclusions: The analysis performed demonstrates the possibility, depending on the organ, of performing solid organ transplant procedures without the use of blood components in selected and carefully prepared patients by experienced multidisciplinary teams....
Background and Clinical Significance: Common Variable Immunodeficiency (CVID) is a prevalent manifestation of primary immunodeficiency disorder. The current mainstay of treatment is immunoglobulin replacement therapy; however, in patients with severe complications or refractory disease, hematopoietic stem cell transplant (HSCT) is indicated. Despite this, there has been little research regarding HSCT as a treatment for CVID, with few case reports demonstrating clinical benefit. Case presentation: We present a unique case of common variable immunodeficiency Type XII (CVID12) with rare NFKB mutation and its management. A 20-year-old female with autoimmune alopecia, eczema, and a congenital atrophic right kidney presented to the emergency department with a three-month history of intermittent fever, malaise, lymphadenopathy, mouth sores, diarrhea, and odynophagia, accompanied by a 5 lb. unintentional weight loss and night sweats. Previously, she received multiple steroid prescriptions for these symptoms, providing only temporary relief with each course. Lab findings revealed severe neutropenia and imaging demonstrated hepatosplenomegaly and lymphadenopathy. Flow cytometry revealed a slightly atypical CD8-positive T-cell population and bone marrow biopsy revealed variable cellular marrow with trilineage hematopoiesis. Genetic testing confirmed the diagnosis of Autosomal Dominant Common Variable Immunodeficiency Type XII with an NFKB1 mutation. Pre-transplant treatments included monthly IVIG, weekly rituximab, and daily filgrastim, all of which failed to improve her autoimmune neutropenia and hypogammaglobulinemia and failed to reduce her symptomatic burden. Given the patient’s young age and refractory autoimmune neutropenia, it was decided to manage them definitively with hematopoietic stem cell transplantation (HSCT). She ultimately underwent allogenic stem cell transplantation (haploidentical, donor was the mother) with 3.96 × 108/kg TNC without immediate post-transplant complications. Conclusions: This article demonstrates a rare case of NFKB1-positive CVID that was successfully treated with HSCT and highlights the importance of considering transplant therapy in younger patients with clinically significant, refractory autoimmune cytopenia....
Free jejunum is used for reconstruction after resection of advanced head and neck cancer. Postoperative transplanted mesenteric lymph nodes swelling is often experienced, but its clinical significance is unclear. This study included patients who underwent free jejunal reconstruction at Gifu University Hospital between March 2017 and November 2023. Regarding the size change of postoperative mesenteric lymph node and risk factors, the correlation with metastasis and prognosis was investigated. This study included 51 patients, of whom 16 cases (31.4%) had postoperative mesenteric lymph node swelling and 2 cases (3.9%) had metastasis. Only two cases with metastasis showed an increase in size of 5 mm or more. Many cases without extracapsular extension and cases of salvage surgery had postoperative mesenteric lymph node swelling (p = 0.0429, p = 0.0269). No correlation was found between postoperative mesenteric lymph node swelling and prognosis. However, because all cases with metastasis were included in cases of postoperative mesenteric lymph node swelling, this could be one factor in determining whether or not metastasis occurred. The transplanted mesenteric lymph node swelling is one of the important postoperative evaluation items, and additional evaluation such as PET-CT may be recommended....
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