Current Issue : January - March Volume : 2016 Issue Number : 1 Articles : 9 Articles
Organ Donation and Transplantation is an issue that has widespread ramifications. In addition to the medical/\ntechnical aspects, there are legal, moral, ethical, economic, logistical and humanitarian aspects. Each of these\naspects may have some peculiarity related to the donor and recipient. This paper deals primarily with the moral,\nethical and humanitarian aspects of the issue. From the viewpoint of Islam, organ transplantation is an acceptable\ntherapeutic value provided the following criteria are fulfilled:\n1. There is no other equally effective therapeutic solution available that is simpler, safer and/or more cost\neffective.\n2. The organ donation does not result in any harm to the donor\n3. The organ donation is done with the free will and full approval of the donor, or in the case of an unconscious\ndonor, or an organ donation taken from a cadaver, the approval of the next of kin or legal guardian.\n4. In the case of the donation of a single organ upon which the life of the donor depends, e.g., the heart or liver,\nthe organ may not be removed from the donor until the donor�s brain stem death is ascertained.\n5. The donated organ is a gift and is not sold.\n6. If the transaction results in material or monetary gain to the donor or to the donor�s family, the gain must\nnot be in the form of price, but the donor or his/her family may accept a gift as a token of appreciation since\nthe donated organ is considered a gift to the recipient.\n7. The transplantation of active reproductive organs is categorically forbidden.\n8. The basic rule governing the entire transaction is that organ transplantation is considered a humanitarian act\nof mercy accomplished with the free will and approval of all parties involved under no pressure, coercion or\ninjustice....
Objectives: Describe clinical and epidemiological differences and risk factors for death among Bloodstream Infections\n(BSI) caused by Gram Negative (GN) and Gram Positive (GP) bacteria in the setting of solid organ transplantation.\nMethods: We performed a retrospective analysis of medical records, which were evaluated patients undergoing solid\norgan transplantation with BSI in the period from January 2000 to January 31, 2006 at Hospital SÃ?£o Paulo and Hospital do\nRim e HipertensÃ?£o (Universidade Federal de SÃ?£o Paulo, Brazil). It was also performed the analysis of risk factors for death.\nResults: 195 patients were included in this study with a mean age of 43.3 (Ã?± 0.90) years, 114 (58.5 %) were male and, 81\n(41.5 %) were female. 168 (86.2 %) were kidney transplants, 16 (8.2 %) kidney-pancreas, 5 (2.6 %) heart, 5 (2.6 %) liver and\n1 (0.5 %) liver-kidney. The mean hospital stay was 34.2 (Ã?± 62.7) days. GN accounted for 147 (75.4 %) of the BSI episodes,\nwhereas 48 (24.6 %) were caused by GP. In the group with BSI by GN the most common site of infection was the urinary\ntract in 68 (46.3 %) cases, and in the group with BSI by GP the most common was the primary source in\n14 (29.1%) of the cases. The overall mortality of patients with BSI by GN was 19.7 % (29 cases) and by GP was 35.4 %\n(17 cases) (p = 0.03). In multiple logistic regression analysis, the variables associated independently with death in patients\nwith BSI by GN were those who developed respiratory failure requiring mechanical ventilation Odds Ratio (OR) 13,2 95 %\nConfidence Interval (CI) = 3.07ââ?¬â??57.19 (p = 0.001), beyond those which had number equal to or greater than two\ncomorbidities OR 12.4 95 % CI = 1.90ââ?¬â??80.35 (p = 0.008). In the population with BSI by GP only the respiratory failure\nrequiring mechanical ventilation OR 28.3 CI 95=2.53ââ?¬â??317.1 (p = 0.007) was independently associated with death.\nConclusions: Patients with BSI showed the urinary source as the main site of infection. Death within 30 days occurred in\n29 (19.7 %) patients with GN and 7 (35.4 %) patients with GP BSI (p = 0.03). Respiratory failure was a risk factor for death in\npatients with BSI by GN and GP....
Background.Although numerous risk factors for delayed graft function (DGF) have been identified, the role of ischemia-reperfusion\ninjury and acute rejection episodes (ARE) occurring during the DGF period is ill-defined and DGF impact on patient and graft\noutcome remains controversial. Methods. From1983 to 2014, 1784 kidney-only transplantations from deceased donors were studied.\nClassical risk factors for DGF along with two novel ones, recipientââ?¬â?¢s perioperative saline loading and residual diuresis, were\nanalyzed by logistic regression and receiver operating characteristic (ROC) curves. Results. Along with other risk factors, absence of\nperioperative saline loading increases acute rejection incidence (OR = 1.9 [1.2ââ?¬â??2.9]). Moreover, we observed two novel risk factors\nfor DGF: patientââ?¬â?¢s residual diuresis ââ?°Â¤500 mL/d (OR = 2.3 [1.6ââ?¬â??3.5]) and absence of perioperative saline loading (OR = 3.3 [2.0ââ?¬â??\n5.4]). Area under the curve of the ROC curve (0.77 [0.74ââ?¬â??0.81]) shows an excellent discriminant power of our model, irrespective\nof rejection. DGF does not influence patient survival (...
Background. Scarcity of grafts for kidney transplantation (KTX) caused an increased consideration of deceased donors with\nsubstantial risk factors. There is no agreement on which ones are detrimental for overall graft-survival. Therefore, we investigated\nin a nationwidemulticentre study the impact of donor and recipient related risks known before KTX on graft-survival based on the\noriginal data used for allocation and graft acceptance. Methods. A nationwide deidentified multicenter study-database was created\nof data concerning kidneys donated and transplanted in Germany between 2006 and 2008 as provided by the national organ\nprocurement organization (Deutsche Stiftung Organtransplantation) and BQS Institute. Multiple Cox regression (significance\nlevel 5%, hazard ratio [95% CI]) was conducted (...
Tacrolimus (FK506) is one of the principal immunosuppressive agents used after solid organ transplantations to prevent allograft\nrejection. Chronic renal injury induced by tacrolimus is characterized by linear fibrosis in the medullary rays; however, the early\nmorphologic findings of acute tacrolimus nephrotoxicity are not well characterized. Kidney injury molecule-1 (KIM-1) is a specific\ninjury biomarker that has been proven to be useful in the diagnosis of mild to severe acute tubular injury on renal biopsies. This\nstudy was motivated by a patient with acute kidney injury associated with elevated serum tacrolimus levels in whomKIM-1 staining\nwas present only in proximal tubules located in the medullary rays in the setting of otherwise normal light, immunofluorescent,\nand electron microscopy. We subsequently evaluated KIM-1 expression in 45 protocol and 39 indicated renal transplant biopsies\nto determine whether higher serum levels of tacrolimus were associated with acute segment specific injury to the proximal tubule,\nas reflected by KIM-1 staining in the proximal tubules of the cortical medullary rays. The data suggest that tacrolimus toxicity\npreferentially affects proximal tubules in medullary rays and that this targeted injury is a precursor lesion for the linear fibrosis\nseen in chronic tacrolimus toxicity....
Renal transplantation in a patient with aortoiliac prosthetic graft is a unique challenge. It requires\nthat the renal artery is anastomosed directly to the vascular prosthetic graft. Nearly 0.2% - 1.7%\nof the patients with aortoiliac prosthesis require renal transplantation in their life time. Outcomes\nfollowing such procedure are controversial and anecdotal. In this report we present a unique case\nin which the renal artery was anastomosed to vascular prosthetic graft with a pertinent review of\nthe literature....
While immunosuppressive agents are necessary to prevent the rejection of transplanted organs, and are a great\nmedical success story for protecting against early allograft loss, graft and patient survival over the long term are\ndiminished by side effects from these same drugs. One striking long-term side effect is a high rate of skin cancer\ndevelopment. The skin cancers that develop in transplant recipients tend to be numerous, as well as particularly\naggressive, and are therefore a major contributor to morbidity and mortality in transplant recipients. An apparent\nreason for the high incidence of skin cancer likely relates to suppression of immune surveillance mechanisms, but\nother more direct effects of certain immunosuppressive drugs are also bound to contribute to cancers of UV-exposed\nskin. However, over the past few years, evidence has emerged to suggest that one class of immunosuppressants,\nmammalian target of rapamycin (mTOR) inhibitors, could potentially inhibit skin tumour formation through a number\nof mechanisms that are still being studied intensively today. Therefore, in light of the high skin cancer incidence in\ntransplant recipients, it follows that clinical trials have been conducted to determine if mTOR inhibitors can significantly\nreduce these post-transplant skin malignancies. Here, the problem of post-transplant skin cancer will be briefly\nreviewed, along with the possible mechanisms contributing to this problem, followed by an overview of the relevant\nclinical trial results using mTOR inhibitors....
Background: Translational research is an evolving discipline that is intended to bridge the gaps between basic science\nresearch, clinical research, and implementation in clinical practice. It is a fluid, multidirectional process that requires strong\ninterdisciplinary collaboration to produce research that is relevant to end-users.\nPurpose of this review: This review summarizes current perspectives on translational research and outlines its relevance\nand importance to kidney transplantation research.\nSources of information: Sources of information used for this review include published reports, articles, and research\nfunding websites.\nFindings: Tissue typing is used as an in-depth example of how translational research has been applied in the\nfield of kidney transplant medicine, and how it has resulted in successful implementation of diagnostic and\nmanagement options for sensitized individuals undergoing kidney transplantation. The value of actively involving\nkidney transplant stakeholders (patients, caregivers, and clinicians) in setting research priorities and determining relevant\noutcomes for future investigation is also discussed.\nLimitations: This is a narrative review of the literature which has been partly influenced by the perspectives\nand experiences of its authors.\nImplications: Translational and patient-oriented research practices should be incorporated into future research\nendeavours in the field of kidney transplantation in order to create beneficial change in clinical practice and\nimprove patient outcomes.\nWhat was known before: Translational research which engages patients in the investigative process can enhance\nthe likelihood that medical discoveries will have a meaningful impact at the bedside.\nWhat this adds: This article applies current perspectives on translational research and patient engagement to the field\nof kidney transplantation, illustrating how these approaches have led to significant advancements in the field. It provides\nfurther justification for deliberate, targeted efforts to cross-collaborate and incorporate the patient voice into kidney\ntransplant research....
Solid organ transplantation is a popular solution for many end stage organ failures. The functional evaluation of these transplanted organs is multi-factorial and involves many aspects involving organ function, overall patient well-being and quality of life. Literature reports on vitamin status following transplantation had been collected together in this review article. This review summarizes the current status of research in this area with focus on reported deficiencies in vitamins following solid organ transplantation. The deficiencies in either fat-soluble vitamins like vitamin D, vitamin A and vitamin K as well as water soluble vitamins like vitamin B6, vitamin B12 and thiamine have been summarized. The reported deficiencies are noteworthy and necessitate a critical evaluation and interventions in many transplantation programs...
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