Current Issue : January - March Volume : 2018 Issue Number : 1 Articles : 5 Articles
Liver Ischaemia Reperfusion (IR) injury is a major cause of post-operative liver dysfunction,\nmorbidity and mortality following liver resection surgery and transplantation. There are no proven\ntherapies for IR injury in clinical practice and new approaches are required. Ischaemic Preconditioning\n(IPC) can be applied in both a direct and remote fashion and has been shown to ameliorate IR injury\nin small animal models. Its translation into clinical practice has been difficult, primarily by a lack of\nknowledge regarding the dominant protective mechanisms that it employs. A review of all current\nstudies would suggest that IPC/RIPC relies on creating a small tissue injury resulting in the release\nof adenosine and L-arginine which act through the Adenosine receptors and the haem-oxygenase\nand endothelial nitric oxide synthase systems to reduce hepatocyte necrosis and improve the hepatic\nmicrocirculation post reperfusion. The next key step is to determine how long the stimulus requires\nto precondition humans to allow sufficient injury to occur to release the potential mediators. This\nwould open the door to a new therapeutic chapter in this field....
We studied registry data of 12,944 adult kidney retransplant recipients categorized by induction regimen received into\nantithymocyte globulin (ATG) (N = 9120), alemtuzumab (N = 1687), and basiliximab (N = 2137) cohorts.We analyzed risk factors\nfor 1-year acute rejection (AR) and 5-year death-censored graft loss (DCGL) and patient death. Compared with the reference,\nbasiliximab: (1) one-year AR risk was lower with ATG in retransplant recipients of expanded criteria deceased-donor kidneys (HR\n= 0.56, 95% CI = 0.35ââ?¬â??0.91 and HR = 0.54, 95% CI = 0.27ââ?¬â??1.08, resp.), while AR risk was lower with alemtuzumab in retransplant\nrecipients with >3 HLA mismatches before transplant (HR = 0.63, 95% CI = 0.44ââ?¬â??0.93 and HR = 0.81, 95% CI = 0.63ââ?¬â??1.06, resp.);\n(2) five-year DCGL risk was lower with alemtuzumab, not ATG, in retransplant recipients of African American race (HR = 0.54,\n95% CI = 0.34ââ?¬â??0.86 and HR = 0.73, 95% CI = 0.51ââ?¬â??1.04, resp.) or with pretransplant glomerulonephritis (HR = 0.65, 95% CI =\n0.43ââ?¬â??0.98 and HR = 0.82, 95% CI = 0.60ââ?¬â??1.12, resp.). Therefore, specific risk factor-induction regimen combinations may predict\noutcomes and this information may help in individualizing induction in retransplant recipients....
Collecting duct carcinoma (CDC) is a rare and aggressive formof renal cell carcinoma (RCC) arising fromthe epitheliumof Bellini�s\nduct. It presents earlier in life and has a poorer prognosis than the clear-cell type. Historically, immunosuppressed renal transplant\npatients are more likely to develop malignancies than the general population. We report a case of CDC of the native kidney in a\n59-year-oldman who initially underwent kidney transplantation five years before the time of presentation. To our knowledge, CDC\nin the setting of renal transplant and long-term immunosuppression has not been previously described....
Introduction. Live donors, extended donor criteria, and the maximum usage of organs with anatomical variants are some of the\nmechanisms used to increase the number of organs available. Case.We present the case of a kidney transplant, in which the organ\nhad an iatrogenic injury to a lower pole arterial branch during retrieval.The donor was a 35-year-old male (DCD, Maastricht III).\nThe right kidney was accepted; it had three veins in a single cava patch and three renal arteries, the main artery with aorta patch\nthat is 8 cm long. A small lower pole artery was sectioned during retrieval surgery at approximately 1 cm from its origin as well as a\nthird small mid-lower pole artery. The lower pole damaged artery was reconstructed using tubularised aorta patch to a total length\nof 5 cm. No additional donor vessels had been sent. After construction of the tubulised aorta, E-E anastomosis to the damaged\npolar artery was done with interrupted 7-0 Prolene sutures. Conclusion.While the waiting list for a kidney continues to rise and we\ncontinue to have organ shortness, vascular retrieval injury should not be an absolute contraindication for transplant...
Pig-to-human xenotransplantation offers a potential bridge to the growing disparity between patients with end-stage organ failure\nand graft availability. Early studies attempting to overcome cross-species barriers demonstrated robust humoral immune\nresponses to discordant xenoantigens. Recent advances have led to highly efficient and targeted genomic editing, drastically\naltering the playing field towards rapid production of less immunogenic porcine tissues and even the discussion of human\nxenotransplantation trials. However, as these humoral immune barriers to cross-species transplantation are overcome with\nadvanced transgenics, cellular immunity to these novel xenografts remains an outstanding issue. Therefore, understanding and\noptimizing immunomodulation will be paramount for successful clinical xenotransplantation. Costimulation blockade agents\nhave been introduced in xenotransplantation research in 2000 with anti-CD154mAb. Most recently, prolonged survival has been\nachieved in solid organ (kidney xenograft survival > 400 days with anti-CD154mAb, heart xenograft survival > 900 days, and liver\nxenograft survival 29 days with anti-CD40mAb) and islet xenotransplantation (>600 days with anti-CD154mAb) with the use of\nthese potent experimental agents. As the development of novel genetic modifications and costimulation blocking agents\nconverges, we review their impact thus far on preclinical xenotransplantation and the potential for future application....
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