Current Issue : April - June Volume : 2018 Issue Number : 2 Articles : 5 Articles
Background: TruGraf is a blood test that measures gene expression signatures in kidney transplant recipients,\nproviding information on adequacy of immunosuppression. Signatures derived from peripheral blood using DNA\nmicroarrays have been internally and externally validated in two populations of transplant recipients: (i) patients\ndesignated as TX (ââ?¬Å?Transplant eXcellenceââ?¬Â) - stable serum creatinine and normal biopsy, indicative of immune\nquiescence, and (ii) patients designated as not-TX (renal dysfunction and/or histological abnormalities). The test is\nintended for use in subjects with stable renal function as an alternative to protocol biopsies.\nMethodology: Simultaneous blood tests and transplant biopsies were performed in 169 patients. The molecular\nlaboratory was blinded to renal function and biopsy results.\nResults: Biopsy-confirmed clinical phenotype was TX (105 cases), not-TX (64). Renal function was stable in 125\nsubjects (105 TX, 20 not-TX). Positive predictive value of TruGraf for detecting TX was 86% and 105/125 (84%) had\na normal biopsy result.\nSignificance of study: In subjects with stable renal function, TruGraf blood test result of TX corresponded to\nbiopsy findings in 88% of cases. Results indicate that had the blood test been run in place of surveillance biopsies,\n107/125 (86%) of patients with stable renal function may have avoided an invasive biopsy and 92/105 (88%) of\nthese patients with biopsy-confirmed TX may have avoided a biopsy for a negative result....
Background. In the context of cirrhosis, portal vein thrombosis (PVT) is present in 2.1% to 26% of patients. PVTis no longer considered\nan absolute contraindication for liver transplantation, and nowadays, surgical strategies depend on the extent of PVT. Complete\nPVTis associated with higher morbidity rates and poor prognosis, while comparable long-term outcomes can be achieved as long\nas physiological portal in8ow is restored. Materials and Methods. We report our experience with a 45-year-old patient undergoing\nliver transplant with a PVT (stage III-b). To restore portal vein in8ow to the liver, an extra-anatomic jump graft from the right\ncolic vein with donor iliac vein interposition was constructed. Results. )e patient recovered well, with a progressive improvement\nof the general conditions, and was ;nally discharged on p.o.d. 14. No anastomotic defects were found at the postoperative CTscan\n10 months after the surgery. Conclusion. Our technical innovation represents a valid and safe alternative to the cavoportal\nhemitransposition, providing a proper 8ow restoration and reproducing a physiological setting, while avoiding the complications\nrelated to the cavoportal shunt. We believe that the reconstitution of liver portal in8ow should be obtained with the most\nphysiological approach possible and considering long-term liver function....
Posttransplant diabetes mellitus (PTDM) is awell-recognized complication of heart transplantation and is associated with increased\nmorbidity and mortality. Previous studies have yielded wide ranging estimates in the incidence of PTDM due in part to variable\ndefinitions applied. In addition, there is a limited published data on the management of PTDM after heart transplantation and\na paucity of studies examining the effects of newer classes of hypoglycaemic drug therapies. In this review, we discuss the role\nof established glucose-lowering therapies and the rationale and emerging clinical evidence that supports the role of incretinbased\ntherapies (glucagon like peptide- (GLP-) 1 agonists and dipeptidyl peptidase- (DPP-) 4 inhibitors) and sodium-glucose\ncotransporter 2 (SGLT2) inhibitors in the management of PTDM after heart transplantation. Recently published Consensus\nGuidelines for the diagnosis of PTDM will hopefully lead to more consistent approaches to the diagnosis of PTDM and provide a\nplatformfor the larger-scalemulticentre trials that will be needed to determine the role of these newer therapies in themanagement\nof PTDM....
Introduction: The presence of multiple renal arteries (MRA) in the donor allograft\nwas once a contraindication to transplantation. Despite concerns about\nrisks, these allografts are being increasingly used to overcome a shortage of\nrenal donors. Objectives: To compare the outcomes of live-donor renal allografts\nwith multiple and single renal arteries (SRA) in terms of overall ischemia\ntimes, early and late graft function, and vascular and urological complications.\nMethods: A prospective, non-randomized cohort study was conducted\nincluding all live donor renal transplants done by the Vascular and Transplant\nUnit of the National Institute of Nephrology Dialysis and Transplantation, Sri\nLanka between March 2010 and March 2016. 312 recipients of live donor renal\nallografts were recruited to the study. Patients were divided into three\ngroups: Group 1ââ?¬â?SRA: single anastomosis (n = 264, 85%); Group 2ââ?¬â?MRA:\nsingle conjoined anastomosis (n = 39, 12%); and Group 3ââ?¬â?MRA: ââ?°Â¥2 anastomoses\n(n = 9, 3%). Results: Mean ischaemia times (donor clamping to graft\nreperfusion) in the three groups were 14, 21 and 17 minutes respectively.\nFailure to normalize creatinine within 72 hours was seen in 29/264 (11%),\n4/39 (10.2%) and 1/9 (11%), (P > 0.05). Delayed graft function (attributable\nto severe rejection) occurred in only one patient who was from group 2.\nOne-year graft survival among the groups was 243/264 (92%), 35/39 (90%)\nand 8/9 (89%), (P > 0.05). One patient from groups 1 and 2 developed\ntransplant renal artery stenosis. Two patients from group 1 needed stenting\nfor ureteric stenosis. Conclusions: Donor grafts with MRA may be accepted\nsafely with careful surgical reconstruction and close surveillance posttransplant....
Liver resection is the only potentially curative treatment option in patients with liver metastases from colorectal cancer, but only\nabout 20% of the patients are resectable. Liver transplantation of patients with unresectable liver metastases was attempted in the\nearly era but it was abandoned due to poor survival. During the last decade, several case reports, a controlled pilot study, and a\nretrospective cohort study indicated that prolonged disease-free survival and overall survival can be obtained in a proportion of\nthese patients. Strict selection criteria have not yet been well defined, but tumor load, response to chemotherapy, pretransplant\ncarcinoembryonic antigen level, and time interval from resection of the primary tumor to transplant are all factors related to\noutcome.Carefully selected patients may obtain 5-year overall survival that approaches conventional indications for liver transplant.\nThescarcity of liver grafts is a significant problem, but this can possibly to some extent be addressed by use of extended criteria grafts\nand novel surgical techniques. There is an increasing interest in liver transplantation in these patients in the transplant community,\nand currently 4 clinical trials are active and are recruiting....
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