Current Issue : January - March Volume : 2019 Issue Number : 1 Articles : 6 Articles
Background: Donor-derived cell free DNA (ddcf DNA) has been reported as\na universal noninvasive biomarker for rejection monitoring in heart, kidney,\nliver, and lung transplantation. Current approaches based on next-generation\nsequencing for quantification of ddcf DNA, although promising, may be restricted\nby the requirement for donor material, as donor samples may not be\navailable. Methods: We proposed a novel next-generation sequencing approach\nwithout donor-derived material and compared the non-donor-derived\napproach and the donor-derived approach using simulation testing and 69\nclinical specimens. We also evaluated the performance for acute rejection and\ninfection monitoring in lung transplantation. Results: The non-donor-derived\napproach reached similar efficacy as the donor-derived approach with a significant\nlinear correlation of R2 = 0.98. Subsequent validation in clinical specimens\ndemonstrated significant difference between the acute rejection group (4.83% ± 2.11%, mean ± SD) and the non-rejection group (1.61% ±\n0.63%, mean ± SD) (P < 0.0001, Welchâ??s t test). With the cut-off value of\n2.999, our approach had 90.48% sensitivity (95% CI, 69.62% - 98.83%), 100%\nspecificity (95% CI, 91.59% - 100%), and AUC 0.9266 (95% CI, 0.8277 -\n1.026). The test also had the ability to simultaneously detect infectious agents,\nespecially cytomegalovirus, as compared with the clinical test. Conclusion:\nThe proposed approach without donor-derived material could potentially be\nused to monitor acute rejection and infection in lung transplantation and\nmay be applied to other types of solid organ transplantation....
Background and Aims. Acute liver failure (ALF) is a severe syndrome with an elevated mortality rate, ranging from 40 to 80\n%. Currently, liver transplantation is the only definitive treatment for these patients and new therapies aiming to treat ALF\ninclude artificial organs implant and stem cells therapy, for example. However, a major limitation of liver donors exists. Living\ndonor liver transplantation (......), split liver transplantation (SLT), and domino liver transplantation (DLT) are some of the\navailable alternatives to treat ALF patients, but these do not reduce the number of patients on waiting lists. Herein, we discuss\ndomino hepatocyte transplantation (DHT) using livers that would not meet transplantation criteria. Methods. We conducted a\nliterature search on PubMed/Medline using acute liver failure, liver transplantation, hepatocyte transplantation, and domino liver\ntransplantation as key words. Results. New sources of biochemically functional hepatocytes and therapeutic treatments, in parallel\nto organ transplantation,may improve liver injury recovery and decreasemortality rates.Moreover, the literature reports hepatocyte\ntransplantation as a therapeutic alternative for organ shortage. However, a major challenge remains for a wide clinical application\nof hepatocytes therapy, i.e., the availability of sufficient amounts of cells for transplantation. Ideally, hepatocytes isolated fromlivers\nrejected for transplantation may be a promising alternative for this problem. Conclusion. Our review suggests that DHT may be an\nexcellent strategy to increase cell supplies for hepatocyte transplantation....
Haploidentical stem cell transplantation provides a plausible alternative for the patients when a fully matched donor is unavailable.\nHistorically, the decision of considering haploidentical transplant has remained elusive; however, with the recent\nadvances, the consideration of haploidentical grafts as a treatment option has become more apparent for both allografting for\ndiseases and engraftment failure. We are reporting here an anecdotal case of a successful haploidentical engraftment in a patient\nwith the prior graft failure of an HLA-matched related donor. Since the patient was severely alloimmunized, desensitization\nprotocol was utilized before the haploidentical transplant, and the patient after 8 months of her second allogeneic transplantation\nis doing great with successful engraftment, no relapse, and no graft-versus-host disease (GVHD). Numerous reports pertinent to\nhaploidentical graft have shown favorable outcomes in the graft placement, a decline in the rate of GVHD, and an improvement in\nthe morbidity and mortality in affected individuals. Based on the current reports, haploidentical transplantation might be more\nfeasible and has meaningful implications in the situations where matched donors are infrequent....
Introduction: Renal transplant recipients (RTRs) are at high cardiovascular risk (CV)\ncompared to the general population, especially after surgical treatment. The literature supports\nthe role of supervised exercise intervention; however no data are available regarding the effects\nof unsupervised exercise programs. We investigated whether a home exercise program could\nreduce CV risk in RTR based on possible changes in renal and cardiometabolic parameters and\nmyocardial performance measured by echocardiography. Methods: From a large cohort of 60 RTRs,\n30 RTRs (12 females and 18 males 48.3 ± 12.3 years) participated in individualized and unsupervised\ntraining programs for 6 months, at moderate intensity. Cardiometabolic risk factors, anthropometric\nparameters, lipid and glycemic blood sample profiles were studied as was myocardial performance\nfrom the 2D echo examination at T0, and T6 months. Results: The lipid profile remained in the\nrange of a low level of risk, although there was no significant improvement, whereas myocardial\nperformance, in particular the EF, was significantly improved. Conclusions: A home exercise program\nfor at least 6 months produces positive effects on myocardial function and helps maintain a low\ncardiovascular risk profile. The trend supports the importance of highlighting the role of a correct\nreconditioning of lifestyle in RTR, from the exercise program without supervision to moderate\nintensity, where well tolerated....
Primary cardiacmyxoma is the most common primary cardiac tumor. Tumor resection is the treatment of choice and overall longterm\nprognosis is good and recurrence is rare. This report presents a case of a young girl who presented with multiple recurrent\ncardiac myxoma. She underwent 3 sternotomy surgeries of 3 separated episodes of cardiac myxoma resection. On the fourth\nrecurrence, the patient underwent orthotopic heart transplant. The patient tolerated the procedure well and is alive 6months after\nthe procedure with NYHA class I.We reviewed evidences and summarized reported cases of orthotopic heart transplant operation\nfor primary cardiac tumor in the literature....
Studies on aortoiliac reconstruction for severe atherosclerosis with renal transplantation are limited. Here, we report a rare experience\nof the simultaneous reconstruction of the external iliac artery caused by severe atherosclerosis with polytetrafluoroethylene\nvascular graft and renal transplantation in a 55-year-old female; she was unable to undergo standard renal artery anastomosis to the\nright external iliac artery because of severe atherosclerosis,whichwould result in complete occlusion.Next,we directly anastomosed\nthe donor renal artery to the polytetrafluoroethylene graft. After transplantation, delayed graft function occurred; therefore, the\npatient had to undergo hemodialysis. On day 7 after transplantation, her creatine level started to decrease. She was discharged from\nthe hospital on the 14th day after transplantation. After 1 month, her serum creatinine level reduced to 1.12mg/dL. After 3 years of\ntransplantation, her serum creatinine level was 1.2mg/dL. The simultaneous implantation of the polytetrafluoroethylene graft and\nrenal transplantation was feasible as well as safe, with no infectious complications and stable renal function noted on long time\nfollow-up. Although our case was rare, it emphasizes the need for transplant surgeons to gain surgical skills for vascular surgery\nusing vascular grafts....
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