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Sample records for heart-lung transplantation patients

  1. Nosocomial legionellosis in three heart-lung transplant patients

    DEFF Research Database (Denmark)

    Bangsborg, Jette Marie; Uldum, S; Jensen, J S

    1995-01-01

    Organ transplant recipients are at high risk of contracting Legionnaires' disease in a hospital environment contaminated with legionellae. This study describes the first cases of culture-verified Legionella infections with an established link to potable hospital water in Denmark; three patients...... operated on at the Cardiopulmonary Transplant Unit, Rigshospitalet, Copenhagen, became infected with legionellae. Environmental and clinical isolates of Legionella pneumophila serogroups 1 and 6 were investigated by restriction enzyme analysis and ribotyping. An ice machine located in the kitchen...... of the intensive care unit was implicated as a source of infection in two of the three cases....

  2. Renal transplantation outcomes following heart and heart-lung transplantation.

    Science.gov (United States)

    Wong, L; Chee, Y R; Healy, D G; Egan, J J; Sadlier, D M; O'Meara, Y M

    2017-11-01

    Chronic kidney disease is a frequent complication following heart and combined heart-lung transplantation. The aim of this study was to analyse the outcome of a subsequent renal transplant in heart, lung and heart-lung transplantation recipients. All heart, lung and heart-lung transplant recipients who received a subsequent renal transplant over a 27-year period in a national heart and lung transplant centre were included in this study. A total of 18 patients who had previously undergone heart (n = 6), lung (n = 7) and heart-lung (n = 5) transplantation received a renal transplant. The mean duration to development of end-stage kidney disease (ESKD) was 115 ± 45.9 months. The most common contributor to ESKD was calcineurin inhibitor nephrotoxicity. The 5-year patient survival and graft survival rates were 91.7 and 85.6%, respectively. The median creatinine level at the most recent follow-up was 123 μmol/L, IQR 90.8-147.5. The overall outcome of renal transplantation following previous non-renal solid organ transplantation is excellent considering the medical complexity and co-morbidities of this patient population. Renal transplantation represents an important treatment option for ESKD in non-renal solid organ transplant recipients.

  3. Obliterative bronchiolitis after lung and heart-lung transplantation.

    Science.gov (United States)

    Reichenspurner, H; Girgis, R E; Robbins, R C; Conte, J V; Nair, R V; Valentine, V; Berry, G J; Morris, R E; Theodore, J; Reitz, B A

    1995-12-01

    Obliterative bronchiolitis (OB) has emerged as the main cause of morbidity and mortality in the long-term follow-up after lung and heart-lung transplantation. The pathogenesis of OB is multifactorial, with acute rejection and cytomegalovirus infection being the main risk factors for the development of OB. The final common pathway of all inciting events seems to be an alloimmune injury, with subsequent release of immunologic mediators and production of growth factors leading to luminal obliteration and fibrous scarring of the small airways. Analyzing the 14 years of experience in 163 patients at Stanford University, we found a current incidence of bronchiolitis obliterans syndrome or histologically proven OB within the first 3 years after lung and heart-lung transplantation of 36.3%, with an overall prevalence of 58.1% after heart-lung and 51.4% after lung transplantation. Both pulmonary function indices (forced expiratory flow between 25% and 75% of forced vital capacity and forced expiratory volume in 1 second) and transbronchial biopsies have proven helpful in diagnosing bronchiolitis obliterans syndrome or OB at an early stage. Early diagnosis of OB and improved management have achieved survival rates in patients with OB after 1, 3, 5, and 10 years of 83%, 66%, 46%, and 22%, compared with 86%, 83%, 67%, and 67% in patients without OB. Recently, different experimental models have been developed to investigate the cellular and molecular events leading to OB and to evaluate new treatment strategies for this complication, which currently limits the long-term success of heart-lung and lung transplantation.

  4. Lymphocyte subset populations in bronchiolitis obliterans after heart-lung transplantation.

    Science.gov (United States)

    Holland, V A; Cagle, P T; Windsor, N T; Noon, G P; Greenberg, S D; Lawrence, E C

    1990-12-01

    The long-term success of heart-lung transplantation is limited by the development of bronchiolitis obliterans, possibly as a form of chronic lung allograft rejection. In the present study, we have characterized by immunohistochemical staining the lymphocytes infiltrating the lesions of bronchiolitis obliterans in one patient following heart-lung transplantation. The finding that the preponderant cells expressed the CD8 (putative cytotoxic/suppressor) marker lends support to the notion that chronic rejection is at least one mechanism for the development of bronchiolotis obliterans following heart-lung transplantation.

  5. Lung and heart-lung transplantation in pulmonary arterial hypertension

    Science.gov (United States)

    López-Meseguer, Manuel; Quezada, Carlos A.; Ramon, Maria A.; Lázaro, María; Dos, Laura; Lara, Antonio; López, Raquel; Blanco, Isabel; Escribano, Pilar

    2017-01-01

    Background Real use of lung (LT) and heart-lung (HLT) transplantation in pulmonary arterial hypertension (PAH) is unknown. The objectives were to describe the indication of these procedures on PAH treatment in a national cohort of PAH patients, and to analyze the potential improvement of its indication in severe patients. Methods Eligibility for LT/HLT was assessed for each deceased patient. Incident patients from REHAP diagnosed between January 2007 and March 2015 and considered eligible for LT/HLT were grouped as follows: those who finally underwent transplantation (LTP) and those who died (D-Non-LT). Findings Of 1391 patients included in REHAP, 36 (3%) were LTP and 375 (27%) died. Among those who died, 36 (3%) were D-Non-LT. LTP and D-Non-LT were equal in terms of age, gender, and clinical status. Ten percent of those who died were functional class I-II. Patients functional class IV were less likely to undergo LT (8.3% LTP vs. 30.6% D-Non-LT, p = 0.017). Patients with idiopathic and drug/toxin-associated PAH were more likely to undergo LT (44.4% LTP vs. 16.7% D-Non-LT, p = 0.011). Conclusions The present results show that the use of LT/HLT could double for this indication. Relevant mortality in early functional class reflects the difficulties in establishing the risk of death in PAH. PMID:29161284

  6. Comprehensive evaluation of lung allograft function in infants after lung and heart-lung transplantation.

    Science.gov (United States)

    Hayes, Don; Naguib, Aymen; Kirkby, Stephen; Galantowicz, Mark; McConnell, Patrick I; Baker, Peter B; Kopp, Benjamin T; Lloyd, Eric A; Astor, Todd L

    2014-05-01

    Limited data exist on methods to evaluate allograft function in infant recipients of lung and heart-lung transplants. At our institution, we developed a procedural protocol in coordination with pediatric anesthesia where infants were sedated to perform infant pulmonary function testing, computed tomography imaging of the chest, and flexible fiberoptic bronchoscopy with transbronchial biopsies. A retrospective review was performed of children aged younger than 1 year who underwent lung or heart-lung transplantation at our institution to assess the effect of this procedural protocol in the evaluation of infant lung allografts. Since 2005, 5 infants have undergone thoracic transplantation (3 heart-lung, 2 lung). At time of transplant, the mean ± standard deviation age was 7.2 ± 2.8 months (range, 3-11 months). Of 24 procedural sessions performed to evaluate lung allografts, 83% (20 of 24) were considered surveillance where the patients were completely asymptomatic. Of the surveillance procedures, 80% were performed as an outpatient, whereas 20% were done as inpatients during the lung or heart-lung transplant post-operative period before discharge home. Sedation was performed with propofol alone (23 of 24) or in addition to ketamine (1 of 24) infusion; mean sedation time was 141 ± 39 minutes (range, 70-214) minutes. Of the 16 outpatient procedures, patients were discharged after 14 (88%) on the same day, and after 2 (12%) were admitted for observation, with 1 being due to transportation issues and the other due to fever during the observation period. A comprehensive procedural protocol to evaluate allograft function in infant lung and heart-lung transplant recipients was performed safely as an outpatient. Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  7. Postoperative complications necessitating right lower lobectomy in a heart-lung transplant recipient with previous sternotomy.

    Science.gov (United States)

    Diethrich, E B; Bahadir, I; Gordon, M; Maki, P; Warner, M G; Clark, R; Siever, J; Silverthorn, A

    1987-09-01

    Heart-lung transplantation for treatment of end-stage cardiopulmonary disease continues to be plagued by many problems. Three primary ones are the technical difficulties that can be encountered, particularly in those patients who have undergone previous cardiac operations, the additional restriction on donor availability imposed by the lack of satisfactory preservation techniques, and the need for lung size compatibility. Two of these difficulties and others surfaced postoperatively in a heart-lung transplant recipient who presented a series of unique operative and therapeutic challenges. A 42-year-old woman with chronic pulmonary hypertension and previous atrial septal defect repair underwent a heart-lung transplantation in August 1985. The operative procedure was expectedly complicated by bleeding from extensive mediastinal adhesions from the previous sternotomy and bronchial collateralization. Excessive chest tube drainage postoperatively necessitated reoperation to control bleeding from a right bronchial artery tributary. Phrenic nerve paresis, hepatomegaly, and marked abdominal distention caused persistent atelectasis and eventual right lower lobe collapse. Arteriovenous shunting and low oxygen saturation necessitated right lower lobectomy 15 days after transplantation, believed to be the first use of this procedure in a heart-lung graft recipient. Although oxygenation improved dramatically, continued ventilatory support led to tracheostomy. An intensive, psychologically oriented physical therapy program was initiated to access and retrain intercostal and accessory muscles. The tracheostomy cannula was removed after 43 days and gradual weaning from supplemental oxygen was accomplished. During this protracted recovery period, an episode of rejection was also encountered and successfully managed with steroid therapy. The patient continued to progress satisfactorily and was discharged 83 days after transplantation. She is well and active 20 months after discharge.

  8. DISTINCT PHENOTYPES OF INFILTRATING CELLS DURING ACUTE AND CHRONIC LUNG REJECTION IN HUMAN HEART-LUNG TRANSPLANTS

    NARCIS (Netherlands)

    WINTER, JB; CLELLAND, C; GOUW, ASH; PROP, J

    1995-01-01

    To differentiate between acute and chronic lung rejection in an early stage, phenotypes of infiltrating inflammatory cells were analyzed in 34 transbronchial biopsies (TBBs) of 24 patients after heart-lung transplantation. TBBs were taken during during acute lung rejection and chronic lung

  9. Transplantes cardiopulmonar e pulmonar com doador em localidade distante Distant donor procurement for heart-lung and lung transplantation

    Directory of Open Access Journals (Sweden)

    Luis Sérgio Fragomeni

    1988-12-01

    Full Text Available Em situações específicas, os transplantes clínicos cardiopulmonar e pulmonar são, hoje, formas estabelecidas de tratamento para estágio final de doença cardiopulmonar e pulmonar. A obtenção de doadores adequados permanece o maior problema e a remoção de órgãos em localidades distantes é, hoje, uma necessidade. Embora muitos métodos de preservação pulmonar possam ser empregados, para períodos isquémicos de até 5 horas, a hipotermia e o uso de solução cardioplégica com infusão da solução de Collins modificada no tronco pulmonar tem sido método simples e eficiente para preservação do bloco coração-pulmão. Descrevemos, aqui, o método corrente que empregamos, com o qual os transplantes cardiopulmonar e pulmonar combinados foram sucedidos de excelente função cárdio-respiratória.In special situations, clinical heart-lung and lung transplantation are today established methods of therapy for end stage cardiopulmonary and pulmonary disease. Adequate donor availability remains a major problem and distant organ procurement is today a necessity. Although many methods of lung preservation can be used, for periods of up to 5 hours, hypothermic storage with cardioplegic arrest and pulmonary artery flush with modified Collins solution has proven to be a simple and reliable method of heart-lung preservation. We here describe our current method of heart-lung block protection, in which heart-lung and double lung transplantation were performed followed by excelent cardiac and pulmonary function.

  10. A testimony to the history of heart and lung transplantation: English translation of Demikhov's paper, "Transplantation of the Heart, Lungs and other Organs".

    Science.gov (United States)

    Shoja, Mohammadali M; Tubbs, R Shane; Ardalan, Mohammad R; Loukas, Marios; Phagava, Helen; Cohen-Gadol, Aaron A

    2010-09-03

    Vladimir Petrovich Demikhov, a Soviet physiologist and surgeon, made meticulous attempts at reviving heart and lung transplantation in the last century. Herein, we present an English translation of Demikhov's 1969 paper of Transplantation of the Heart, Lungs and other Organs (published in Eksperimental'naia Khirurgiia i Anesteziologiia), which represented a synopsis of his experiences with experimental transplantation. A brief account of Demikhov's life and contributions to transplant medicine is also given. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  11. Atrial arrhythmias after lung and heart-lung transplant: effects on short-term mortality and the influence of amiodarone.

    Science.gov (United States)

    Isiadinso, Ijeoma; Meshkov, Arnold B; Gaughan, John; Sandhu, Paul; Lim, Sharon; Cordova, Francis; Criner, Gerard

    2011-01-01

    The incidence and effect of atrial fibrillation or flutter (AF) after lung transplant are variable. An effect of pharmacologic treatment on outcomes is undetermined. One hundred thirty-seven consecutive lung or heart-lung transplant patients were reviewed retrospectively. Uni- and multivariate analyses were performed to determine statistically significant risk factors for AF and short-term mortality. AF occurred in 45.0% of patients within 26 days. By univariate analysis, male gender was predictive of AF (hazard ratio [HR] = 2.25, 95% confidence interval [CI] 1.21 to 4.20, p = 0.011). Mortality within 200 days occurred in 36 of 137 (22.6%) patients. Those with AF had higher mortality than those without AF (27 of 62 [43.5%] vs 9 of 75 [12%]; p amiodarone died, whereas 3 of 26 (11.5%) patients treated without amiodarone died (p amiodarone (9 of 75 [12%] vs 3 of 26 [11.5%], p = 1.00). By multivariate analysis, chronic obstructive pulmonary disease (HR = 0.395, CI 0.175 to 0.892, p = 0.025), primary pulmonary hypertension (HR = 7.245, CI 1.89 to 27.84, p = 0.0039), and use of amiodarone (HR = 2.967, CI 1.187 to 7.415, p = 0.020) were associated with death. Amiodarone was shown to be a significant statistical moderator (p amiodarone. In patients with severe lung pathology, amiodarone pulmonary toxicity may be more common than previously known, and may be a significant contributor to mortality. Amiodarone use should be restricted in the lung transplant patient population. Copyright © 2011 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  12. Poisoned patients as potential organ donors: postal survey of transplant centres and intensive care units

    National Research Council Canada - National Science Library

    Wood, David Michael; Dargan, Paul Ivor; Jones, Alison Linda

    2003-01-01

    .... The use of kidney, heart, lung, liver and pancreas transplants from poisoned patients following deliberate methanol ingestion, cardiac arrest presumed secondary to cocaine overdose, accidental...

  13. Focused Sonographic Examination of the Heart, Lungs and Deep Veins in Acute Admitted Patients with Respiratory Symptoms

    DEFF Research Database (Denmark)

    Laursen, Christian Borbjerg; Sloth, Erik; Lassen, Annmarie Touborg

    2012-01-01

    . Patients were included if one or more of the following symptoms or clinical findings were present: respiratory rate > 20, saturation chest pain. Within one hour after the primary evaluation, focused sonography of the heart, lungs and deep veins...

  14. Impact of congenital heart disease on outcomes of pediatric heart-lung transplantation.

    Science.gov (United States)

    Keeshan, Britton C; Goldfarb, Samuel B; Lin, Kimberly Y; Kreindler, James L; Kaufman, Beth D; Gaynor, James W; Shaddy, Robert E; Rossano, Joseph W

    2014-03-01

    HLT is reserved for children with cardiopulmonary disease not amendable to alternative therapies. Children with CHD with or without ES may be considered for HLT. Outcomes of HLT in this population are not well described. To test the hypothesis that CHD without ES is associated with worse graft survival and identify factors associated with poor outcome, a retrospective analysis of the UNOS database was performed. One hundred and seventy-eight pediatric HLTs were performed between 1987 and 2011. CHD was the diagnosis in 65 patients, of which 34 had CHD without ES. Patients with CHD without ES had decreased patient survival (median 1.31 yr) compared with CHD with ES (4.80 yr, p = 0.05). On multivariable analysis, the following were associated with graft failure: CHD without ES (adjusted HR 1.69, 95% CI 1.09-2.62), younger age (1.04, 1.01-1.08), pretransplant mechanical ventilation (1.75, 1.01-3.06), pretransplant ECMO (3.07, 1.32-7.12), pretransplant PRAs (1.53, 1.06-2.20), and transplant era (1.85, 1.16-2.94). In children with CHD who require HLT, underlying physiology influences outcomes. Those without ES have a worse prognosis. The diagnosis of CHD without ES and preoperative factors may inform decisions in a complex patient population. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. The Effects of Heart-Lung Bypass on Endothelial Function of Patients with Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Mohammad Borzouee

    2015-06-01

    Full Text Available Background: Endothelium is an essential organ for maintaining an adequate vascular tone and preventing the pathological process of atherosclerosis. Heart-lung machine is a mechanical support for maintenance of blood circulation during open heart surgery. It has been shown that flow of blood through this circuit can induce complement activation, endotoxines production, and release of many inflammatory mediators. Objectives: Cardiopulmonary Bypass (CPB has some detrimental effects on endothelial function. Flow Mediated Dilation (FMD is also a noninvasive method for evaluation of endothelial function. Patients and Methods: This study was conducted on 22 patients who were admitted in cardiac surgery ward for open heart operation and met the inclusion criteria of the study. Brachial artery FMD was measured the day before and 2 days after CPB. Results: The mean duration of CPB was 62.95 minutes. The mean percent of FMD changes was measured and compared before and after CPB (4.29 and 0.03 vs. 1.38 and 1.99, < 0.001. The results showed a significant relationship between CPB and bronchial endothelial function. Conclusions: This study revealed the influence of CPB on endothelial function. Yet, more studies are necessary to confirm this important issue, and decline in use of CPB is appreciated.

  16. Pharmacodynamics of cyclosporine in heart and heart-lung transplant recipients. I: Blood cyclosporine concentrations and other risk factors for cardiac allograft rejection.

    Science.gov (United States)

    Best, N G; Trull, A K; Tan, K K; Spiegelhalter, D J; Cary, N; Wallwork, J

    1996-11-27

    We have attempted to determine the optimal clinical use of cyclosporine during the first 3 months after heart transplantation. We used multiple logistic regression to quantify how blood cyclosporine concentrations and other potential risk factors influence the risk of histologically confirmed acute rejection in 111 heart transplant recipients. A 50% increase in cyclosporine concentration was associated with a 15% reduction in risk of rejection in the subsequent 5 days (P=0.002). Increasing oral corticosteroid dose also protected against rejection (P=0.01). Rejection was over 2.5 times more likely during the first 20 postoperative days, and patients with 2 HLA-DR mismatches who were transplanted for cardiomyopathy or who had multiple previous rejection episodes were predisposed to further rejection (Pcyclosporine concentrations was weakly associated with risk of rejection (P=0.1). Investigation of threshold levels for the cyclosporine concentration-effect relationship suggested that concentrations above 375 microgram L(-1) provide optimal protection against acute cardiac allograft rejection. This result yields an objectively defined therapeutic threshold for targeting early cyclosporine concentrations following heart transplantation, although the upper end of the range will depend on the individual's susceptibility to nephrotoxicity and infection.

  17. Organ transplantation and its physiological implications – A review ...

    African Journals Online (AJOL)

    Organ transplantation is the mechanism of transferring an organ (heart, lung, etc.) from one body to another or from one donor site on the patient's own body for the purpose of replacing the recipient's damaged or absent organ. The different types of transplantation considering the relationship between the donor and the ...

  18. Use of autoperfusion for distant procurement of heart-lung allografts.

    Science.gov (United States)

    Ladowski, J S; Kapelanski, D P; Teodori, M F; Stevenson, W C; Hardesty, R L; Griffith, B P

    1985-05-01

    Heart-lung transplantation has been limited to on-site organ procurement because current methods of lung preservation are unreliable for periods in excess of one hour. A method of dynamic heart-lung preservation has been evaluated as a possible means for distant procurement for human transplantation. Canine and bovine heart-lung blocks were removed and preserved by autoperfusion for periods of two to nine hours. The key features of the method included normothermic coronary autoperfusion with donor blood by an autoregulating beating heart, and a stabilizing reservoir bag interposed between the donor aorta and the right atrium. The reservoir is positioned one meter above the aortic valve, and determines the pressure in the aorta. Flow from the bag to the right heart dictates venous return, pulmonary blood flow, and ventricular stroke volume. The lungs are ventilated with room air and 5% to 10% of CO2, at 4 liters/minute. Normothermia is ensured by immersion of the heart-lungs block in a temperature controlled crystalloid bath. Eleven canine and eight bovine heart-lung blocks were evaluated for two to nine hours. Lung function was excellent during this period, and cardiac output did not decline from pre-harvest levels. Five heart-lung allografts were transplanted after an average of four hours of autoperfusion and all functioned satisfactorily. All animals could be weaned from the extracorporeal circulation support. Two to three hours later, cardiac outputs and arterial pO2 were normal. The peak airway pressures averaged 29 cm H2O.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Sporotrichosis in Renal Transplant Patients

    Directory of Open Access Journals (Sweden)

    Paulo Gewehr

    2013-01-01

    Full Text Available The current report describes two renal transplant recipients who presented with sporotrichosis. In addition, the authors review the general aspects of sporotrichosis in renal transplant recipients reported in the literature. Sporotrichosis is a rare fungal infection in transplant patients and has been reported primarily in renal transplant recipients not treated with antifungal prophylaxis. Extracutaneous forms of sporotrichosis without skin manifestations and no previous history of traumatic injuries have been described in such patients and are difficult to diagnose. Renal transplant recipients with sporotrichosis described in the present report were successfully treated with antifungal therapy including amphotericin B deoxycholate, lipid amphotericin B formulations, fluconazole and itraconazole.

  20. Retinal changes in solid organ and bone marrow transplantation patients.

    Science.gov (United States)

    Malerbi, Fernando Korn; Teixeira, Sergio Henrique; Hirai, Luis Gustavo Gondo; Matsudo, Nilson Hideo; Carneiro, Adriano Biondi Monteiro

    2017-01-01

    To evaluate retinal changes in patients who underwent solid organ or bone marrow transplantation. A retrospective analysis of medical records of patients evaluated from February 2009 to December 2016. All patients included underwent funduscopy. Clinical and demographic data regarding transplantation and ophthalmological changes were collected. A total of 126 patients were analyzed; of these, 108 underwent transplantation and 18 were in the waiting list. Transplantation modalities were heart, lung, kidney, liver, pancreas, combined pancreas and kidney and bone marrow transplantation. The main pre-transplantation comorbidities were diabetes and arterial hypertension. Of the 108 transplanted patients, 82 (76%) had retinal changes. All patients who underwent pancreas or combined pancreas and kidney transplantation had diabetic retinopathy. The main retinal changes found were diabetic retinopathy, hypertensive retinopathy, retinal vascular occlusions, chorioretinal infections and central serous chorioretinopathy. Retinal changes were either related to preexisting conditions, mainly diabetic retinopathy, or developed postoperatively as a complication of the surgical procedure, or as an infection related to the immunosuppressive status, or due to drug toxicity. These patients may present with complex ophthalmological changes and should be carefully evaluated prior to surgery and further followed by an ophthalmologist skilled in the management of diabetic retinopathy and posterior pole infections. Analisar as alterações retinianas de pacientes submetidos a transplantes de órgãos sólidos ou de medula óssea. Análise de prontuário dos pacientes avaliados no período de fevereiro de 2009 a dezembro de 2016. Todos os pacientes incluídos foram submetidos à avaliação fundoscópica. Foram coletados dados demográficos e clínicos, referentes ao transplante e às alterações oftalmológicas encontradas. Foram avaliados 126 pacientes, sendo 108 submetidos a transplantes

  1. Lung transplantation and repair of complex congenital heart lesions in patients with pulmonary hypertension.

    Science.gov (United States)

    Mendeloff, E N; Huddleston, C B

    1998-04-01

    Pulmonary vascular disease in conjunction with either a previously repaired or an unrepaired congenital heart defect is the third most common indication for lung transplantation in the pediatric age range. Because scarcity of donor organs remains a critical issue and heart-lung donor blocks are becoming diminishingly available, efforts must be directed towards other options such as combining lung transplantation with correction of the underlying congenital heart defect. Certain defects like congenital pulmonary vein stenosis are eradicated by removal of the diseased lungs, whereas others such as complete atrioventricular canal and pulmonary atresia with ventricular septal defect require cardioplegic arrest of the heart and intracardiac repair in conjunction with the lung transplantation. A breakdown of this patient population into subgroups may be helpful both in thinking about the pathophysiology and in determining appropriate indications and timing of transplantation. Earlier studies from our center showed the high-risk nature and formidable undertaking of caring for this complex group of patients. Through continued experience, there has been gradual improvement in early outcomes. As with all other groups of lung transplantation patients, obliterative bronchiolitis remains the major deterrent to long-term survival.

  2. Mycoses in the transplanted patient.

    Science.gov (United States)

    Dictar, M O; Maiolo, E; Alexander, B; Jacob, N; Verón, M T

    2000-01-01

    The incidence of invasive fungal infection (IFI) has increased considerably over the past 20 years, and transplant recipients are at especially high risk for fungal infections owing to their overall immunosuppressed condition. Organ transplantation procedures were incorporated as a therapeutic option for many patients who lacked the normal functions of organs such as the heart, liver, kidney, lung, pancreas and small bowel. The prevalence of IFI in solid organ transplant (SOTR) patients ranges from 5 to 50% in kidney and liver transplants, respectively. In bone marrow transplant (BMT) patients, IFI are major causes of morbidity and mortality due to the protracted neutropenic period and graft-versus-host disease. Candida spp. and Aspergillus spp. account for >80% of fungal episodes in both SOTR and BMT. The development of new immunosuppressive agents, new prophylaxis strategies (as pre-emptive therapy) and the improvement in surgical techniques led to increase survival of transplant recipients. In this session, a clear and concise update of the recent advances in the laboratory diagnosis of candidiasis and aspergillosis in this kind of patients was presented. However, we still need to establish more rapid, sensitive and specific methods for IFI diagnosis. Representatives of the 'Subcomision de Infecciones en el Paciente Neutropenico y Transplantado (SIPNYT)' de la Sociedad Argentina de Infectologia (SADI), presented the results of an unusual multicenter study both retrospective and descriptive studies of IFI in SOTR and BMT patients in Argentina. In addition, a study of IFI in 1,861 SOTR patients from four centers and the analysis of IFI in 2,066 BMT patients from all 12 BMT centers from Argentina was presented. From these studies it can be concluded that 'all transplant recipients are not the same' and that they should be stratified according to their different risk degrees in order to determine the best prophylaxis and treatment strategies.

  3. A systematic review of complicated diverticulitis in post-transplant patients.

    Science.gov (United States)

    Oor, J E; Atema, J J; Boermeester, M A; Vrouenraets, B C; Ünlü, Ç

    2014-11-01

    Immunosuppression could increase the complication rate in patients with acute diverticulitis. This would justify a low threshold for elective sigmoid resection in these patients after an episode of diverticulitis. Well-documented groups of immunocompromised patients are transplant patients, in which many prospective studies have been conducted. The aim of this systematic review is to assess the incidence of complicated diverticulitis in post-transplant patients. We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases for papers published between January 1966 and January 2014. Publications dealing with post-transplant patients and left-sided diverticulitis were eligible for inclusion. The following exclusion criteria were used for study selection: abstracts, case-series and non-English articles. Primary outcome measure was the incidence of complicated diverticulitis. Secondary outcome was the incidence of acute diverticulitis and the proportion of complicated diverticulitis. Pooling of data was only performed when more than five reported on the outcome of interest with comparable cohorts. Only studies describing proportion of complicated diverticulitis and renal transplant studies were eligible for pooling data. Seventeen articles met the inclusion criteria. Nine renal transplant cohorts, four mixed lung-heart-heart lung transplant cohorts, two heart transplant cohorts, and two lung cohorts. A total of 11,966 post-transplant patients were included in the present review. Overall incidence of complicated diverticulitis in all transplantation studies ranged from 0.1 to 3.5%. Nine studies only included renal transplant patients. Pooled incidence of complicated diverticulitis in these patients was 1.0% (95% CI 0.6 to 1.5%). Ten studies provided proportion of complicated diverticulitis. Pooled incidence of acute diverticulitis in these studies was 1.7% (95% CI 1.0 to 2.7%). Pooled proportion of complicated diverticulitis among these patients was 40.1% (95% CI 32.2 to

  4. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, Christian B; Sloth, Erik; Lambrechtsen, Jess

    2013-01-01

    Patients with acute respiratory symptoms still remain a diagnostic challenge. The aim of the study was to evaluate whether focused sonography could potentially diagnose life-threatening conditions missed at the primary assessment in a patient population consisting of admitted patients with acute...... respiratory symptoms....

  5. Successful cardiac transplantation outcomes in patients with adult congenital heart disease.

    Science.gov (United States)

    Menachem, Jonathan N; Golbus, Jessica R; Molina, Maria; Mazurek, Jeremy A; Hornsby, Nicole; Atluri, Pavan; Fuller, Stephanie; Birati, Edo Y; Kim, Yuli Y; Goldberg, Lee R; Wald, Joyce W

    2017-09-01

    The purpose of our study is (1) to characterise patients with congenital heart disease undergoing heart transplantation by adult cardiac surgeons in a large academic medical centre and (2) to describe successful outcomes associated with our multidisciplinary approach to the evaluation and treatment of adults with congenital heart disease (ACHD) undergoing orthotopic heart transplantation (OHT). Heart failure is the leading cause of death in patients with ACHD leading to increasing referrals for OHT. The Penn Congenital Transplant Database comprises a cohort of patients with ACHD who underwent OHT between March 2010 and April 2016. We performed a retrospective cohort study of the 20 consecutive patients. Original cardiac diagnoses include single ventricle palliated with Fontan (n=8), dextro-transposition of the great arteries after atrial switch (n=4), tetralogy of Fallot (n=4), pulmonary atresia (n=1), Ebstein anomaly (n=1), unrepaired ventricular septal defect (n=1) and Noonan syndrome with coarctation of the aorta (n=1). Eight patients required pretransplant inotropes and two required pretransplant mechanical support. Nine patients underwent heart-liver transplant and three underwent heart-lung transplant. Three patients required postoperative mechanical circulatory support. Patients were followed for an average of 38 months as of April 2016, with 100% survival at 30 days and 1 year and 94% overall survival (19/20 patients). ACHD-OHT patients require highly specialised, complex and multidisciplinary healthcare. The success of our programme is attributed to using team-based, patient-centred care including our multidisciplinary staff and specialists across programmes and departments. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Renal insufficiency, bleeding and prescription of discharge medication in patients undergoing percutaneous coronary intervention in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry.

    Science.gov (United States)

    Maree, Andrew O; Margey, Ronan J; Selzer, Faith; Bajrangee, Amrit; Jneid, Hani; Marroquin, Oscar C; Mulukutla, Suresh R; Laskey, Warren K; Jacobs, Alice K

    2016-01-01

    To establish the relationship between renal insufficiency, bleeding and prescription of cardiovascular medication. This was a prospective, multi-center, cohort study of consecutive patients undergoing PCI during three NHLBI Dynamic Registry recruitment waves. Major and minor bleeding, access site bleeding and rates of prescription of cardiovascular medication at discharge were determined based on estimated glomerular filtration rate (eGFR). Renal insufficiency was an independent predictor of major adverse cardiovascular events (MACE). Bleeding events and access site bleeding requiring transfusion were significantly associated with degrees of renal insufficiency (pinsufficiency is associated with bleeding in patients undergoing PCI. Patients with renal insufficiency are less likely to receive recommended discharge pharmacotherapy. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. After the Transplant

    Science.gov (United States)

    ... have died Transplants from living donors Finding a living donor Being a living donor Liver Heart Lung Pancreas Intestine VCA Common ... Living donation What is living donation? Organs Types Being a living donor First steps Being asked to donate Qualifications ...

  8. Before the Transplant

    Science.gov (United States)

    ... have died Transplants from living donors Finding a living donor Being a living donor Liver Heart Lung Pancreas Intestine VCA Common ... Living donation What is living donation? Organs Types Being a living donor First steps Being asked to donate Qualifications ...

  9. Organ transplantation in Bulgaria.

    Science.gov (United States)

    Naumova, Elissaveta; Panchev, Petar; Simeonov, Pencho J; Mihaylova, Anastassia; Penkova, Kalina; Boneva, Petia; Marinova, Daniela; Paskalev, Emil; Simeonov, Petar L; Zlatev, Assen

    2008-12-01

    The transplantation program in Bulgaria started in 1968 with renal transplantations to a child and adult woman. In 1986 the first heart transplantation was performed. To date a total of 10 heart transplants have been performed, including one combined heart/lung. A liver transplantation program was launched in 2005 with a total number of 16 transplantations-7 from living donors and 9 from deceased donors. The highest transplantation activity is registered in the field of renal transplantation. During the period 1980-2006, 462 Bulgarian recipients of kidney were transplanted in Bulgaria. The ratio between transplantations from deceased and living related donors is approximately 1:0.9. Annual transplantation activity varies among the years from 1 to 12 renal transplantations p.m.p./per year. The 1- (80.7% vs. 63.1%), 5- (57.86% vs. 39.0%) and 10-year (42.65% vs. 23.62%) graft survival rates are higher for recipients of living donor kidneys compared to those of deceased donor. In 1983 a National kidney waiting list was established. Currently the number of the registered patients eligible for renal transplantation is 885. The proportion of sensitized patients in the waiting list is 20.45% and 4.34% of them are hyperimmunized. Recently HLAMatchmaker program has been implemented not only for sensitized patients but also for those with rare alleles and haplotypes. Post-transplant immunological monitoring showed a strong association between alloantibody presence and delayed graft function (Chi-square=10.73, P<0.001), acute rejection (Chi-square=14.504, P<0.001), chronic rejection (Chi-square=12.84, P<0.001) and graft loss (Chi-square=20.283, P<0.001). Based on the experience in our transplant center a strategy for improvement of long-term renal graft survival was developed and implemented.

  10. Clinico-pathological Analysis of the Lungs from Patients with Lung Transplantation in a Single Institute in Korea.

    Science.gov (United States)

    Kim, Hyojin; Jeon, Yoon Kyung; Lee, Hyun Joo; Kim, Young Tae; Chung, Doo Hyun

    2015-10-01

    Recently, the numbers of lung transplantation (LT) has been increased in Korea. However, post-LT outcome has not been successful in all patients, which may be partially affected by the primary lung disease. Therefore comprehensive understanding in original pathological diagnosis of patients with LT would be needed for achieving better clinical outcome. To address this issue, we performed clinico-pathological analysis of the explanted lungs from 29 patients who underwent LT over a 9-yr period in Seoul National University Hospital. Among them, 26 patients received single (1/26) or double (25/26) LT, while heart-lung transplantation was performed in 3 patients. The final clinico-pathological diagnoses were idiopathic pulmonary fibrosis/usual interstitial pneumonia (UIP) (n = 6), acute interstitial pneumonia (AIP)/diffuse alveolar damage (DAD) (n = 4), AIP/non-specific interstitial pneumonia with DAD (n = 1), collagen vascular disease-related interstitial lung disease (CVD-ILD)/DAD (n = 3), CVD-ILD/UIP (n = 1), lymphangioleiomyomatosis (n = 1), bronchiectasis (n = 4), pulmonary arterial hypertension (n = 2), tuberculosis (n = 1), bronchiolitis obliterans (BO) (n = 1), and lung cancer (n = 1). Moreover, 4 patients who had chemotherapy and hematopoietic stem cell transplantation due to hematologic malignancy showed unclassifiable interstitial pneumonia with extensive fibrosis in the lungs. Our study demonstrates that pathology of the explanted lungs from Korean patients with LT is different from that of other countries except for interstitial lung disease and bronchiectasis, which may be helpful for optimization of selecting LT candidates for Korean patients.

  11. Revisional bariatric surgery in a transplant patient

    Directory of Open Access Journals (Sweden)

    Salman Al Sabah

    2017-01-01

    Conclusion: Bariatric surgery is a safe and effective procedure to assist renal transplant patients in losing weight. In addition, it has proven to be effective in the management of the co-morbidities that are associated with renal failure. Our study was also able to prove that converting form an SG to a bypass in a transplant patient is a safe and feasible option.

  12. Parvovirus B19 in kidney transplant patients.

    Science.gov (United States)

    Zolnourian, Z R; Curran, M D; Rima, B K; Coyle, P V; O'Neill, H J; Middleton, D

    2000-05-27

    Renal transplant patients were screened for the presence of parvovirus B19, before transplantation and monthly for 4 months after transplantation, by means of a sensitive nested PCR assay. Upon screening plasma from 110 patients, we found that two asymptomatic patients were B19 DNA positive. One of these patients was PCR positive in the plasma sample taken 2 months after transplantation; the plasma contained anti-B19 IgG antibodies before transplant and throughout the follow-up period, with an increase in the IgG level in the second posttransplant sample coinciding with the detection of B19 DNA. IgM antibodies to B19 were not detected in this patient. Because, for this patient, the donor's spleen DNA was also B19 DNA positive, we suspect B19 transmission from the donor and limited B19 replication, inasmuch as this patient already had a primed immune response to B19. The other patient was PCR positive in the pretransplant and in the plasma sample taken 1 month after transplant and contained a strong anti-B19 IgG response in the pretransplant sample and throughout the follow-up period-and anti-B19 IgM antibodies were not detected before or after transplantation. By testing samples taken from this patient at 2 weeks, 2 months, and 3 months before transplantation, we were able to determine that the infection occurred shortly before transplantation. Unexpectedly, this graft failed and was removed 2 days after transplantation despite a negative cross-match. A pathological examination of the kidney indicated acute vascular rejection, suggesting a possible role for B19 in this complication.

  13. The National Heart, Lung, and Blood Institute Small Business Program

    Directory of Open Access Journals (Sweden)

    Kurt W. Marek, PhD

    2016-12-01

    Full Text Available Small companies working to develop products in the cardiovascular space face numerous challenges, from regulatory, intellectual property, and reimbursement barriers to securing funds to keep the lights on and reach the next development milestone. Most small companies that spin out from universities have the scientific knowledge, but product development expertise and business acumen are also needed to be successful. Other challenges include reduced interest in early-stage technologies and limited deal flow for cardiovascular products. The National Heart, Lung, and Blood Institute (NHLBI small business program is a comprehensive ecosystem designed to address these critical challenges and to provide resources and expertise to assist early-stage companies developing cardiovascular and other products within the institute’s mission. This article describes steps that NHLBI has taken to enhance our small business program to more effectively translate basic discoveries into commercial products to benefit patients and public health, including enhancing internal expertise and developing nonfinancial resources to assist small businesses as they develop their products and seek private sector investment and partnership.

  14. Knee Pain in a Renal Transplant Patient

    Science.gov (United States)

    2017-04-26

    HUBBARD FROM: 59 MDW/SGVU SUBJECT: Professional Presentation Approval 25 APR 2017 1. Your paper, entitled Knee Pain In A Renal T ransplant Patient...MATERIAL TO BE PUBLISHED OR PRESENTED: Knee Pain in a Renal Transplant Patient 7. FUNDING RECEIVED FOR THIS STUDY? 0 YES IZJNO FUNDING SOURCE: 8. DO...41-108 PREVIOUS EDITIONS ARE OBSOLETE Page 3 of 3 Pages Title: Knee Pain in a Rena l Transplant Patient Authors: Matthew Hubbard, DO. Liem

  15. Oral lesions in kidney transplant patients.

    Science.gov (United States)

    Sahebjamee, Mahnaz; Shakur Shahabi, Maryam; Nikoobakht, Mohammad Reza; Momen Beitollahi, Jalil; Mansourian, Arash

    2010-07-01

    Oral hygiene in kidney transplant recipients contributes to maintenance of the transplanted organ and its function. Thus, an investigation of oral lesions could be counted as a notable work. These patients have the potential to be involved with lesions developed as a result of the administration of immunosuppressive drugs. The aim of this study was to investigate oral lesions in a group of kidney transplant recipients. The present study was a cross-sectional research on 100 patients with a kidney transplant for at least 3 months. Oral mucosa was assessed clinically for any lesion. Additional data on systemic diseases, transplant duration, and medications were recorded. Twenty-four percent of the patients had at least 1 oral lesion. The most common lesion was oral candidiasis in 16% of the participants (13 cases of acute pseudomembranous and 3 cases of chronic oral candidiasis). Gingival enlargement was seen in 7% of the kidney transplant recipients, and 2% had a coated tongue. Elimination of oral fungal lesions in kidney transplant recipients is highly recommended. We hope this study can shed light on this particular aspect of healthcare in kidney transplant recipients.

  16. 42 CFR 121.13 - Definition of Human Organ Under section 301 of the National Organ Transplant Act, as amended.

    Science.gov (United States)

    2010-10-01

    ... the human (including fetal) kidney, liver, heart, lung, pancreas, bone marrow, cornea, eye, bone, skin..., DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT ORGAN PROCUREMENT AND TRANSPLANTATION...

  17. 21 CFR 870.4220 - Cardiopulmonary bypass heart-lung machine console.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass heart-lung machine console. 870.4220 Section 870.4220 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... Cardiopulmonary bypass heart-lung machine console. (a) Identification. A cardiopulmonary bypass heart-lung machine...

  18. OCULAR PATHOLOGY IN PATIENTS AFTER KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2011-01-01

    Full Text Available Structural changes in eyes are present in all patients with chronic kidney disease. A study to detect ocular patho- logy in patients with end-stage chronic renal failure after kidney transplantation in the early and late postopera- tive period compared with patients receiving replacement therapy with hemodialysis. Revealed that in the early post-transplant period in recipients of kidneyas in patients on hemodialysis, continued angioretinopatiya, 40% of patients had «dry eye syndrome». In the delayed post-transplant period, patients showed significant impro- vement in the retina and retinal vessels, the improvement of spatial-temporal parameters of visual perception. However, a decrease of visual acuity on the background of the development of posterior subcapsular cataract caused by prolonged corticosteroid, and an increased incidence of viral and bacterial conjunctivitis. 

  19. Liver transplantation in patients with hepatocellular carcinoma

    NARCIS (Netherlands)

    Polak, Wojciech G.; Soyama, Akihiko; Slooff, Maarten J. H.

    2008-01-01

    Liver transplantation has a definitive place in the treatment of patients with hepatocellular carcinoma (HCC) in a cirrhotic liver. Patients with a tumor load within the Milan criteria have excellent survival comparable to survival in patients with benign indications. When tumor load exceeds the

  20. Heart transplantation in adults with congenital heart disease.

    Science.gov (United States)

    Houyel, Lucile; To-Dumortier, Ngoc-Tram; Lepers, Yannick; Petit, Jérôme; Roussin, Régine; Ly, Mohamed; Lebret, Emmanuel; Fadel, Elie; Hörer, Jürgen; Hascoët, Sébastien

    2017-05-01

    With the advances in congenital cardiac surgery and postoperative care, an increasing number of children with complex congenital heart disease now reach adulthood. There are already more adults than children living with a congenital heart defect, including patients with complex congenital heart defects. Among these adults with congenital heart disease, a significant number will develop ventricular dysfunction over time. Heart failure accounts for 26-42% of deaths in adults with congenital heart defects. Heart transplantation, or heart-lung transplantation in Eisenmenger syndrome, then becomes the ultimate therapeutic possibility for these patients. This population is deemed to be at high risk of mortality after heart transplantation, although their long-term survival is similar to that of patients transplanted for other reasons. Indeed, heart transplantation in adults with congenital heart disease is often challenging, because of several potential problems: complex cardiac and vascular anatomy, multiple previous palliative and corrective surgeries, and effects on other organs (kidney, liver, lungs) of long-standing cardiac dysfunction or cyanosis, with frequent elevation of pulmonary vascular resistance. In this review, we focus on the specific problems relating to heart and heart-lung transplantation in this population, revisit the indications/contraindications, and update the long-term outcomes. Copyright © 2017. Published by Elsevier Masson SAS.

  1. An autopsy-based study of Trypanosoma cruzi persistence in organs of chronic chagasic patients and its relevance for transplantation.

    Science.gov (United States)

    Benvenuti, Luiz A; Roggério, Alessandra; Cavalcanti, Marta M; Nishiya, Anna S; Levi, José E

    2017-12-01

    Chagas' disease (CD) is caused by infection with the protozoan Trypanosoma cruzi. The disease can affect the heart and/or the gastrointestinal (GI) tract, but around 70% of infected individuals remain asymptomatic in the chronic form. Organ transplantation from T. cruzi-infected donors is often avoided because of the risk of disease transmission, previously reported after heart, kidney, or liver transplantation. We investigated by histology, immunohistochemistry, and polymerase chain reaction (PCR) the persistence of T. cruzi in samples of the heart, lung, liver, kidney, pancreas, adrenal gland, esophagus, and GI tract of 21 chronic chagasic patients. Parasite persistence was detected in 12/21 (57.1%) heart samples, mainly by PCR-based assays. T. cruzi parasites were detected by histology and immunohistochemistry in smooth muscle cells of the central vein from 1/21 (4.8%) adrenal gland samples. No samples of the lung, liver, kidney, pancreas, esophagus, or GI tract were found to have parasites by histology, immunohistochemistry, or PCR. We concluded that, aside from the heart, the other solid organs of T. cruzi-infected donors can be used for transplantation with a lot of caution. Such organs are not safe in the view of previous reports of CD transmission, but seem to present a low T. cruzi load compared to the heart. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Types of Cancer Associated with Transplant Recipients

    Science.gov (United States)

    ... have died Transplants from living donors Finding a living donor Being a living donor Liver Heart Lung Pancreas Intestine VCA Common ... Living donation What is living donation? Organs Types Being a living donor First steps Being asked to donate Qualifications ...

  3. Cutaneous melanoma in solid organ transplant patients.

    Science.gov (United States)

    Russo, I; Piaserico, S; Belloni-Fortina, A; Alaibac, M

    2014-08-01

    Solid organ transplant patients are at greatly increased risk of developing a wide variety of skin cancers, particularly epithelial skin cancers. On the other hand, it is well known that an intact immune system limits the development of benign melanocytic lesions. The eruptive nevi phenomenon, which we can observe in solid organ transplant recipients, is indicative of the relationship between melanocyte proliferation and immune system. Regression of melanocytic nevi after restoration of complete immune responsiveness is a further clinical example the role of immunosurveillance on melanocyte proliferation. However, melanoma incidence in organ transplant recipients appears only 2-3 folds higher than in general population. To this regard, organ transplant recipients who develop de novo melanomas thicker than 2mm seem to have a significantly worse outcome with a greatly increased risk of dying of metastatic melanoma, whereas those who develop a ≤2 mm thickness melanoma seem to have a prognosis similar to that of the general population. Furthermore, there is no evidence supporting an increased risk of melanoma recurrences after transplant in patients with a history of low-risk melanoma. Melanoma is also one of the most frequent and lethal donor-derived malignancies suggesting that a history of invasive melanoma should be considered an absolute contraindication to donation. The aim of this review is to investigate the relationship between immunosuppression and melanoma and to discuss its clinical implications for the management of transplant-associated melanoma.

  4. Skin Findings in Renal Transplantation Patients

    Directory of Open Access Journals (Sweden)

    Demet Kartal

    2013-03-01

    Full Text Available Objective: It was aimed to identify skin findings those were seen in patients who undergone renal transplantation. Methods: Patients who have been followed in Erciyes University Nephrology Hospital renal transplantation outpatient clinic were included in the study. They were evaluated for dermatologic findings during routine controls. Age, gender, transplantation date, identity of organ donor, history of medications, dermatological history and dermatological findings during examination were recorded. Biopsy was performed when needed. Results: In total 94 patients, 25 female (26.6% and 69 male (73.4%, were recruited to the study. Mean age was 36±10 years. The most frequent skin finding was drug-related acne (n=20. Most common infectious disease was verruca (n=17. There were viral disease other than verruca such as herpes zoster (n=3, superficial mycosis such as onychomycosis (n=5, tinea versicolor, tinea pedis and bacterial skin disease (n=2, and paronychia (n=1 and pre-malign lesions such as actinic cheilitis and bowenoid papulosis. Besides these, stria (n=3, kserosis (n=2, cornu cutaneum, café-au-lait spots, sebaceous hyperplasia and seborrheic dermatitis, skin tag, hypertrichosis, unguis incarinatus and calcinosis were other skin findings those were seen. No malign skin lesion was observed in any of patients. Conclusion: Miscellaneous skin lesions should develop in patients those undergone renal transplantation due to long-term utilization of various immunosuppressive drugs.

  5. The story of heart transplantation: From cape town to cape comorin

    Directory of Open Access Journals (Sweden)

    Aakshi Kalra

    2016-01-01

    Full Text Available Norman Shumway is widely regarded as the father of heart transplantation although the world's first adult human heart transplant was performed by Christiaan Barnard, on December 3, 1967, at the Groote Schuur Hospital in Cape Town, South Africa. Adrian Kantrowitz performed the world's first pediatric heart transplant on December 6, 1967 and Norman Shumway performed the first adult heart transplant in the United States on January 6, 1968, at the Stanford University Hospital. In India, PK Sen attempted the first heart transplant in humans soon after Christaan Barnaard but the first and subsequent patients died. The first successful heart transplant in India was by Dr. P Venugopal in 1994 at AIIMS, New Delhi. This was followed soon after by Dr. KM Cherian who also did the first pediatric and first heart lung transplant in India.

  6. Determinants of complications in liver transplant patients

    NARCIS (Netherlands)

    E.L.D. de Mare-Bredemeijer (Emmeloes)

    2015-01-01

    markdownabstractAbstract The aims of this thesis were to identify risk factors for the occurrence of complications in patients with end-stage liver disease (ESLD), both before and after liver transplantation (LTx), and to develop strategies to optimize immunosuppression after LTx in order to

  7. Retrospective analysis of kidney transplanted patients

    Directory of Open Access Journals (Sweden)

    Tamer Sağıroğlu

    2009-06-01

    Full Text Available Kidney transplantation has become one of the best treatment methods for significantly improving the quality of life for patients suffering from kidney disease. This study aimed to provide a retrospective evaluation of kidney transplantation cases between the years 2004 and 2007.Initially, the following data was collected: number of annual cases, age, gender, hepatitis serology, hypertension, and cardiovascular illness, number of cadaver and living donors, kinship, and duration of hospital stay, post-operational complications, mortality and graft loss. 39% of the patients were female whilst 61% were male. 3.8% of the patients were positive for hepatitis serology. 28.8% of the patients were hypertensive. 61% of the patients received their kidneys from live donors. 60.6% of the live donors were the mothers of the patients and 18.2% were the fathers. The average length of hospital stay was 48 days. 21.4% of the patients were identified as having developed major complications including sepsis, heart failure, pulmonary emboli, respiratory insufficiency and rejection. 5.4% of the patients developing major complications ended with mortality and 1.8% with graft loss. Even though the total number of annual cases is constantly rising, we think that this figure is much lower that it should be considering the number of patients dependent on dialysis machines. Kidney transplantation is the most appropriate treatment in terms of cost-effectiveness and thus increasing the ratio of kidney transplantations would be beneficial to both the patient’s health and to the national economy.

  8. Nutritional status of renal transplant patients | du Plessis | South ...

    African Journals Online (AJOL)

    To assess the effect of renal transplantation on the nutritional status of patients. Design. Prospective descriptive study. Setting. Renal Transplant Clinic at Tygerberg Hospital, Western Cape. Subjects. Fifty-eight renal transplant patients from Tygerberg Hospital were enrolled in the study. The sample was divided into two ...

  9. Development of a miniaturized heart-lung machine for neonates with congenital heart defect.

    Science.gov (United States)

    Arens, Jutta; Schnöring, Heike; Reisch, Fabian; Vázquez-Jiménez, Jaime F; Schmitz-Rode, Thomas; Steinseifer, Ulrich

    2008-01-01

    Predominantly, standard adult heart lung machines are used for pediatric cardiac surgery, only with individually downsized components. Downsizing is limited, e.g., by the required gas exchange surface. To diminish complications, we developed a new miniaturized heart lung machine (MiniHLM) for neonates, with significantly reduced priming volume and blood contact surface by integration of all major system components in one single device. In particular, a rotary blood pump is centrically integrated into the oxygenator and the cardiotomy reservoir with integrated heat exchanger is directly connected. Thus, tubing is only necessary between patient and MiniHLM. A total priming volume of 102 ml could be achieved for the entire extracorporeal circuit (including arterial/venous line), in contrast to the currently smallest device on the market with 213 ml. In first animal experiments with female New Zealand rabbits, the MiniHLM guaranteed both a sufficient gas exchange and an adequate blood flow; 12 rabbits could successfully be weaned off after 1 hour of aortic clamp time. The first in vitro and in vivo tests confirm the concept of the MiniHLM. Its low priming volume and blood contact surface may significantly reduce complications during heart surgery in neonates.

  10. Renal cancer in kidney transplanted patients.

    Science.gov (United States)

    Frascà, Giovanni M; Sandrini, Silvio; Cosmai, Laura; Porta, Camillo; Asch, William; Santoni, Matteo; Salviani, Chiara; D'Errico, Antonia; Malvi, Deborah; Balestra, Emilio; Gallieni, Maurizio

    2015-12-01

    Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.

  11. The Aachen MiniHLM--a miniaturized heart-lung machine for neonates with an integrated rotary blood pump.

    Science.gov (United States)

    Arens, Jutta; Schnoering, Heike; Pfennig, Michael; Mager, Ilona; Vázquez-Jiménez, Jaime F; Schmitz-Rode, Thomas; Steinseifer, Ulrich

    2010-09-01

    The operation of congenital heart defects in neonates often requires the use of heart-lung machines (HLMs) to provide perfusion and oxygenation. This is prevalently followed by serious complications inter alia caused by hemodilution and extrinsic blood contact surfaces. Thus, one goal of developing a HLM for neonates is the reduction of priming volume and contact surface. The currently available systems offer reasonable priming volumes for oxygenators, reservoirs, etc. However, the necessary tubing system contains the highest volumes within the whole system. This is due to the use of roller pumps; hence, the resulting placement of the complete HLM is between 1 and 2 m away from the operating table due to connective tubing between the components. Therefore, we pursued a novel approach for a miniaturized HLM (MiniHLM) by integrating all major system components in one single device. In particular, the MiniHLM is a HLM with the rotary blood pump centrically integrated into the oxygenator and a heat exchanger integrated into the cardiotomy reservoir which is directly connected to the pump inlet. Thus, tubing is only necessary between the patient and MiniHLM. A total priming volume of 102 mL (including arterial filter and a/v line) could be achieved. To validate the overall concept and the specific design we conducted several in vitro and in vivo test series. All tests confirm the novel concept of the MiniHLM. Its low priming volume and blood contact surface may significantly reduce known complications related to cardiopulmonary bypass in neonates (e.g., inflammatory reaction and capillary leak syndrome). © 2010, Copyright the Authors. Artificial Organs © 2010, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  12. Second Kidney Transplant in a Patient with Artificial Urinary Sphincter

    OpenAIRE

    Gavin Tansley; Sertaç Çimen; Sanem Güler Çimen; Mark Walsh

    2015-01-01

    Artificial urinary sphincter (AUS) is regarded as the gold standard treatment for post-prostatectomy urinary incontinence. Kidney transplantation is gold standard treatment for end stage renal disease. Since both AUS implantation and renal transplant surgeries are relatively common, a co-occurrence is likely and a patient with AUS may need a kidney transplant. Herein, we report a patient with an AUS who underwent second kidney transplantation. Since the iliac fossa ipsilateral to the AUS part...

  13. Vitamin D status in kidney transplant patients

    DEFF Research Database (Denmark)

    Ewers, Bettina; Gasbjerg, Ane; Moelgaard, Christian

    2008-01-01

    kidney transplant patients. DESIGN: This was a cross-sectional study of 173 adult kidney transplant patients with a mean (+/-SD) age of 53.4 +/- 11.7 y and a median graft age of 7.4 y (interquartile range: 3.3-12.7 y). Serum concentrations of intact parathyroid hormone (S-PTH), 25-hydroxyvitamin D [S-25....... Low S-25(OH)D concentrations were associated with 1) increased S-PTH concentrations (P = 0.0002), independently of S-1,25(OH)(2)D concentrations, and 2) decreased S-1,25(OH)(2)D concentrations (P = 0.002), independently of graft function. CONCLUSIONS: Hypovitaminosis D is common among Danish kidney...

  14. Kidney transplant in diabetic patients: modalities, indications and results

    Directory of Open Access Journals (Sweden)

    Rangel Érika B

    2009-08-01

    Full Text Available Abstract Background Diabetes is a disease of increasing worldwide prevalence and is the main cause of chronic renal failure. Type 1 diabetic patients with chronic renal failure have the following therapy options: kidney transplant from a living donor, pancreas after kidney transplant, simultaneous pancreas-kidney transplant, or awaiting a deceased donor kidney transplant. For type 2 diabetic patients, only kidney transplant from deceased or living donors are recommended. Patient survival after kidney transplant has been improving for all age ranges in comparison to the dialysis therapy. The main causes of mortality after transplant are cardiovascular and cerebrovascular events, infections and neoplasias. Five-year patient survival for type 2 diabetic patients is lower than the non-diabetics' because they are older and have higher body mass index on the occasion of the transplant and both pre- and posttransplant cardiovascular diseases prevalences. The increased postransplant cardiovascular mortality in these patients is attributed to the presence of well-known risk factors, such as insulin resistance, higher triglycerides values, lower HDL-cholesterol values, abnormalities in fibrinolysis and coagulation and endothelial dysfunction. In type 1 diabetic patients, simultaneous pancreas-kidney transplant is associated with lower prevalence of vascular diseases, including acute myocardial infarction, stroke and amputation in comparison to isolated kidney transplant and dialysis therapy. Conclusion Type 1 and 2 diabetic patients present higher survival rates after transplant in comparison to the dialysis therapy, although the prevalence of cardiovascular events and infectious complications remain higher than in the general population.

  15. [Lung transplantation. State of the art].

    Science.gov (United States)

    García-Covarrubias, Lisardo; Salerno, Tomas A; Panos, Anthony L; Pham, Si M

    2007-01-01

    Lung transplantation is currently considered an established treatment for some advanced lung diseases. The beginning of experimental lung transplantation dates back to the 1940's when the Soviet Vladimir P. Demikhov performed the first lung transplants in animals. Two decades later, James Hardy performed the first lung transplant in humans. Unfortunately, the beginning of clinical lung transplantation was hampered by technical complications and the excessive toxicity of immunosuppressive drugs. Improvement in the surgical technique along with the development of more effective and less toxic immunosuppressive drugs has led to a better outcome in lunt transplant recipients. Donor selection and management before organ procurement play a key role in the receptor's outcome. Due to the shortage of donors, some institutions are using more liberal selection criteria, reporting satisfactory outcomes. The approach of the lung and heart-lung transplant patient is multidisciplinary and includes the cardiothoracic transplant surgeon, pulmonologist, anesthesiologist, and intensivist, among others. Herein, we review some relevant historical aspects and recent advances in the management of lung transplant recipients, including indications and contraindications, evaluation of donors and recipients, surgical techniques and peripost-operative care.

  16. Oral candidiasis in patients with renal transplants

    Science.gov (United States)

    Hernández, Gonzalo; de Arriba, Lorenzo; de Andrés, Amado

    2013-01-01

    Objectives: Oral candidiasis (OC) is a frequent oral lesion in renal transplant patients (RTPs). Despite the increased prevalence of OC in RTPs, no study has examined related risk factors. The aims of this study were to analyze the prevalence of and risk factors for OC in RTPs compared with age- and gender-matched healthy control group (HC) as well as determine the incidence of OC after transplantation. Study Design: We analyzed the prevalence and risk factors of OC in a group of 500 RTPs (307 men, 193 women, mean age 53.63 years) and 501 HC subjects (314 men, 187 women, mean age 52.25 years). Demographic and pharmacological data were recorded for all subjects. Incident cases of OC were ascertained retrospectively from outpatient clinical records only in the RTP group. Results: The prevalence of OC was 7.4% in RTPs compared with 4.19% in HC (P<0.03). The most frequent type of OC in the two groups was denture stomatitis. Statistical association was found between OC and age, mycophenolate mofetil dose and blood levels, dentures and tobacco. The multiple logistic regression model only chose for denture variable. According to the outpatient clinical records, 24 RTPs suffered OC during the first moth post-transplant. Severe lesions affecting the oral cavity and pharynx appeared in 79% of the OC cases. Conclusions: This study shows a lower prevalence of OC in RTPs than previous reports. Denture stomatitis was the most frequent OC prevalence form described in RTPs. Severe candidiasis is more frequent in the immediate posttransplant period. The presence of denture is an important risk factor of OC. These results emphasise the importance of adequate pre- and post-transplant oral health and denture cleaning and adjustment is recommended for these subjects to prevent this infection. Key words:Oral candidiasis, immunosuppressive therapy, renal transplantation. PMID:23385511

  17. Group therapy for kidney transplant patients.

    Science.gov (United States)

    Buchanan, D C

    1975-01-01

    A short-term, open membership group therapy program for kidney transplant patients and their families is described. The content and process of this group is related to the ten curative factors described by Yalom for psychiatric patients. The primary benefits for the patients seemed to be the opportunity to observe others cope with similar problems and to learn of the adaptive strategies used by others. The patients were able to offer advice to others, to overcome their tendency toward seclusion and in general, experience a feeling of hope for the future. The family members gained more from a sense of group cohesiveness than did the patients. Both family and patients utilized the meetings to ventilate their anger and frustrations associated with chronic illness and to learn more about transplantation. A more realistic expectation of the future was provided. The group did not seem long enough to measurably improve the interpersonal relations between patients and their families nor did the group members comment upon maladaptive behaviors exhibited between family members within the meetings.

  18. Procalcitonin in liver transplant patients--yet another stone turned

    DEFF Research Database (Denmark)

    Jensen, Jens-Ulrik; Lundgren, Jens D

    2008-01-01

    Liver transplantation has been reported to initiate increases in procalcitonin levels, in the absence of bacterial infection. The results of a study investigating the course of procalcitonin levels over several days after liver transplantation in noninfected patients were recently reported...... undergoing liver transplantation with and without bacterial infection are needed....

  19. The Sources of Stress in Renal Transplant Patients

    OpenAIRE

    Najmeh Valizadeh; Eesa Mohammadi; Kourosh Zarei; Fatemeh Khorashadizadeh; Sima Oudi Avval

    2015-01-01

    Introduction Renal transplant is the best treatment of choice for patients with end-stage renal disease (1). Annually, about 17000 patients receive deceased or living donor transplants, which help them promote health and self-efficacy (1-2). However, despite advances in transplant technology, patients face a number of post-operative challenges, which might lead to stress in patients, including uncertainty about future health, costs and finances, side effects of medicinal treatment and m...

  20. 78 FR 12766 - National Heart, Lung, and Blood Institute; Notice of Closed Meetings

    Science.gov (United States)

    2013-02-25

    ... of Committee: National Heart, Lung, and Blood Institute Special Emphasis Panel; SBIR Topic 80... Emphasis Panel; Improving Safety and Efficiency of Red Blood Cell Products in Transfusions. Date: March 4... HUMAN SERVICES National Institutes of Health National Heart, Lung, and Blood Institute; Notice of Closed...

  1. Difficult conversations: Australian Indigenous patients' views on kidney transplantation.

    Science.gov (United States)

    Devitt, Jeannie; Anderson, Kate; Cunningham, Joan; Preece, Cilla; Snelling, Paul; Cass, Alan

    2017-10-11

    Indigenous Australians suffer a disproportionate burden of end stage kidney disease (ESKD) but are significantly less likely to receive a transplant. This study explores Indigenous ESKD patients' views on transplantation as a treatment option. The Improving Access to Kidney Transplants (IMPAKT) research program investigated barriers to kidney transplantation for Indigenous Australians. An interview study, conducted in 2005-2006, elicited illness experience narratives from 146 Indigenous patients, including views on transplant. Interviews were conducted at 26 sites that collectively treat the majority of Indigenous ESKD patients. Key themes were identified via team consensus meetings, providing a flexible framework and focus for continued coding. Four inter-related themes were identified in patient commentary: a very high level (90% of respondents) of positive interest in transplantation; patients experienced a range of communication difficulties and felt uninformed about transplant; family involvement in decision-making was constrained by inadequate information; and patients needed to negotiate cultural and social sensitivities around transplantation. Indigenous ESKD patients demonstrated an intense interest in transplantation preferring deceased over living kidney donation. Patients believe transplant is the path most likely to support the re-establishment of their 'normal' family life. Patients described themselves as poorly informed; most had only a rudimentary knowledge of the notion of transplant but no understanding of eligibility criteria, the transplant procedure and associated risks. Patients experienced multiple communication barriers that - taken together - undermine their engagement in treatment decision-making. Families and communities are disempowered because they also lack information to reach a shared understanding of transplantation. Cultural sensitivities associated with transplantation were described but these did not appear to constrain patients

  2. Second Kidney Transplant in a Patient with Artificial Urinary Sphincter

    Directory of Open Access Journals (Sweden)

    Gavin Tansley

    2015-09-01

    Full Text Available Artificial urinary sphincter (AUS is regarded as the gold standard treatment for post-prostatectomy urinary incontinence. Kidney transplantation is gold standard treatment for end stage renal disease. Since both AUS implantation and renal transplant surgeries are relatively common, a co-occurrence is likely and a patient with AUS may need a kidney transplant. Herein, we report a patient with an AUS who underwent second kidney transplantation. Since the iliac fossa ipsilateral to the AUS parts had to be preferred for the second kidney transplant, risks of AUS damage and infection were higher. This report illustrates the precautions taken to minimize these risks.

  3. Sepsis in Solid-Organ Transplant Patients.

    Science.gov (United States)

    Bafi, Antônio Tonete; Tomotani, Daniere Yurie Vieira; de Freitas, Flávio Geraldo Rezende

    2017-01-01

    The growing population of solid organ transplant (SOT) recipients is at a significantly increased risk for developing infections. In some patients, the infection can lead to a dysregulated systemic inflammatory response with acute organ dysfunction. SOT recipients with sepsis tend to have less fever and leukocytosis instances. Moreover, they have diminished symptoms and attenuated clinical and radiologic findings. The current management of sepsis is similar to general patients. It relies mainly on early recognition and treatment, including appropriate administration of antibiotics and resuscitation with intravenous fluids and vasoactive drugs when needed. The infusion of fluids should be closely monitored because elevated central venous pressure levels and fluid overload can be particularly harmful. There is no consensus on how to manage immunosuppressive therapies during sepsis, although dose reduction or withdrawal is suggested to improve the host immunological response. There is compelling evidence suggesting that infections are associated with reduced allograft and patient survival. However, the traditional belief that SOT patients who develop sepsis have worse outcomes than non-transplanted patients has been challenged.

  4. Renal transplantation in patients with Balkan endemic nephropathy.

    Science.gov (United States)

    Basic-Jukic, N; Hrsak-Puljic, I; Kes, P; Bubic-Filipi, L; Pasini, J; Hudolin, T; Kastelan, Z; Reiner, Z; Kordic, M; Brunetta, B; Juric, I

    2007-06-01

    Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial disease prevalent in Croatia, Romania, Bulgaria, Bosnia and Herzegovina, and Serbia. In addition to renal disease, an increased incidence of upper urothelial carcinomas (UUCs) has been observed in the foci of BEN. Carcinoma may occur alone or in combination with BEN. Immunosuppression is associated with an increased risk for development of different malignancies. There are no data in the literature about the outcome of patients with BEN after transplantation. We performed a retrospective evaluation of the database and review of the charts and pathology reports of 601 renal transplant recipients treated at our institution. From January 1995 to December 2004, kidney transplantations were performed in nine patients with BEN. One-year graft survival was 100%. A man, who was transplanted in 1997 died 2 years after transplantation with a functioning graft due to disseminated cancer from the pelvis of his own kidney. A female patient developed UCC 2 years after transplantation. They were both treated with a bolus of methylprednisolone before transplantation, because of four HLA-mismatches. A male patient developed UCC in the native and transplanted kidneys. He underwent a native nephroureterectomy with partial nephroureterectomy of transplanted kidney. His graft function was preserved with decreased immunosuppression. Three years later a urinary bladder carcinoma was discovered on a regularly performed multislice computed tomography. One patient developed a skin malignancy. Other patients have had uneventful posttransplantation courses with excellent graft function. Thus, 33.3% of patients with BEN developed UUC, compared with a 0.67% prevalence of urinary tract tumors among transplanted patients with other causes of end-stage renal disease. Patients with BEN are at increased risk for the development of UCC after transplantation. Regular screening for early detection of malignancy is mandatory. Longer follow

  5. Vitamin D status in kidney transplant patients

    DEFF Research Database (Denmark)

    Ewers, Bettina; Gasbjerg, Ane; Moelgaard, Christian

    2008-01-01

    BACKGROUND: A high prevalence of vitamin D insufficiency has been found in the general population and in patients with chronic kidney disease. OBJECTIVE: The aim was to examine vitamin D status and determinants and metabolic correlates of serum 25-hydroxyvitamin D in a population of adult Danish...... kidney transplant patients. DESIGN: This was a cross-sectional study of 173 adult kidney transplant patients with a mean (+/-SD) age of 53.4 +/- 11.7 y and a median graft age of 7.4 y (interquartile range: 3.3-12.7 y). Serum concentrations of intact parathyroid hormone (S-PTH), 25-hydroxyvitamin D [S-25......(OH)D], and 1,25-dihydroxyvitamin D [S-1,25(OH)(2)D] were measured. Dietary and supplementary intake of vitamin D, avoidance of solar ultraviolet B exposure, and selected lifestyle factors were assessed in a subgroup (n = 97). RESULTS: Fifty-one percent of the patients had vitamin D insufficiency [S...

  6. Challenges for paediatric transplantation in Africa.

    Science.gov (United States)

    Spearman, C W N; McCulloch, M I

    2014-11-01

    Transplantation is the accepted mode of treatment for patients with end-stage organ disease affecting the heart, lungs, kidney, pancreas, liver and intestine. Long-term outcomes have significantly improved and the aim of management is no longer only long-term survival, but also focuses on quality of life especially in children. Transplantation in Africa faces a number of challenges including wide socioeconomic disparity, lack of legislation around brain death and organ donation in many countries, shortage of skilled medical personnel and facilities, infectious disease burden and insecure access to and monitoring of immunosuppression. Whilst there is a need for transplantation, the establishment and sustainability of transplant programmes require careful planning with national government and institutional support. Legislation regarding brain death diagnosis and organ retrieval/donation; appropriate training of the transplant team; and transparent and equitable criteria for organ allocation are important to establish before embarking on a transplant programme. Establishing sustainable, self-sufficient transplant programmes in Africa with equal access to all citizens is an important step towards curtailing transplant tourism and organ trafficking and has a further beneficial effect in raising the level of medical and surgical care in these countries. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Vitamin D status in kidney transplant patients

    DEFF Research Database (Denmark)

    2008-01-01

    BACKGROUND: A high prevalence of vitamin D insufficiency has been found in the general population and in patients with chronic kidney disease. OBJECTIVE: The aim was to examine vitamin D status and determinants and metabolic correlates of serum 25-hydroxyvitamin D in a population of adult Danish...... kidney transplant patients. DESIGN: This was a cross-sectional study of 173 adult kidney transplant patients with a mean (+/-SD) age of 53.4 +/- 11.7 y and a median graft age of 7.4 y (interquartile range: 3.3-12.7 y). Serum concentrations of intact parathyroid hormone (S-PTH), 25-hydroxyvitamin D [S-25....... Low S-25(OH)D concentrations were associated with 1) increased S-PTH concentrations (P = 0.0002), independently of S-1,25(OH)(2)D concentrations, and 2) decreased S-1,25(OH)(2)D concentrations (P = 0.002), independently of graft function. CONCLUSIONS: Hypovitaminosis D is common among Danish kidney...

  8. Oral lesions in Saudi renal transplant patients

    Directory of Open Access Journals (Sweden)

    Al-Mohaya Maha

    2009-01-01

    Full Text Available Renal transplantation has evolved as the best treatment option for patients with end-stage renal disease. Different oral problems arise in these patients, either as a direct consequence of drug-induced immunosuppression or pharmacokinetics. To determine the prevalence of intra-oral lesions in a group of medically stable Saudi renal transplant patients (RTP and to identify possible risk factors, in comparison with age and sex-matched healthy control subjects (HCS, we studied 58 RTP and 52 HCS. All subjects had a thorough oral examination and oral lesions were diagnosed according to the clinically accepted criteria. Gingival overgrowth (GO, erythematous candidiasis (EC and hairy leukoplakia (HL were diagnosed in RTP with prevalence of 74.1%, 15.5%, and 8.6%, respectively. The severity of the gingival overgrowth significantly correlated with the use of cyclosporine and nifedipine combination therapy, serum cyclosporine, and serum creatinine level. In conclusions, the finding of our study strongly propose that RTP should undergo routine and regular comprehensive oral examination, and any suspicious lesion must be investigate and treated.

  9. Liver transplantation for patients with alcoholic hepatitis.

    Science.gov (United States)

    Artru, Florent; Louvet, Alexandre; Mathurin, Philippe

    2017-03-01

    Alcoholic liver disease, considered as a self-inflected disease, is an example of how moral judgment may affect ethical exercise of medicine which requires equity and fair utilization of a scarce resource in a context of organ shortage. Some consider that selection process should prioritize access to liver transplantation (LT) for patients who develop liver failure "through no fault of their own" even if limiting care because of a patient's perceived responsibility has been considered unethical. The absence of improvement after alcohol withdrawal, the high short-term mortality risk and the poor predictability of the 6-month rule in post-LT relapse in alcohol consumption in AH patients not responding to medical therapy led to recommend an evaluation of LT. In the French-Belgian pilot study, 26 patients with severe AH not responding to medical therapy underwent early LT (eLT). Stringent selection criteria were applied. Six-month and 2-year survivals of eLT patients were better than that of non-transplanted matched controls: 77% vs 23% and 71% vs 23% respectively. Alcohol relapse occurred in 12% of patients after eLT. Three studies confirmed these results. The impact organ donation should be limited as showed by a recent survey and the efforts that should be made in public information campaigns based on scientific data and medical ethics. In conclusion, the ongoing accumulation of scientific evidence and requirement of ethical exercise of medicine lead to continue evaluating eLT as a therapeutic option in patients with severe AH not responding to medical therapy. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Lung Transplantation for FLNA-Associated Progressive Lung Disease.

    Science.gov (United States)

    Burrage, Lindsay C; Guillerman, R Paul; Das, Shailendra; Singh, Shipra; Schady, Deborah A; Morris, Shaine A; Walkiewicz, Magdalena; Schecter, Marc G; Heinle, Jeffrey S; Lotze, Timothy E; Lalani, Seema R; Mallory, George B

    2017-07-01

    To describe a series of patients with pathogenic variants in FLNA and progressive lung disease necessitating lung transplantation. We conducted a retrospective chart review of 6 female infants with heterozygous presumed loss-of-function pathogenic variants in FLNA whose initial presentation was early and progressive respiratory failure. Each patient received lung transplantation at an average age of 11 months (range, 5-15 months). All patients had pulmonary arterial hypertension and chronic respiratory failure requiring tracheostomy and escalating levels of ventilator support before transplantation. All 6 patients survived initial lung transplantation; however, 1 patient died after a subsequent heart-lung transplant. The remaining 5 patients are living unrestricted lives on chronic immunosuppression at most recent follow-up (range, 19 months to 11.3 years post-transplantation). However, in all patients, severe ascending aortic dilation has been observed with aortic regurgitation. Respiratory failure secondary to progressive obstructive lung disease during infancy may be the presenting phenotype of FLNA-associated periventricular nodular heterotopia. We describe a cohort of patients with progressive respiratory failure related to a pathogenic variant in FLNA and present lung transplantation as a viable therapeutic option for this group of patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Torque teno virus among dialysis and renal-transplant patients.

    Science.gov (United States)

    Takemoto, Angélica Yukari; Okubo, Patrícia; Saito, Patricia Keiko; Yamakawa, Roger Haruki; Watanabe, Maria Angélica Ehara; Veríssimo da Silva Junior, Waldir; Borelli, Sueli Donizete; Bedendo, João

    2015-03-01

    Patients who undergo dialysis treatment or a renal transplant have a high risk of blood-borne viral infections, including the Torque teno virus (TTV). This study identified the presence of TTV and its genome groups in blood samples from 118 patients in dialysis and 50 renal-transplant recipients. The research was conducted in a hospital in the city of Maringá, state of Paraná. The viral DNA, obtained from whole blood, was identified by using two nested Polymerase Chain Reactions (PCR). The frequencies of TTV were 17% and 36% in dialysis patients using the methodology proposed by Nishizawa et al . (1997) and Devalle and Niel (2004) , respectively, and 10% and 54% among renal-transplant patients. There was no statistically significant association between the frequency of the pathogen and the variables: gender, time in dialysis, time since transplant, blood transfusions, and the concomitant presence of hepatitis B, for either the dialysis patients or the renal-transplant recipients. Among dialysis patients and renal-transplant recipients, genogroup 5 was predominant (48% and 66% respectively), followed by genogroup 4 (37% and 48%) and genogroup 1 (23% and 25%). Genogroup 2 was present in both groups of patients. Some patients had several genogroups, but 46% of the dialysis patients and 51% of the renal-transplant recipients had only a single genogroup. This study showed a high prevalence of TTV in dialysis patients and renal-transplant recipients.

  12. Impact of Pre-Transplant Bacterial Infections on Post-Operative Outcomes in Patients after Liver Transplantation.

    Science.gov (United States)

    Kim, Im-Kyung; Park, Joon Seong; Ju, Man Ki

    In contrast to studies evaluating the negative effect of bacterial infections on clinical outcomes after liver transplantation, there is little evidence with regard to pre-transplant bacterial infections. We aimed to investigate the impact of pre-transplant bacterial infections on post-transplant outcomes in patients after liver transplantation. We retrospectively analyzed clinical data from 33 consecutive patients who underwent primary liver transplantations. Patients were divided into two groups based on the occurrence of a bacterial infection within the 30 days before transplantation. Of the 33 patients, 23 patients did not have pre-transplant bacterial infections, while 10 patients did have pre-transplant bacterial infections. Pre-transplant bacterial infections were urinary tract infections (n = 4), spontaneous bacterial peritonitis (n = 3), and one each of pneumonia, bacteremia, and cellulitis. There were no differences in clinical characteristics between the two groups. Post-operative clinical outcomes, including post-operative bacterial infection, intensive-care unit re-admission, 30-day re-hospitalization, and 90-day mortality rate were not significantly different between the two groups. The two-year overall survival rate was 76.7% in patients with pre-transplant infections and 80.0% in those without pre-transplant infections. Patients with pre-transplant bacterial infections did not have inferior clinical outcomes, compared with those without pre-transplant bacterial infections.

  13. Vitamin D status in kidney transplant patients

    DEFF Research Database (Denmark)

    Ewers, Bettina; Gasbjerg, Ane; Moelgaard, Christian

    2008-01-01

    -25(OH)D 40-75 nmol/L], and an additional 29% had moderate-to-severe vitamin D deficiency [S-25(OH)D vitamin D supplementation (positive association) were independent determinants of S-25(OH)D concentrations...... transplant patients and is associated with reduced concentrations of S-1,25(OH)(2)D and increased S-PTH concentrations. Sun avoidance and vitamin D supplementation are important determinants of vitamin D status. The observed hypovitaminosis D might be corrected by intensified routine vitamin D......BACKGROUND: A high prevalence of vitamin D insufficiency has been found in the general population and in patients with chronic kidney disease. OBJECTIVE: The aim was to examine vitamin D status and determinants and metabolic correlates of serum 25-hydroxyvitamin D in a population of adult Danish...

  14. Dialysis and renal transplantation in HIV-infected patients

    DEFF Research Database (Denmark)

    Trullas, Joan Carles; Mocroft, Amanda; Cofan, Federico

    2010-01-01

    To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients.......To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients....

  15. Acute renal failure in liver transplant patients: Indian study.

    Science.gov (United States)

    Naik, Pradeep; Premsagar, B; Mallikarjuna, M

    2015-01-01

    The acute renal failure is the frequent medical complication observed in liver transplant patients. The objective of this study was to determine the cause of acute renal failure in post liver transplant patients. A total of 70 patients who underwent (cadaveric 52, live 18) liver transplantation were categorized based on clinical presentation into two groups, namely hepatorenal failure (HRF, n = 29), and Hepatic failure (HF, n = 41). All the patients after the liver transplant had received tacrolimus, mycophenolate and steroids. We analyzed the modification of diet in renal disease, (MDRD) serum urea, creatinine and albumin before and after 5th and 30th day of liver transplant and data was categorized into survivors and non-survivors group. In HRF survivor group, serum creatinine, and urea levels were high and, albumin, MDRD were low in pre- transplant and reached to normal levels on 30th day of post transplant, and 79.3 % of patients in this group showed resumption of normal kidney function. On the contrary in HRF nonsurvivor group, we did not observed any significant difference and 20.7 % of patients showed irreversible changes after the liver transplant. In HF survivor group, 82.9 % of liver failure patients did not show any deviation in serum creatinine, urea, albumin and MDRD, whereas in HF non survivor group, 17.1 % of liver failure patients who had HCV positive before the transplant developed acute renal failure. The levels of creatinine, urea, albumin and MDRD were normal before the transplant and on day 30th, the levels of albumin and MDRD were significantly low whereas serum urea, creatinine levels were high. In conclusion, based on these observations, an diagnosis and treatment of Acute renal failure is important among the liver transplantation cases in the early postoperative period.

  16. Sinusitis in patients undergoing allogeneic bone marrow transplantation - a review.

    Science.gov (United States)

    Drozd-Sokolowska, Joanna Ewa; Sokolowski, Jacek; Wiktor-Jedrzejczak, Wieslaw; Niemczyk, Kazimierz

    Sinusitis is a common morbidity in general population, however little is known about its occurrence in severely immunocompromised patients undergoing allogeneic hematopoietic stem cell transplantation. The aim of the study was to analyze the literature concerning sinusitis in patients undergoing allogeneic bone marrow transplantation. An electronic database search was performed with the objective of identifying all original trials examining sinusitis in allogeneic hematopoietic stem cell transplant recipients. The search was limited to English-language publications. Twenty five studies, published between 1985 and 2015 were identified, none of them being a randomized clinical trial. They reported on 31-955 patients, discussing different issues i.e. value of pretransplant sinonasal evaluation and its impact on post-transplant morbidity and mortality, treatment, risk factors analysis. Results from analyzed studies yielded inconsistent results. Nevertheless, some recommendations for good practice could be made. First, it seems advisable to screen all patients undergoing allogeneic hematopoietic stem cell transplantation with Computed Tomography (CT) prior to procedure. Second, patients with symptoms of sinusitis should be treated before hematopoietic stem cell transplantation (HSCT), preferably with conservative medical approach. Third, patients who have undergone hematopoietic stem cell transplantation should be monitored closely for sinusitis, especially in the early period after transplantation. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  17. Leucocyte filtration of residual heart-lung machine blood in children undergoing congenital heart surgery

    NARCIS (Netherlands)

    de Vries, AJ; Gu, YJ; van Oeveren, W

    2004-01-01

    Cardiopulmonary bypass (CPB) leads to a generalized inflammatory reaction, resulting in increased postoperative leucocyte counts and decreased pulmonary function. In adults, removal of leucocytes from the residual heart - lung machine blood after CPB improved postoperative oxygenation. In children,

  18. [Nosocomial infection in patients receiving a solid organ transplant or haematopoietic stem cell transplant].

    Science.gov (United States)

    Moreno Camacho, Asunción; Ruiz Camps, Isabel

    2014-01-01

    Bacterial infections are the most common infections in solid organ transplant recipients. These infections occur mainly in the first month after transplantation and are hospital-acquired. Nosocomial infections cause significant morbidity and are the most common cause of mortality in this early period of transplantation. These infections are caused by multi-drug resistant (MDR) microorganisms, mainly Gram-negative enterobacteria, non-fermentative Gram-negative bacilli, enterococci, and staphylococci. The patients at risk of developing nosocomial bacterial infections are those previously colonized with MDR bacteria while on the transplant waiting list. Intravascular catheters, the urinary tract, the lungs, and surgical wounds are the most frequent sources of infection. Preventive measures are the same as those applied in non-immunocompromised, hospitalized patients except in patients at high risk for developing fungal infection. These patients need antifungal therapy during their hospitalization, and for preventing some bacterial infections in the early transplant period, patients need vaccinations on the waiting list according to the current recommendations. Although morbidity and mortality related to infectious diseases have decreased during the last few years in haematopoietic stem cell transplant recipients, they are still one of the most important complications in this population. Furthermore, as occurs in the general population, the incidence of nosocomial infections has increased during the different phases of transplantation. It is difficult to establish general preventive measures in these patients, as there are many risk factors conditioning these infections. Firstly, they undergo multiple antibiotic treatments and interventions; secondly, there is a wide variability in the degree of neutropenia and immunosuppression among patients, and finally they combine hospital and home stay during the transplant process. However, some simple measures could be

  19. Vaccination in Renal Transplant Patients (VcRtp study)

    LENUS (Irish Health Repository)

    Rathore, F

    2016-02-01

    Adverse outcomes of influenza & pneumococcal infections in solid organ transplant recipients have been well documented. Vaccinations are therefore recommended by multiple guidelines. Despite emerging evidence of the safety & effectiveness among immunosuppressed patients, most vaccines are still underutilized, we conducted a survey among the renal transplant patients in Beaumont Hospital to determine the awareness and uptake of vaccinations. Questionnaires were handed to patients during a clinic visit over a span of 2 weeks and 250 questionnaires were posted out to randomly selected transplant patients, The Questionnaire addressed various aspects including the awareness of importance of vaccinations, source of information, if they were up to date with the vaccines & where did they receive it?

  20. Interventional radiology in the management of the liver transplant patient.

    Science.gov (United States)

    Thornburg, Bartley; Katariya, Nitin; Riaz, Ahsun; Desai, Kush; Hickey, Ryan; Lewandowski, Robert; Salem, Riad

    2017-10-01

    Liver transplantation (LT) is commonly used to treat patients with end-stage liver disease. The evolution of surgical techniques, endovascular methods, and medical care has led to a progressive decrease in posttransplant morbidity and mortality. Despite these improvements, a multidisciplinary approach to each patient remains essential as the early diagnosis and treatment of the complications of transplantation influence graft and patient survival. The critical role of interventional radiology in the collaborative approach to the care of the LT patient will be reviewed. Liver Transplantation 23 1328-1341 2017 AASLD. © 2017 by the American Association for the Study of Liver Diseases.

  1. Diabetes mellitus after kidney transplantation in Japanese patients: The Japan Academic Consortium of Kidney Transplantation study.

    Science.gov (United States)

    Okumi, Masayoshi; Unagami, Kohei; Hirai, Toshihito; Shimizu, Tomokazu; Ishida, Hideki; Tanabe, Kazunari

    2017-03-01

    To clarify the incidence rate of post-transplant diabetes mellitus and associated risk factors in Japanese kidney transplant recipients, and to explore which treatment components are most effective in reducing post-transplant diabetes mellitus. We analyzed 849 Japanese non-diabetic adult recipients who had undergone living kidney transplantation and had received tacrolimus-based immunosuppression from 1996 to 2013 with a median follow-up of 5 years. In all, 127 patients developed post-transplant diabetes mellitus during the follow-up period. The incidence rate of post-transplant diabetes mellitus was 15.1% (95% confidence interval 12.7-17.5) at 5 years. Recipient age (hazard ratio 1.05, 95% confidence interval 1.05-1.06, P diabetes mellitus. Estimated 5-year predicted incidence rate after adjusting for age and obesity was 9.4% for recipients with a low tacrolimus trough level, and receiving mycophenolate mofetil and 38.4% for recipients with a high tacrolimus trough level and not receiving mycophenolate mofetil. Post-transplant diabetes mellitus is a common complication in Japan, similar to that in other Western countries. The present results show that an appropriate immunosuppressive regimen with a combination of tacrolimus and mycophenolate mofetil can reduce the likelihood of developing post-transplant diabetes mellitus. Clinical trials are required to confirm these findings. © 2016 The Japanese Urological Association.

  2. Successful renal transplant in patient with controlled pulmonary non ...

    African Journals Online (AJOL)

    infections in solid organ transplant recipients: a case-control study. Transpl Infect Dis. 2014; 16: 76Б83. 2. Haas S, Scully B, Cohen D, Radhakrishnan J. Mycobacterium avium complex infection in kidney transplant patients. Transpl. Infect Dis. 2005; 7: 75Б9. 3. Piersimoni C. Nontuberculous mycobacteria infection in solid.

  3. TREATMENT OF INVASIVE BLADDER CANCER IN PATIENT AFTER RENAL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    D. V. Perlin

    2010-01-01

    Full Text Available There are case report and literature review of the treatment recurrent bladder cancer after kidney transplantation. Radical cystectomy and Bricker ileal conduit was performed. Detailed operative technique is described. Radical cystectomy is an effective curative treatment for recurrent disease. Bricker ileal conduit is safe and feasible in renal transplant patients

  4. The perception of sleep quality in kidney transplant patients during the first year of transplantation

    Directory of Open Access Journals (Sweden)

    Dnyelle Souza Silva

    2012-12-01

    Full Text Available OBJECTIVE: Poor sleep quality is one of the factors that adversely affects patient quality of life after kidney transplantation, and sleep disorders represent a significant cardiovascular risk factor. The objective of this study was to investigate the prevalence of changes in sleep quality and their outcomes in kidney transplant recipients and analyze the variables affecting sleep quality in the first years after renal transplantation. METHODS: Kidney transplant recipients were evaluated at two time points after a successful transplantation: between three and six months (Phase 1 and between 12 and 15 months (Phase 2. The following tools were used for assessment: the Pittsburgh Sleep Quality Index; the quality of life questionnaire Short-Form-36; the Hospital Anxiety and Depression scale; the Karnofsky scale; and assessments of social and demographic data. The prevalence of poor sleep was 36.7% in Phase 1 and 38.3% in Phase 2 of the study. RESULTS: There were no significant differences between patients with and without changes in sleep quality between the two phases. We found no changes in sleep patterns throughout the study. Both the physical and mental health scores worsened from Phase 1 to Phase 2. CONCLUSION: Sleep quality in kidney transplant recipients did not change during the first year after a successful renal transplantation.

  5. Transplantation activities in Iran.

    Science.gov (United States)

    Broumand, Behrooz

    2005-06-01

    Iranian Network for Transplantation Organ Procurement. This act helped to expand heart, lung, and liver transplantation programs. By 2003, Iran had performed 131 liver, 77 heart, 7 lung, 211 bone marrow, 20,581 cornea, and 16,859 liver tranplantations. Sources of these donations were living-unrelated donor, 82%; cadaver, 10%; and living-related donor, 8%. The 3-year renal transplant patient survival rate was 92.9%, and the 40-month graft survival rate was 85.9%. Another large step in expanding the transplantation program is the construction of the Avi- Cenna (Abou Ali Sina) Transplant Hospital in Shiraz. This hospital hopefully will begin operation in 2 years. It will offer the opportunity for the exchange and sharing of organs and increased cooperation between transplant teams in the Middle East. The hospital offers great promise for transplant medicine in Iran and other Persian Gulf countries.

  6. Quantification of Pathologic Air Trapping in Lung Transplant Patients Using CT Density Mapping: Comparison with Other CT Air Trapping Measures.

    Directory of Open Access Journals (Sweden)

    Olga Solyanik

    Full Text Available To determine whether density mapping (DM is more accurate for detection and quantification of pathologic air trapping (pAT in patients after lung transplantation compared to other CT air trapping measures. One-hundred forty-seven lung and heart-lung transplant recipients underwent CT-examinations at functional residual capacity (FRC and total lung capacity (TLC and PFT six months after lung transplantation. Quantification of air trapping was performed with the threshold-based method in expiration (EXP, density mapping (DM and the expiratory to inspiratory ratio of the mean lung density (E/I-ratio MLD. A non-rigid registration of inspiration-expiration CT-data with a following voxel-to-voxel mapping was carried out for DM. Systematic variation of attenuation ranges was performed for EXP and DM and correlated with the ratio of residual volume to total lung capacity (RV/TLC by Spearman rank correlation test. AT was considered pathologic if RV/TLC was above the 95th percentile of the predicted upper limit of normal values. Receiver operating characteristic (ROC analysis was performed. The optimal attenuation range for the EXP method was from -790 HU to -950 HU (EXP(-790 to -950HU (r = 0.524, p<0.001 to detect air trapping. Within the segmented lung parenchyma, AT was best defined as voxel difference less than 80 HU between expiration and registered inspiration using the DM method. DM correlated best with RV/TLC (r = 0.663, p<0.001. DM and E/I-ratio MLD showed a larger AUC (0.78; 95% CI 0.69-0.86; 0.76, 95% CI 0.67-0.85 than EXP(-790 HU to -950 HU (0.71, 95% CI 0.63-0.78. DM and E/I-ratio MLD showed better correlation with RV/TLC and are more suited quantitative CT-methods to detect pAT in lung transplant patients than the EXP(-790HU to -950HU.

  7. Warts in a cohort of Danish kidney transplanted patients

    DEFF Research Database (Denmark)

    Zachariae, Claus; Sand, Carsten; Hansen, Jesper Melchior

    2012-01-01

    with the Dermatology Life Quality Index (DLQI). Of 740 patients with a functioning renal allograft and were free of dialysis who were surveyed, 568 returned the questionnaires. Patients were asked about general health issues, with a focus on transplantation history, cutaneous warts and whether they had ever had......There are no published clinical studies evaluating the impact of warts on quality of life after transplantation. The aim of this study was to determine the frequency of self-reported skin warts and skin cancer and their impact on quality of life in kidney transplanted patients, as measured...

  8. Cyclosporin versus tacrolimus for liver transplanted patients

    DEFF Research Database (Denmark)

    Haddad, E M; McAlister, V C; Renouf, E

    2006-01-01

    Most liver transplant recipients receive either cyclosporin or tacrolimus to prevent rejection. Both drugs inhibit calcineurin phosphatase which is thought to be the mechanism of their anti-rejection effect and principle toxicities. The drugs have different pharmacokinetic profiles and potencies....... Several randomised clinical trials have compared cyclosporin and tacrolimus in liver transplant recipients, but it remains unclear which is superior....

  9. Bile acids for liver-transplanted patients

    DEFF Research Database (Denmark)

    Poropat, Goran; Giljaca, Vanja; Stimac, Davor

    2010-01-01

    Liver transplantation has become a widely accepted form of treatment for numerous end-stage liver diseases. Bile acids may decrease allograft rejection after liver transplantation by changing the expression of major histocompatibility complex class molecules in bile duct epithelium and central vein...

  10. Technology Experience of Solid Organ Transplant Patients and Their Overall Willingness to Use Interactive Health Technology.

    Science.gov (United States)

    Vanhoof, Jasper M M; Vandenberghe, Bert; Geerts, David; Philippaerts, Pieter; De Mazière, Patrick; DeVito Dabbs, Annette; De Geest, Sabina; Dobbels, Fabienne

    2017-11-28

    The use of interactive health technology (IHT) is a promising pathway to tackle self-management problems experienced by many chronically ill patients, including solid organ transplant (Tx) patients. Yet, to ensure that the IHT is accepted and used, a human-centered design process is needed, actively involving end users in all steps of the development process. A first critical, predevelopment step involves understanding end users' characteristics. This study therefore aims to (a) select an IHT platform to deliver a self-management support intervention most closely related to Tx patients' current use of information and communication technologies (ICTs), (b) understand Tx patients' overall willingness to use IHT for self-management support, and investigate associations with relevant technology acceptance variables, and (c) explore Tx patients' views on potential IHT features. We performed a cross-sectional, descriptive study between October and December 2013, enrolling a convenience sample of adult heart, lung, liver, and kidney Tx patients from the University Hospitals Leuven, Belgium. Broad inclusion criteria were applied to ensure a representative patient sample. We used a 35-item newly designed interview questionnaire to measure Tx patients' use of ICTs, their overall willingness to use IHT, and their views on potential IHT features, as well as relevant technology acceptance variables derived from the Unified Theory of Acceptance and Use of Technology and a literature review. Descriptive statistics were used as appropriate, and an ordinal logistic regression model was built to determine the association between Tx patients' overall willingness to use IHT, the selected technology acceptance variables, and patient characteristics. Out of 139 patients, 122 agreed to participate (32 heart, 30 lung, 30 liver, and 30 kidney Tx patients; participation rate: 88%). Most patients were male (57.4%), married or living together (68%), and had a mean age of 55.9 ± 13.4 years

  11. Biliary strictures complicating liver transplantation in pediatric patients: Experience in a South American transplant center

    OpenAIRE

    Echeverry Junga, Gabriel Jaime; Holguin Holguin, Alfonso José; Rodriguez-Takeuchi, Sara Yukie; Ospina, Laura; Acosta, Diana; Botero Osorio, Verónica; Thomas Pérez, Laura Sofia; Villegas Otálora, Jorge Iván; Caicedo Rusca, Luis Armando

    2017-01-01

    To describe the experience of percutaneous transhepatic cholangiography (PTC) with biliary dilatation and drainage after pediatric liver transplantation and to determine the long-term outcome of this procedure. Methods: Retrospective study from 2001 to 2013. Follow-up after treatment was also undertaken. A survival analysis was performed in patients in whom the procedure and eventual removal of the catheter were successful. Results: In all, 196 children received liver transplants; 40 of them ...

  12. Heart and lung transplantation in the United States, 1997-2006.

    Science.gov (United States)

    Mulligan, M S; Shearon, T H; Weill, D; Pagani, F D; Moore, J; Murray, S

    2008-04-01

    This article highlights trends in heart and lung transplantation between 1997 and 2006, drawing on data from the OPTN and SRTR. The total number of candidates actively awaiting heart transplantation declined by 45% over the last decade, dropping from 2414 patients in 1997 to 1327 patients in 2006. The overall death rates among patients awaiting heart transplantation declined over the same period. The distribution of recipients among the different status groups at the time of heart transplantation changed little between the inception of the new classification system in 1999 and 2005. Deaths in the first year after heart transplantation have steadily decreased. At the end of 2006, 2885 candidates were awaiting a lung transplant, up 10% from the 1997 count. The median time-to-transplant for listed patients decreased by 87% over the decade, dropping from 1053 days in 1997 to 132 days in 2006. Selection for listing and transplantation has shifted toward more urgent patients since the May 2005 implementation of a new lung allocation system based on survival benefit and urgency rather than waiting time. Only 31 heart-lung transplants were performed in 2006, down from a high of 62 in 1997.

  13. Grief and loss for patients before and after heart transplant.

    Science.gov (United States)

    Poole, Jennifer; Ward, Jennifer; DeLuca, Enza; Shildrick, Margrit; Abbey, Susan; Mauthner, Oliver; Ross, Heather

    2016-01-01

    The purpose of the study was to examine the loss and grief experiences of patients waiting for and living with new hearts. There is much scholarship on loss and grief. Less attention has been paid to these issues in clinical transplantation, and even less on the patient experience. Part of a qualitative inquiry oriented to the work of Merleau-Ponty, a secondary analysis was carried out on audiovisual data from interviews with thirty participants. Patients experience loss and three forms of grief. Pre-transplant patients waiting for transplant experience loss and anticipatory grief related to their own death and the future death of their donor. Transplanted patients experience long-lasting complicated grief with respect to the donor and disenfranchised grief which may not be sanctioned. Loss as well as anticipatory, complicated and disenfranchised grief may have been inadvertently disregarded or downplayed. More research and attention is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Challenging hepatitis C-infected liver transplant patients

    Directory of Open Access Journals (Sweden)

    Oliver M

    2016-01-01

    Full Text Available Madeleine Oliver,1 Christopher Chiodo Ortiz,2 Jorge Ortiz31University of Toledo College of Medicine, Toledo, OH, 2Bucknell University, Lewisburg, PA, 3Department of Transplant Surgery, University of Toledo Medical Center, Toledo, OH, USA Abstract: Caring for liver transplant patients suffering from chronic hepatitis C virus (HCV infection is a challenging task for transplant surgeons and primary physicians alike. HCV is the leading cause of liver transplantation in the USA and comes with a myriad of complications that increase morbidity and mortality. This review focuses on patient follow-up, spanning from before the liver transplant occurs to the patient's long-term health. Pretransplant, both donor and recipient variables, must be carefully chosen to ensure optimal surgical success. Risk factors must be identified and HCV viral load must be reduced to a minimum. In addition to standard transplant complications, HCV patients suffer from additional problems, such as fibrosing cholestatic hepatitis and widespread viremia. Physicians must focus on the balance of immunosuppressive and antiviral medications, while considering possible side effects from these potent drugs. Over the years following surgery, physicians must identify any signs of failing liver health, as HCV-positive patients have an increased risk for cirrhosis and certain life-threatening malignancies. Keywords: liver transplant, hepatitis C virus, postoperative, cirrhosis, donor and recipient variables, viremia

  15. Kidney transplant

    Science.gov (United States)

    ... always take your medicine as directed. Alternative Names Renal transplant; Transplant - kidney Patient Instructions Kidney removal - discharge Images Kidney anatomy Kidney - blood and urine flow Kidneys Kidney transplant - ...

  16. Preoperative psychological evaluation of transplant patients: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Kumnig M

    2015-06-01

    Full Text Available Martin Kumnig,1 Sheila Jowsey-Gregoire2 1Center for Advanced Psychology in Plastic and Transplant Surgery (CAPPTS, Department of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria; 2Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA Abstract: Psychological assessments are crucial for the evaluation and optimization of the suitability of transplant patients. The interdisciplinary evaluation in modern transplantation medicine focuses on important psychosocial issues, such as assessing patients’ characteristics that predict best postoperative outcome after solid organ transplantation. When assessing patients for reconstructive hand transplantation, the psychological evaluation should identify whether reconstructive hand transplantation is the best treatment option to regain functionality and sensation, to resolve body image concerns, and to improve health-related quality of life (HRQOL for each patient. These psychosocial issues in transplantation medicine are receiving increased attention; however, standardized psychological evaluation and follow-up protocols are still being developed. Previously published reports in transplantation medicine have attempted to identify psychosocial factors important in the evaluation of transplant patients and that predict psychosocial outcomes. This review will provide an overview of recent investigations in solid organ and vascularized composite allotransplantation (VCA, including the domains of evaluation, pre- and posttransplant follow-up, psychiatric complications, evaluation of body image, and HRQOL. Recent work highlights the potential for a multicenter research approach utilizing standardized assessment strategies and emphasizing the need for a shared assessment approach to understand psychosocial outcomes. For example, the Chauvet Workgroup convened in 2014 in Paris with stakeholders in the assessment of psychosocial factors to discuss key areas and propose an

  17. Cicletanine-induced hyponatremia and hypokalemia in kidney transplant patients

    Directory of Open Access Journals (Sweden)

    Eun Young Choi

    2016-09-01

    Conclusion: We demonstrate that cicletanine may induce hyponatremia or hypokalemia in kidney transplant patients. Hyponatremia is more frequently associated with cicletanine than hypokalemia, and extended use of cicletanine may increase the risk of hyponatremia.

  18. Energy expenditure is increased in kidney transplant patients.

    Directory of Open Access Journals (Sweden)

    Christophe Montaurier

    2012-06-01

    In conclusion, in kidney transplant patient weight gain occurs despite hyper-metabolism during sleep and over 24 h. Mechanisms of weight gain therefore possibly involve changes in food intake and/or spontaneous physical activity.

  19. Peritonitis in peritoneal dialysis patients after renal transplantation

    NARCIS (Netherlands)

    Bakir, N; Surachno, S; Sluiter, WJ; Struijk, DG

    1998-01-01

    Background. The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed.

  20. Peritonitis in peritoneal dialysis patients after renal transplantation

    NARCIS (Netherlands)

    Bakir, N.; Surachno, S.; Sluiter, W. J.; Struijk, D. G.

    1998-01-01

    The occurrence of peritonitis in peritoneal dialysis patients after renal transplantation during immunosuppression might increase morbidity and mortality. Hence the timing of catheter removal is still controversial. The associated risk factors of this complication have not been analyzed. We

  1. RENAL ALLOGENEIC TRANSPLANTATION IN PATIENT WITH HAEMOPHILIA B

    Directory of Open Access Journals (Sweden)

    N. V. Purlo

    2014-01-01

    Full Text Available We report the case of successful renal allogeneic transplantation and treatment in a 56-year-old patient with haemophilia B at Hematology Research Center. He has received replacement therapy by factor IX since 2010. The transplant is marked with good renal function during 13 post-transplant months without episodes of rejection or bleeding complications. The complicated surgical interventions are possible in patients with haemophilia В аnd end-stage chronic renal failure in the presence of replacement therapy of IX factor for the purpose of achievement of optimum hemostasis.

  2. Patients' experiences of everyday life after lung transplantation.

    Science.gov (United States)

    Thomsen, Doris; Jensen, Birte Østergaard

    2009-12-01

    To investigate the experiences of everyday life after lung transplantation of patients with previous chronic obstructive pulmonary disease (COPD). Compared with patients being transplanted due to other indications, those with COPD prior to lung transplantation report more problems in the form of shortness of breath, fatigue, sexual problems, insomnia and increased appetite. In addition, they are often faced with problems returning to normal working life. How these problems influence the patient's everyday life is unknown. An exploratory qualitative study. Ten COPD patients (five females and five males) aged 51-69 and more than six months post transplantation, were interviewed using of a semi-structured interview guide. All interviews were taperecorded, transcribed verbatim and analysed using qualitative content analysis. The analysis revealed four themes of experience: a second chance; an ordinary life without chronic rejection; even minor daily activities take time with chronic rejection; and need for support and knowledge that were considered important by the participants for their situation and daily life. This is the first study describing the experiences of everyday life after lung transplantation of patients with COPD prior to surgery. The findings highlight the importance of addressing these patients' experiences of gratitude, positive life orientation and informational needs in relation to everyday life. Health professionals should be aware of the kind of problems both women and men may experience a long time after the lung transplantation. They constitute a basic knowledge of a patient's everyday life that is important when planning individual counselling and rehabilitation.

  3. Erectile dysfunction in liver transplant patients.

    Science.gov (United States)

    Huyghe, E; Kamar, N; Wagner, F; Yeung, S J; Capietto, A H; El-Kahwaji, L; Muscari, F; Plante, P; Rostaing, L

    2008-12-01

    The objectives of the study were to determine the frequency of erectile dysfunction (ED) after liver transplantation (LT) and discuss potential risk factors. Of 123 eligible LT men, 98 (79.7%) responded to a questionnaire about sexual function at a mean time posttransplant of 5.4 +/- 4.0 years (1.0-21). Erection was evaluated using the five-question international index for erectile function score, and sexual satisfaction by the patient-baseline treatment-satisfaction status (TSS) score. Questions also focused on patient perception of changes overtime. We found that after LT, the proportion of sexually inactive men decreased from 29% to 15% (p = 0.01), but the proportion of men with ED remained unchanged. The absence of sexual activity was associated with pretransplant sexual inactivity (p = 0.001), age (p = 0.008), cardiovascular disease (p = 0.03), use of diuretics (p = 0.04), anticoagulants (p = 0.001), statins (p = 0.01) and treatment for diabetes (p = 0.03). Cardiovascular disease (p = 0.05), posttransplantation diabetes (p = 0.04), alcohol abuse (p = 0.03), antidepressants (p = 0.05) and angiotensin II receptor blockers (p = 0.05) were associated with having ED after LT. Having a low TSS score was associated with a history of endocrine disease (p = 0.03), antidepressants (p = 0.04) and diuretics (p = 0.03). In conclusion, LT improves sexual activity, but ED is multifactorial and remains a long-term condition in the majority of patients.

  4. Successful Fecal Microbiota Transplantation in a Patient with Severe Complicated Clostridium difficile Infection after Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Kai Markus Schneider

    2018-02-01

    Full Text Available Clostridium difficile infection (CDI represents one of the most common healthcare-associated infections. Due to increasing numbers of recurrences and therapy failures, CDI has become a major disease burden. Studies have shown that fecal microbiota transplantation (FMT can both be a safe and highly efficacious therapy for patients with therapy-refractory CDI. However, patients undergoing solid organ transplantation are at high risk for CDI due to long-term immunosuppression, previous antibiotic therapy, and proton pump inhibitor use. Additionally, these patients may be especially prone to adverse events related to FMT. Here, we report a successful FMT in a patient with severe therapy-refractory CDI after liver transplantation.

  5. The safety of transplanting cryopreserved ovarian tissue in cancer patients

    DEFF Research Database (Denmark)

    Rosendahl, Mikkel; Greve, Tine; Andersen, Claus Yding

    2013-01-01

    Transplantation of frozen/thawed ovarian tissue from patients with a malignant condition is associated with a risk of re-introduction of the disease as the tissue usually is removed before anti-cancer therapy and may thus contain malignant cells. We review studies investigating the presence of ma...... of malignant cells in cryopreserved ovarian tissue from patients with malignant disease and based on the strength of the evidence, recommendations for transplantations are proposed....

  6. Cytomegalovirus (CMV) Infection: A Guide for Patients and Families After Stem Cell Transplant

    Science.gov (United States)

    ... Infection: A Guide for Patients and Families after Stem Cell Transplant What is cytomegalovirus (CMV)? Cytomegalovirus (CMV), a ... weakened by medicines that you must take after stem cell transplant and by the transplant itself. Your body ...

  7. Psychological rejection of the transplanted organ and graft dysfunction in kidney transplant patients

    Directory of Open Access Journals (Sweden)

    Látos M

    2016-06-01

    Full Text Available Melinda Látos,1 György Lázár,1 Zoltán Horváth,1 Victoria Wittmann,1 Edit Szederkényi,1 Zoltán Hódi,1 Pál Szenohradszky,1 Márta Csabai2 1Department of Surgery, Faculty of Medicine, 2Psychology Institute, University of Szeged, Szeged, Hungary Abstract: Interdisciplinary studies suggest that the mental representations of the transplanted organ may have a significant effect on the healing process. The objective of this study was to examine the representations of the transplanted organ and their relationship with emotional and mood factors, illness perceptions, and the functioning of the transplanted organ. One hundred and sixty-four kidney transplant patients were assessed using the Spielberger Anxiety Inventory, the Beck’s Depression Scale, the Posttraumatic Growth Inventory, the Brief Illness Perception Questionnaire, and the Transplanted Organ Questionnaire. Medical parameters were collected from the routine clinical blood tests (serum creatinine and estimated glomerular filtration rate levels and biopsy results. Our most outstanding results suggest that kidney-transplanted patients’ illness representations are associated with health outcomes. The Transplanted Organ Questionnaire “psychological rejection” subscale was connected with higher serum creatinine and estimated glomerular filtration rate levels. Logistic regression analysis showed that psychological rejection subscale, Brief Illness Perception Questionnaire, and Posttraumatic Growth Questionnaire total scores were associated with graft rejection. These results may serve as a basis for the development of complex treatment interventions, which could help patients to cope with the bio-psycho-social challenges of integrating the new organ as part of their body and self. Keywords: anxiety, depression, illness representations, posttraumatic growth, psychological rejection, renal transplantation

  8. Serum leptin in renal transplant patients

    OpenAIRE

    Rafieian-Kopaei, Mahmoud; Nasri, Hamid

    2013-01-01

    Leptin is a small peptide hormone that is mainly produced in adipose tissues. Leptin plays animportant role in regulating appetite and energy expenditure and may be involved in modulatingbone mineralization. This study was designed to test the association of serum leptin kidneyfunction in renal transplant recipients. We studied 72 kidney transplanted recipients. In thisstudy a significant difference of serum leptin between males and females with higher values infemales was seen (p>0.05). Ther...

  9. De Novo Malignant Neoplasms in Renal Transplant Patients.

    Science.gov (United States)

    Yılmaz Akçay, Eda; Tepeoğlu, Merih; Özdemir, Binnaz Handan; Deniz, Ebru; Börcek, Pelin; Haberal, Mehmet

    2016-11-01

    The aim of this study was to evaluate the incidence of posttransplant malignancy in kidney transplant patients and investigate the clinical and histopathologic features of these patients. We retrospectively reviewed information on donor and recipient characteristics, patient and graft survival, and cancer incidence after transplant for 867 kidney transplant patients. Patients with neoplasms prior to transplant were excluded. A follow-up study estimated cancer incidence after transplant. Neoplasms were diagnosed in 59 patients (6.8%), 41 men and 18 women; 22 (37.3%) had skin tumors, 19 (32.2%) had solid tumors, 10 (16.9%) had posttransplant lymphoproliferative disorders, and 8 (13.6%) had Kaposi sarcoma. The mean age at the time of malignant tumor diagnosis was 42.7 ± 13.6 years, and statistically significant differences were found between tumor groups (P < .01). The average latency period between transplant and diagnosis of malignant tumors was 99.8 ± 56.9 months for solid tumors, 78.4 ± 52 months for skin tumors, 64.5 ± 48.8 months for posttransplant lymphoproliferative disorders, and 13.5 ± 8.8 months for Kaposi sarcoma, with significant difference found between tumor groups (P < .01). Ten patients (16.9%) had more than 1 malignant tumor. Eighteen patients died, with a mean time to death of 31.5 ± 22.8 months after tumor diagnosis. A significant positive association was found between survival and the number of tumors (P = .001); 5-year survival after tumor diagnosis was 81% and 40% for patients with 1 malignant tumor and patients with more than 1 malignant tumor, respectively. Malignancy is a common cause of death after renal transplant. Early detection and treatment of posttransplant malignancies is an important challenge. Screening these patients for malignancies posttransplant is crucial, and efforts should be directed to define effective immunosuppressive protocols that are associated with a lower incidence of malignancy.

  10. Life on Facebook: self-care in renal transplantation patients.

    Science.gov (United States)

    Roso, Camila Castro; Kruse, Maria Henriqueta Luce

    2017-07-06

    To analyze self-care in renal transplantation patients. Qualitative research, inspired in the post-structuralism. The empirical material was composed by the posts of a Facebook group of Renal Transplantation Patients, collected from February to May of 2016, totaling 53 posts from 35 participants. The research data were analyzed under the perspective of cultural analysis, using theories derived from Foucault. Self-care in renal transplantation patients was identified by the preoccupation with themselves and others, habits and lifestyles, restrictions and limitations that the disease imposes, such as lessons, ways of living and lifestyles after the procedure. This experience forces people that have been submitted to renal transplantation to reflect on the lifestyle they follow. The group also stimulates adhesion to treatment.

  11. Bilateral native nephrectomy for refractory hypertension in kidney transplant and kidney pancreas transplant patients

    Directory of Open Access Journals (Sweden)

    Mark J. Lerman

    2015-01-01

    We found laparoscopic bilateral native nephrectomy to be beneficial in renal and simultaneous kidney pancreas transplant patients with severe and refractory hypertension. Our patients with better baseline renal allograft function at time of nephrectomy received the most benefit. No decrease in allograft function could be attributed to acute rejection.

  12. Biliary strictures complicating liver transplantation in pediatric patients: Experience in a South American transplant center.

    Science.gov (United States)

    Holguin, Alfonso J; Rodriguez-Takeuchi, Sara; Ospina, Laura; Acosta, Diana; Botero, Veronica; Thomas, Laura; Villegas, Jorge; Echeverry, Gabriel J; Caicedo, Luis

    2017-02-01

    To describe the experience of percutaneous transhepatic cholangiography (PTC) with biliary dilatation and drainage after pediatric liver transplantation and to determine the long-term outcome of this procedure. Retrospective study from 2001 to 2013. Follow-up after treatment was also undertaken. A survival analysis was performed in patients in whom the procedure and eventual removal of the catheter were successful. In all, 196 children received liver transplants; 40 of them (20 boys and 20 girls; median age of 4 years) were treated using PTC due to biliary complications. Sixty-one PTC procedures were performed in 40 liver transplant recipients. Technically successful PTC was achieved in 87.5% of the patients. The probability of a patient not developing unfavorable outcomes 1, 5, and 10 years after treatment was 88.9%, 83.0%, and 74.1%. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Stimulating high impact HIV-related cardiovascular research: recommendations from a multidisciplinary NHLBI Working Group on HIV-related heart, lung, and blood disease.

    Science.gov (United States)

    Shah, Monica R; Cook, Nakela; Wong, Renee; Hsue, Priscilla; Ridker, Paul; Currier, Judith; Shurin, Susan

    2015-02-24

    The clinical challenges confronting patients with human immunodeficiency virus (HIV) have shifted from acquired immunodeficiency syndrome (AIDS)-related illnesses to chronic diseases, such as coronary artery disease, chronic lung disease, and chronic anemia. With the growing burden of HIV-related heart, lung, and blood (HLB) disease, the National Heart, Lung, and Blood Institute (NHLBI) recognizes it must stimulate and support HIV-related HLB research. Because HIV offers a natural, accelerated model of common pathological processes, such as inflammation, HIV-related HLB research may yield important breakthroughs for all patients with HLB disease. This paper summarizes the cardiovascular recommendations of an NHLBI Working Group, Advancing HIV/AIDS Research in Heart, Lung, and Blood Diseases, charged with identifying scientific priorities in HIV-related HLB disease and developing recommendations to promote multidisciplinary collaboration among HIV and HLB investigators. The working group included multidisciplinary sessions, as well as HLB breakout sessions for discussion of disease-specific issues, with common themes about scientific priorities and strategies to stimulate HLB research emerging in all 3 groups. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  14. Urological complications of renal transplant in patients with prolonged anuria.

    Science.gov (United States)

    Wu, Yi-Ju; Veale, Jeffrey L; Gritsch, Hans Albin

    2008-11-15

    Because of the shortage of deceased donor kidneys, some patients are on dialysis for over 10 years before renal transplantation. Many of these patients are anuric. We reviewed the urological complications in renal transplant recipients with anuria on hemodialysis for more than 10 years, compared with preemptive transplant recipients. The records of 4012 renal transplants from January 1988 to September 2007 were retrospectively reviewed. A total of 2735 deceased donor transplants were performed during this period. We identified a group of patients who were on hemodialysis for over 10 years and made less than 500 mL of urine per day. We compared the rate of urologic complications in this group with patients who were never on dialysis and had normal bladder function based on history and physical examination. Seventy-two patients met the strict inclusion criteria. There were 41 recipients in the anuric group and 31 recipients in the preemptive group. The surgical complications were not significantly different between the two groups (P=0.503). However, the anuric group required five more hospital admissions for complicated urinary tract infections (P=0.044). Renal transplant recipients who have been anuric for a prolonged period have higher rates of complicated urinary tract infections, but the long-term risks of urological complications are not significantly different.

  15. Can patients with schizophrenia undergo renal transplantation with success?

    Science.gov (United States)

    Bouhlel, Saoussen

    2014-05-01

    We report a case of a 41-year-old man suffering from paranoid schizophrenia. The patient has been consulting in our psychiatric hospital since he was 29 years old. Eight years later, he developed kidney failure and required peritoneal dialysis. After more than two years, the nephrology team indicated a renal transplantation and his brother suggested giving his kidney. There were no obstacles for transplantation in the immune and histological compatibilities; the psychiatric staff decided to check the patient's compliance with medication. The patient was compliant to all his medications and to the salt-free diet after the transplant operation. Few weeks later, he developed steroid-induced diabetes. Through the last two years, he had psychotic exacerbations with major anxiety and fear of losing the transplant. These relapses were managed by increasing doses of antipsychotics without need for hospitalization. At the present time, three years after transplantation, the nephrologists are decreasing the immunosuppressive agents and the steroids. The renal function is optimum and the diabetes is stabilized. This case exemplifies the potential for schizophrenic patients to undergo renal transplantation and to comply with follow-up medical care through a close cooperation between the patient's family, the psychiatric staff and the nephrology team.

  16. [Evaluation of quality of life in patients with liver transplant].

    Science.gov (United States)

    Mendoza-Sánchez, Federico; Ramírez-González, Luis Ricardo; Reyes-Cruz, Alan Alejandro; González-Ojeda, Alejandro; Hernández-Machuca, Joel Sealtiel; Fuentes-Orozco, Clotilde

    2016-01-01

    Complications in patients with liver transplant may occur in less than 10 % of cases. These appear in short and/or long term and are due to a vascular or biliary cause, rejection, recurrence of the disease or adverse effects of immunosuppression, among others, which may affect the quality of life. The aim of this article is to evaluate the quality of life in patients with deceased donor liver transplantation through the questionnaire SF-36. A descriptive cross-sectional study. The quality of life of patients with deceased donor liver transplantation was assessed during the period from January 1, 2005 to December 31, 2012. The variables evaluated were: age, sex, time and main reason for transplantation and quality of life using the short form SF-36 version 1.1 for Mexican population. 37 patients were included. The mean age was 48.7 years. The most frequent cause was cirrhosis (n = 35). The highest average score corresponded to the mental health component, and the lowest score to the physical component. The average time of liver transplantation was 6.73 ± 3.53 years. Liver transplantation is still the most effective treatment for end-stage liver disease. It can increase the patient's life expectancy and their quality of life, assessed with the SF-36 questionnaire. The results were similar to those in other studies in both the physical and mental component.

  17. Cholelithiasis in patients on the kidney transplant waiting list

    Directory of Open Access Journals (Sweden)

    André Thiago Scandiuzzi Brito

    2010-01-01

    Full Text Available OBJECTIVES: To evaluate the prevalence of cholecystopathy in chronic renal patients awaiting kidney transplants. INTRODUCTION: The prevalence and management of cholelithiasis in renal transplant patients is not well established. METHODS: A total of 342 chronic renal failure patients on the waiting list for a kidney transplant were studied. Patients were evaluated for the presence of cholelithiasis and related symptoms, previous cholecystectomies and other abdominal surgeries, time on dialysis, and general data (gender, age, number of pregnancies, and body mass index. RESULTS: Cholelithiasis was found in 41 out of 342 patients (12%. Twelve of these patients, all symptomatic, had previously undergone cholecystectomies. Five out of 29 patients who had not undergone surgery were symptomatic. Overall, 17 patients (41.5% were symptomatic. Their mean age was 54 (range 32-74 years old; 61% were female, and their mean body mass index was 25.4. Nineteen (76% out of 25 women had previously been pregnant, with an average of 3.6 pregnancies per woman. CONCLUSIONS: The frequency of cholelithiasis was similar to that reported in the literature for the general population. However, the high frequency of symptomatic patients points toward an indication of routine pre-transplant cholecystectomy to avoid serious post-transplant complications.

  18. Overview of Pregnancy in Renal Transplant Patients

    Directory of Open Access Journals (Sweden)

    Silvi Shah

    2016-01-01

    Full Text Available Kidney transplantation offers best hope to women with end-stage renal disease who wish to become pregnant. Pregnancy in a kidney transplant recipient continues to remain challenging due to side effects of immunosuppressive medication, risk of deterioration of allograft function, risk of adverse maternal complications of preeclampsia and hypertension, and risk of adverse fetal outcomes of premature birth, low birth weight, and small for gestational age infants. The factors associated with poor pregnancy outcomes include presence of hypertension, serum creatinine greater than 1.4 mg/dL, and proteinuria. The recommended maintenance immunosuppression in pregnant women is calcineurin inhibitors (tacrolimus/cyclosporine, azathioprine, and low dose prednisone; and it is considered safe. Sirolimus and mycophenolate mofetil should be stopped 6 weeks prior to conception. The optimal time to conception continues to remain an area of contention. It is important that counseling for childbearing should start as early as prior to getting a kidney transplant and should be done at every clinic visit after transplant. Breast-feeding is not contraindicated and should not be discouraged. This review will help the physicians in medical optimization and counseling of renal transplant recipients of childbearing age.

  19. [Survival and impact of bronchiolitis obliterans syndrome after lung transplantation at the Academic Hospital Groningen, 1990/'98].

    Science.gov (United States)

    van den Berg, J W; van der Bij, W; de Boer, W J; Postma, D S; Timens, W; Koëter, G H

    1999-10-30

    To describe the results of the lung transplantation programme in Groningen in relation to the bronchiolitis obliterans syndrome (BOS), in the first 118 consecutive patients. Retrospective. Data were collected on the 118 patients subjected to lung transplantation in November 1990 to June 1998 in the University Hospital Groningen, the Netherlands, regarding the prevalence of chronic transplant dysfunction (BOS) and survival. 117 lung transplantations (95 bilateral lung transplantations including 2 retransplants, and 22 single lung transplantations) and 1 heart-lung transplantation had been performed. The patients were 70 males and 48 females with a mean age of 42 years (range: 9-64). The mean (SD) survival at 1, 2, 3 and 5 years post transplantation was 83% (3), 70% (4), 66% (5) and 61% (5) respectively. The median survival amounted to 2447 days. The mean (SD) prevalence of BOS at respectively 1, 2, 3 and 5 years post transplantation was 32% (5), 36% (5), 44% (5) en 54% (6). After a diagnosis of BOS stage I the median survival was 649 days. The survival of the lung transplant programme of the University Hospital Groningen is considered to compare favourably with other centres. The prevalence of BOS is considerable, and comparable with the prevalence of BOS reported by other programmes. BOS is associated with a decreased life expectancy.

  20. Severe asthma: lessons learned from the National Heart, Lung, and Blood Institute Severe Asthma Research Program.

    Science.gov (United States)

    Jarjour, Nizar N; Erzurum, Serpil C; Bleecker, Eugene R; Calhoun, William J; Castro, Mario; Comhair, Suzy A A; Chung, Kian Fan; Curran-Everett, Douglas; Dweik, Raed A; Fain, Sean B; Fitzpatrick, Anne M; Gaston, Benjamin M; Israel, Elliot; Hastie, Annette; Hoffman, Eric A; Holguin, Fernando; Levy, Bruce D; Meyers, Deborah A; Moore, Wendy C; Peters, Stephen P; Sorkness, Ronald L; Teague, W Gerald; Wenzel, Sally E; Busse, William W

    2012-02-15

    The National Heart, Lung, and Blood Institute Severe Asthma Research Program (SARP) has characterized over the past 10 years 1,644 patients with asthma, including 583 individuals with severe asthma. SARP collaboration has led to a rapid recruitment of subjects and efficient sharing of samples among participating sites to conduct independent mechanistic investigations of severe asthma. Enrolled SARP subjects underwent detailed clinical, physiologic, genomic, and radiological evaluations. In addition, SARP investigators developed safe procedures for bronchoscopy in participants with asthma, including those with severe disease. SARP studies revealed that severe asthma is a heterogeneous disease with varying molecular, biochemical, and cellular inflammatory features and unique structure-function abnormalities. Priorities for future studies include recruitment of a larger number of subjects with severe asthma, including children, to allow further characterization of anatomic, physiologic, biochemical, and genetic factors related to severe disease in a longitudinal assessment to identify factors that modulate the natural history of severe asthma and provide mechanistic rationale for management strategies.

  1. Unusual causes of sudden anuria in renal transplant patients.

    Science.gov (United States)

    Abutaleb, Nasrulla; Obaideen, Abdulmunaem; Zakaria, Mahmoud; El Jubab, Abdulwahab; Hamza, Abdulmajeed; Younis, Seddiq; Adem, Muhalab

    2007-06-01

    Sudden unexplained anuria in renal transplant patients could well be secondary to occult internal hemorrhage rather than the usual vascular thrombotic or obstructive event, even in the completely stable patient. Urgent intervention in such bleeding states can save a patient's life and graft function. Graft survival is very exceptional in graft artery or vein thrombosis. Contrary to hemorrahagic events, life is usually not threatened by thrombotic events involving the renal graft vasculature. We present here three unfortunate cases that shared the problem of unexpected anuria due to a hemorrhagic event in apparently stable renal transplant patients.

  2. Can patients with schizophrenia undergo renal transplantation with success?

    Directory of Open Access Journals (Sweden)

    Saoussen Bouhlel

    2014-01-01

    Full Text Available We report a case of a 41-year-old man suffering from paranoid schizophrenia. The patient has been consulting in our psychiatric hospital since he was 29 years old. Eight years later, he developed kidney failure and required peritoneal dialysis. After more than two years, the nephrology team indicated a renal transplantation and his brother suggested giving his kidney. There were no obstacles for transplantation in the immune and histological compatibilities; the psychiatric staff decided to check the patient′s compliance with medication. The patient was compliant to all his medications and to the salt-free diet after the transplant operation. Few weeks later, he developed steroid-induced diabetes. Through the last two years, he had psychotic exacerbations with major anxiety and fear of losing the transplant. These relapses were managed by increasing doses of antipsychotics without need for hospitalization. At the present time, three years after transplantation, the nephrologists are decreasing the immunosuppressive agents and the steroids. The renal function is optimum and the diabetes is stabilized. This case exemplifies the potential for schizophrenic patients to undergo renal transplantation and to comply with follow-up medical care through a close cooperation between the patient′s family, the psychiatric staff and the nephrology team.

  3. Professional and social activity of patients after heart transplant

    Directory of Open Access Journals (Sweden)

    Urszula Marcinkowska

    2015-08-01

    Full Text Available Objectives: The aim of the study is to describe both professional and social activities of patients after heart transplant. Material and Methods: Ninety-five heart transplant patients treated at the Silesian Center for Heart Diseases in Zabrze were surveyed, comprising 29 women (30.5% and 66 men (69.5%. The average age of respondents was 54.3 years old (standard deviation (SD = 15 years; the average period that had elapsed since the heart transplant was 7.1 years (SD = 4 years. We designed a questionnaire as a tool for collecting information from patients. Results: Twenty-five percent of patients worked at the time of completion of the questionnaire. Eighty percent of those patients were working before and after the transplant, 20% – only after transplantation (p < 0.05. A different job position at a new workplace had 47.8% of patients, 34.8% of them had the same job position at the same work place as they had had before, 63.4% of the heart transplant respondents were pensioners. Eighty-two percent of patients had a certificate with a designated degree of disability – among them: 69% had a certificate for a significant degree of disability, 22% – for a moderate degree of disability. Among those surveyed, 52.5% said that their financial situation had not changed whereas 34.5% of those surveyed reported a change for the worse. Thirty-seven percent of respondents reported changes in family relationships. Seventy-seven percent reported that they received help from family members, as compared with 19% who did not. Conclusions: Only 25.3% of the patients treated at the Silesian Centre for Heart Diseases after heart transplant are employed and it is one of the lowest employment rates in this category of patients in Europe. One third of working patients have the same work place as they had before their operation. Heart transplant is a cause of changes in family relationships. Most often family bonds are strengthened but sometimes family members

  4. Professional and social activity of patients after heart transplant.

    Science.gov (United States)

    Marcinkowska, Urszula; Kukowka, Karol; Gałeczka, Michał; Pudlo, Robert; Zakliczyński, Michał; Zembala, Marian

    2015-01-01

    The aim of the study is to describe both professional and social activities of patients after heart transplant. Ninety-five heart transplant patients treated at the Silesian Center for Heart Diseases in Zabrze were surveyed, comprising 29 women (30.5%) and 66 men (69.5%). The average age of respondents was 54.3 years old (standard deviation (SD) = 15 years); the average period that had elapsed since the heart transplant was 7.1 years (SD = 4 years). We designed a questionnaire as a tool for collecting information from patients. Twenty-five percent of patients worked at the time of completion of the questionnaire. Eighty percent of those patients were working before and after the transplant, 20%--only after transplantation (p < 0.05). A different job position at a new workplace had 47.8% of patients, 34.8% of them had the same job position at the same work place as they had had before, 63.4% of the heart transplant respondents were pensioners. Eighty-two percent of patients had a certificate with a designated degree of disability--among them: 69% had a certificate for a significant degree of disability, 22%--for a moderate degree of disability. Among those surveyed, 52.5% said that their financial situation had not changed whereas 34.5% of those surveyed reported a change for the worse. Thirty-seven percent of respondents reported changes in family relationships. Seventy-seven percent reported that they received help from family members, as compared with 19% who did not. Only 25.3% of the patients treated at the Silesian Centre for Heart Diseases after heart transplant are employed and it is one of the lowest employment rates in this category of patients in Europe. One third of working patients have the same work place as they had before their operation. Heart transplant is a cause of changes in family relationships. Most often family bonds are strengthened but sometimes family members become nervous, impatient and unwilling to talk about the transplant. This work

  5. Postoperative morbidity after reconstruction of alveolar bone defects with chin bone transplants in cleft patients - 111 consecutive patients

    DEFF Research Database (Denmark)

    Andersen, Kristian; Nørholt, Sven Erik; Knudsen, Johan

    Postoperative morbidity after reconstruction of alveolar bone defects with chin bone transplants in cleft patients - 111 consecutive patients......Postoperative morbidity after reconstruction of alveolar bone defects with chin bone transplants in cleft patients - 111 consecutive patients...

  6. Sirolimus and mirabegron interaction in a hematopoietic cell transplant patient.

    Science.gov (United States)

    Engle, Jeff A; Fair, Christina

    2017-01-01

    Purpose Hematopoietic cell transplant patients are exposed to numerous classes of medications. Transplant practitioners must vigilantly monitor for drug interactions especially involving immunosuppressants. We report a hematopoietic cell transplant patient receiving sirolimus who developed supratherapeutic serum concentrations after initiating mirabegron. Summary A 31-year-old, 98 kg female received a second umbilical cord blood transplant four years after the first transplant for relapsed acute myeloid leukemia. Mycophenolate mofetil and sirolimus were utilized for graft versus host disease prophylaxis. The patient was receiving sirolimus 2 mg daily and the serum concentration on day 26 post-transplant (day + 26) was within therapeutic range (6.7 μg/L, goal range 3-12 μg/L). Her post-transplant course was complicated by BK viruria-associated cystitis for which she was started on mirabegron. Six days after starting the new medication (day + 33), the sirolimus serum concentration increased to 19.2 μg/L. Thus mirabegron was discontinued and sirolimus was held. Sirolimus was restarted once the serum concentration was within goal and subsequently stabilized with a combination of 1 mg and 2 mg daily for a total weekly dose of 10 mg. The proposed mechanisms of interaction include: (1) sirolimus inhibition of organic anion transporting polypeptide leading to increased mirabegron in the intestinal lumen; (2) mirabegron inhibition of P-glycoprotein leading to increased absorption of sirolimus and; (3) increased sirolimus absorption leading to increased sirolimus serum concentrations. Conclusion To our knowledge, this is the first report of a potential drug interaction between sirolimus and mirabegron. Transplant specialists should be aware of this potential interaction when considering the concurrent use of these medications.

  7. Voriconazole-Induced Periostitis & Enthesopathy in Solid Organ Transplant Patients: Case Reports

    OpenAIRE

    Sircar, Monica; Kotton, Camille; Wojciechowski, David; Safa, Kassem; Gilligan, Hannah; Heher, Eliot; Williams, Winfred; Thadhani, Ravi; Tolkoff-Rubin, Nina

    2016-01-01

    Background Voriconazole is frequently used to treat fungal infections in solid organ transplant patients. Recently, there have been reports suggesting that prolonged voriconazole therapy may lead to periostitis. Aim Here we present two cases of voriconazole-induced periostitis in solid organ transplant patients. Case Presentation Voriconazole was given to two transplant patients-one with a liver transplant and the second with a heart transplant, to treat their fungal infections. Both develope...

  8. Long-term graft and patient survival following renal transplantation in diabetic patients

    DEFF Research Database (Denmark)

    Rømming Sørensen, Vibeke; Schwartz Sørensen, Søren; Feldt-Rasmussen, Bo

    2006-01-01

    OBJECTIVE: To study long-term graft and patient survival following renal transplantation in diabetic and non-diabetic patients. MATERIAL AND METHODS: Over the time period 1985-99, 498 transplantations in 399 non-diabetic patients and 68 transplantations in 62 diabetic patients were performed...... patients, 55% were smokers. Among the diabetic patients, graft and patient survival were independent of smoking habits, blood pressure, HbA1c and total cholesterol. CONCLUSIONS: Graft survival was similar in diabetic and non-diabetic patients. For the first 5 years following renal transplantation......% at 1 year, 52% vs 52% at 5 years and 27% vs 33% (p=NS) at 10 years. In the diabetic patients, mean haemoglobin (Hb)A1c 2 years before and 2 years after the transplantation was 7.5+/-1.4 vs 8.2+/-1.6 mmol/l (p

  9. Allogeneic split-skin grafting in stem cell transplanted patients

    DEFF Research Database (Denmark)

    Olsen, Jan Kyrre Berg; Vindeløv, Lars; Schmidt, G.

    2008-01-01

    SUMMARY: We present a unique case of a bone marrow stem cell transplanted (BMT) patient with cutaneous chronic Graft versus Host Disease (cGvHD) who underwent successful allogeneic split-thickness skin graft (STSG) transplantation. BMT had previously been carried out due to myelodysplasia and non......). Allogeneic skin grafts are known to be acutely rejected. Successful allogeneic STSG has only been reported in sporadic cases of identical twins (isotransplantation). This case is the first to demonstrate what works in theory: the immune system of a stem cell transplanted patient with 100% or mixed stable...... donor chimaerism will not recognise skin from the stem cell donor as foreign. Due to advances in haematology, the number of BMT patients and their long-term survival is expected to increase. cGvHD, predisposing to skin problems and ulcerations, complicates up to 70% of cases of BMT. In BMT patients...

  10. Renal transplantation in HIV-infected patients: 2010 update.

    Science.gov (United States)

    Trullas, Joan C; Cofan, Federico; Tuset, Montse; Ricart, María J; Brunet, Mercedes; Cervera, Carlos; Manzardo, Christian; López-Dieguez, María; Oppenheimer, Federico; Moreno, Asuncion; Campistol, Josep M; Miro, Jose M

    2011-04-01

    The prognosis of human immunodeficiency virus (HIV) infection has improved in recent years with the introduction of antiretroviral treatment. While the frequency of AIDS-defining events has decreased as a cause of death, mortality from non-AIDS-related events including end-stage renal diseases has increased. The etiology of chronic kidney disease is multifactorial: immune-mediated glomerulonephritis, HIV-associated nephropathy, thrombotic microangiopathies, and so on. HIV infection is no longer a contraindication to transplantation and is becoming standard therapy in most developed countries. The HIV criteria used to select patients for renal transplantation are similar in Europe and North America. Current criteria state that prior opportunistic infections are not a strict exclusion criterion, but patients must have a CD4+ count above 200 cells/mm(3) and a HIV-1 RNA viral load suppressible with treatment. In recent years, more than 200 renal transplants have been performed in HIV-infected patients worldwide, and mid-term patient and graft survival rates have been similar to that of HIV-negative patients. The main issues in post-transplant period are pharmacokinetic interactions between antiretrovirals and immunosuppressants, a high rate of acute rejection, the management of hepatitis C virus coinfection, and the high cardiovascular risk after transplantation. More studies are needed to determine the most appropriate antiretroviral and immunosuppressive regimens and the long-term outcome of HIV infection and kidney graft. © 2011 International Society of Nephrology

  11. [Intestinal transplant in patients with parenteral nutrition at home].

    Science.gov (United States)

    de Cos, A I; Gómez Candela, C; Vázquez, C; López Santamaría, M; Vicente, E

    2003-01-01

    Failure of the intestine, whether due to functional or anatomical reasons, constrains Parenteral Nutrition Therapy in children or adults who, as a result of intestinal resections, alterations in motility, diseases of the microvilli or other reasons, present insufficient intestine to cover their needs in terms of nutrients and fluids. Nonetheless, the maintenance of support with parenteral nutrition at home in subjects with irreversible intestinal failure is not without life-threatening complications: liver disease, recurrent sepsis and loss of central routes recommend the assessment of the indication of intestinal transplant in this group of patients. The incidence of morbidity and mortality after intestinal transplant is greater than in other transplants (kidney, liver), but the long-term survival is around 50-60%. In Spain, 7 transplants (6 children and 1 adult) have been performed so far: 3 of intestine alone, 3 of liver plus intestine and 1 mutivisceral transplant. In 4 cases, the indication for transplant was due to terminal liver disease, with the remainder being due to the loss of venous access, intractable diarrhoea and intra-abdominal desmoid tumour, respectively. Except for one girl who presented severe rejection of the graft, the rest achieved digestive autonomy. One boy has presented lymphocyte neoplasia (PTLD) after 2 years and another died after the transplant as a result of a routine liver biopsy (with functioning grafts). Of the 38 patients assessed for transplant, 18 were considered as candidates and of these, three youthful candidates for hepato-intestinal transplant (with short intestine syndrome) have died while on the waiting list and a fourth in the operating theatre prior to an attempted multivisceral transplant. Intestinal transplants must not be considered as the last desperate therapeutic option in patients with permanent intestinal failure. The type of graft, clinical expertise and the use of new inducers (Sirulimos) all contribute to the

  12. Steroid withdrawal in renal transplant patients: the Irish experience.

    LENUS (Irish Health Repository)

    Phelan, P J

    2012-02-01

    BACKGROUND: Steroid therapy is associated with significant morbidity in renal transplant recipients. However, there is concern that steroid withdrawal will adversely affect outcome. METHODS: We report on 241 renal transplant recipients on different doses of corticosteroids at 3 months (zero, <\\/= 5 mg\\/day, > 5 mg\\/day). Parameters analysed included blood pressure, lipid profile, weight change, new onset diabetes after transplantation (NODAT), allograft survival and acute rejection. RESULTS: Elimination of corticosteroids had no impact on allograft survival at 1 year. There were no cases of NODAT in the steroid withdrawal group compared with over 7% in each of the steroid groups. There were no significant improvements in weight gain, blood pressure control or total cholesterol with withdrawal of steroids before 3 months. CONCLUSIONS: In renal transplant patients treated with tacrolimus and mycophenolate, early withdrawal of steroids does not appear to adversely affect allograft outcome at 1 year. It may result in less NODAT.

  13. Practical Guidelines: Lung Transplantation in Patients with Cystic Fibrosis

    Science.gov (United States)

    Hirche, T. O.; Knoop, C.; Hebestreit, H.; Shimmin, D.; Solé, A.; Elborn, J. S.; Ellemunter, H.; Aurora, P.; Hogardt, M.; Wagner, T. O. F.; ECORN-CF Study Group

    2014-01-01

    There are no European recommendations on issues specifically related to lung transplantation (LTX) in cystic fibrosis (CF). The main goal of this paper is to provide CF care team members with clinically relevant CF-specific information on all aspects of LTX, highlighting areas of consensus and controversy throughout Europe. Bilateral lung transplantation has been shown to be an important therapeutic option for end-stage CF pulmonary disease. Transplant function and patient survival after transplantation are better than in most other indications for this procedure. Attention though has to be paid to pretransplant morbidity, time for referral, evaluation, indication, and contraindication in children and in adults. This review makes extensive use of specific evidence in the field of lung transplantation in CF patients and addresses all issues of practical importance. The requirements of pre-, peri-, and postoperative management are discussed in detail including bridging to transplant and postoperative complications, immune suppression, chronic allograft dysfunction, infection, and malignancies being the most important. Among the contributors to this guiding information are 19 members of the ECORN-CF project and other experts. The document is endorsed by the European Cystic Fibrosis Society and sponsored by the Christiane Herzog Foundation. PMID:24800072

  14. The idea of corporeity analyzed from heart transplanted patients

    Directory of Open Access Journals (Sweden)

    Ana Mª Palmar Santos

    2008-09-01

    Full Text Available Introduction: Heart transplant in Spain is a frequent and raising technique with big personal, social and financial impact to those who get involved. However, the corporeity analysis, although it is a key constituent element in the integral definition of the human being, is poorly approached in the process.Objective: This work seeks to analyse the heart transplanted patient’s own corporeity perception through himself/herself as well as through his/her closest relatives.Method: We will approach the study from the phenomenological paradigm consisting of fully describing the lived experiences as well as the consequent perceptions in order to obtain a holistic and deep knowledge of reality. So that we will make a descriptive research work with qualitative approach. Sound recorded open interviews will be carried out to fellows who had been heart transplanted in Transplants Unit of Puerta de Hierro Hospital in Madrid. Initial informants’ selection criteria will be:1. Older than eighteen years old patients who had been heart transplanted within the last two years.2. Interviews to relatives who normally live together with the transplanted patients. Individual and social perception o corporeity from each subject will be analysed as well as that perception in function of genre. Data will be obtained from the interviews generated information and they will be analysed through the qualitative technique called “speech analysis”.

  15. Patients' expectations and experiences of rehabilitation following lung transplantation.

    Science.gov (United States)

    Fuller, L M; Button, B; Tarrant, B; Battistuzzo, C R; Braithwaite, M; Snell, G; Holland, A E

    2014-02-01

    Exercise rehabilitation is a key element of care following lung transplantation; however, little is known about the patients' experience of rehabilitation, or whether it meets the needs of this complex patient group. This qualitative study explored patients' expectations of a supervised exercise rehabilitation program following lung transplantation. Participants undertook two semi-structured interviews, one before and one after the rehabilitation program. Interviews were digitally recorded, and themes were developed using line-by-line iterative thematic analysis and grounded theory. Eighteen adults (11 females) with mean age of 52 participated in a mean of 26 sessions of exercise training. Themes were (i) desire for normalcy including resuming family roles and performing everyday activities; (ii) the importance of rehabilitation as the mechanism for how this transformation occurred; (iii) the benefits of exercising in a group setting; and (iv) the limitations on rehabilitation that were imposed by comorbidities, either existing pre-transplant or occurring as a postoperative sequelae. Post-transplant exercise rehabilitation was perceived as a highly valuable tool that assisted recipients to return to "normal life." Group exercise was motivational, offered peer support, and therefore was advantageous to assist patients to achieve their desired physical performance level following transplantation. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Liver transplantation for viral hepatitis - which patients will benefit ...

    African Journals Online (AJOL)

    Liver transplantation constitutes a significant part of the hepatologist's armamentarium and has become the treatment of choice for most patients with chronic end-stage liver disease. The results continue to improve and many centres are now able to achieve 1-year survival figures in excess of 90% in selected patients.

  17. [Outcome of kidney transplantation in patients on peritoneal dialysis].

    Science.gov (United States)

    Hrvacevic, R; Maksic, Dj; Aleksic, S; Paunic, Z; Ignjatovic, Lj; Vavic, N; Draskovic-Pavlovic, B; Maric, M

    2001-01-01

    The initial experience suggested that kidney transplantation could be hazardous for patients on peritoneal dialysis due to the high risk of peritonitis and a possible high incidence of acute rejection. In this paper we have presented our experience with kidney transplantation in these patients. During the last four years kidney transplantation was performed in 9 patients on peritoneal dialysis. The average time spent on peritoneal dialysis was 20.6 +/- 7.6 months. In all patients peritoneal catheter was removed during the surgery. During the posttransplantation period a triple immunosuppressive therapy including steroids, cyclosporin and azathioprineor mycophenolate mofetil was administered in all patients. In comparison to patients on hemodialysis no significant difference in the incidence of acute rejection episodes, delayed graft function, graft arterial thrombosis and graft function recovery was observed. Patients on peritoneal dialysis had significantly greater and longer wound drainage in comparison to patients on hemodialysis. It was concluded that peritoneal dialysis had no negative influence on short-term outcome of kidney transplantation.

  18. Current outcome of prioritized patients for kidney transplantation

    Directory of Open Access Journals (Sweden)

    Hideki Kanashiro

    2012-06-01

    Full Text Available PURPOSE: To analyze the outcome of deceased donor recipients given priority in allocation due to lack of access for dialysis and compare this data to the one obtained from non-prioritized deceased donor kidney transplant recipients. MATERIALS AND METHODS: we reviewed electronic charts of 31 patients submitted to kidney transplantation that were given priority in transplantation program due to lack of access for dialysis from January 2005 to December 2008. Immunological and surgical complications rates, and grafts and patients survival rates were analyzed. These data were compared to those obtained from 100 regular patients who underwent kidney transplantation without allocation priority during the same period. RESULTS: Overall surgical complication rate was 25.8% and 27% in the patients with priority in allocation and in the non-prioritized patients, respectively. There was no statistical significant difference for surgical complications (p = 1.0, immunological complications (p = 0.21 and graft survival (p = 0.19 rates between the groups. However, patient survival rate was statistically significant worse in prioritized patients (p = 0.05. CONCLUSIONS: patients given priority in allocation owing to lack of access for dialysis have higher mortality rate when compared to those non-prioritized.

  19. Optimal Technique for Abdominal Fascial Closure in Liver Transplant Patients

    Directory of Open Access Journals (Sweden)

    Unal Aydin

    2010-01-01

    Conclusion: Our results indicate that the novel technique used in this study contributed to overcoming early and late postoperative complications associated with closure of the abdominal fascia in liver transplant patients. In addition, this new technique has proven to be easily applicable, faster, safer and efficient in these patients; it is also potentially useful for conventional surgery.

  20. The role of statins in patients after heart transplantation.

    Science.gov (United States)

    Szyguła-Jurkiewicz, Bożena; Szczurek, Wioletta; Zembala, Marian

    2015-03-01

    Numerous studies have shown that statin therapy initiated early after heart transplantation improves the short- and long-term prognosis, leading to a reduction in the incidence of cardiac allograft vasculopathy (CAV), acute rejection episodes and significantly lowers the incidence of cancer in this patient population. The molecular mechanisms responsible for the beneficial effects of statins in patients after heart transplantation are complex; the effectiveness of statins is associated not only with their hypolipemic action, but also with their pleiotropic properties. Statins have been shown to exert protective and therapeutic effects against cancer because they act as antiproliferative agents, promoting apoptosis and inhibiting angiogenesis. Moreover, they reduce the number of circulating monocytes, which inhibits the secretion of proinflammatory cytokines, growth factors, adhesion molecules, chemokines, and matrix metalloproteinases, preventing chronic rejection and CAV. For these reasons, statins should be used as part of standard therapy in patients after heart transplantation.

  1. Clinical Outcome of Patients Transplanted with Marginal Donor Lungs via Ex Vivo Lung Perfusion Compared to Standard Lung Transplantation.

    Science.gov (United States)

    Fildes, James E; Archer, Louise D; Blaikley, John; Ball, Alexandra L; Stone, John P; Sjöberg, Trygve; Steen, Stig; Yonan, Nizar

    2015-05-01

    Lung transplantation is limited by a scarcity of suitable donors resulting in high waiting list mortality. Ex vivo lung perfusion (EVLP) allows the evaluation and reconditioning of marginal donor lungs for use in transplantation. This study aimed to compare clinical outcome of patients transplanted with marginal organs by means of EVLP with a standard lung transplant cohort through a multicenter open trial. Group 1 (n = 9) included patients transplanted using EVLP reconditioned marginal lungs. Group 2 (n = 46) consisted of date-matched patients transplanted using standard transplantation of acceptable lungs. The primary composite endpoint included acute rejection and infection at 12 months after transplantation. There was no significant difference in the overall incidence of acute rejection (P = 0.754) and the number of treated infection episodes (proven/probable pneumonia; P = 0.857/0.368 and proven/probable tracheobronchitis; P = 0.226/0.529) up to 12 months after transplantation, between group 1 and group 2. Additionally, there was no significant difference in early clinical outcome, including intensive care unit stay, hospital stay, and 1 year mortality between the two groups (P = 0.338, P = 0.112 and P = 0.372, respectively). This multicenter study demonstrates that EVLP is associated with no adverse effect on clinical outcome, including the incidence of acute rejection and infection after lung transplantation.

  2. [Complications associated with hyperglycemia in liver transplant patients].

    Science.gov (United States)

    Builes Montaño, Carlos Esteban; Montoya, Julián Felipe; Londoño, Carolina Aguilar; Palacios Bayona, Karen Lorena; Restrepo Gutiérrez, Juan Carlos; Restrepo, Johnayro Gutiérrez; Arango Toro, Clara María; Jaimes Barragan, Fabián Alberto

    2014-01-01

    Hyperglycemia is a frequent phenomenon in hospitalized patients that is associated with negative outcomes. It is common in liver transplant patients as a result of stress and is related to immunosuppressant drugs. Although studies are few, a history of diabetes and the presentation of hyperglycemia during liver transplantation have been associated with a higher risk for rejection. To analyze whether hyperglycemia during the first 48hours after liver transplantation was associated with a higher risk for infection, rejection, or longer hospital stay. A retrospective cohort study was conducted on patients above the age of 15years that received a liver transplant. Hyperglycemia was defined as a value above 140mg/dl and it was measured in three different manners (as an isolated value, as a mean value, and as a weighted value over time). The relation of hyperglycemia to a risk for acute rejection, infection, or longer hospital stay was evaluated. Some form of hyperglycemia was present in 94% of the patients during the first 48 post-transplantation hours, regardless of its definition. There was no increased risk for rejection (OR: 1.49; 95%CI: 0.55-4.05), infection (OR: 0.62; 95%CI: 0.16-2.25), or longer hospital stay between the patients that presented with hyperglycemia and those that did not. Hyperglycemia during the first 48hours after transplantation appeared to be an expected phenomenon in the majority of patients and was not associated with a greater risk for rejection or infection and it had no impact on the duration of hospital stay. Copyright © 2014 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  3. Orthotopic liver transplantation for patients with Caroli's disease.

    Science.gov (United States)

    Wang, Zhen-Xia; Yan, Lu-Nan; Li, Bo; Zeng, Yong; Wen, Tian-Fu; Wang, Wen-Tao

    2008-02-01

    Caroli's disease, a rare congenital hepatic disease, has a poor prognosis, especially in patients with diffuse dilatation of the bile ducts. But liver transplantation has been a curative option. The aim of this study was to investigate the feasibility and rationality of orthotopic liver transplantation as an indication for patients with diffuse Caroli's disease. The data from 3 patients with diffuse Caroli's disease who had undergone orthotopic liver transplantation in our unit were analyzed retrospectively. On postoperative day 7, patient 1 had acute rejection which was relieved after pulse treatment with methylprednisolone. He was discharged from hospital on postoperative day 27 and has been in good health for 82 months. Patient 2 had no acute rejection or severe complications, but died of chronic graft dysfunction 34 months postoperatively. Patient 3 had acute rejection on postoperative days 10 and 35, complicated with pulmonary infection, pleural effusion and opportunistic infection. After successful treatment, she resumed work and has been followed up for 47 months. Her condition is good. Liver transplantation can offer an effective therapy for patients with diffuse Caroli's disease, and can provide satisfactory long-term results.

  4. [Infectious complications due to immunosuppression in organ transplant patients].

    Science.gov (United States)

    Morelon, Emmanuel; Touraine, Jean-Louis

    2007-10-15

    Prevention and treatment of allograft rejection by immunosuppressive treatments expose organ transplant patients to frequent and sometimes severe infectious complications. Immunosuppressive drugs inhibit both the immune response to alloantigens, and the anti-infectious immunity; they promote intracellular infections, including infections with viruses and with bacterial, parasitic and mycotic agents. Infectious risks are related to duration of immunosuppression exposure, type of immunosuppressive drugs, combination of drugs and trough levels required to control rejection. Assessment of the risk of infectious diseases in transplant patients before transplantation has to take into account past medical history, number of previous transplantations, immunosuppressive regimen, and the risk of infectious diseases transmitted from the donor. After the graft, infectious risks have to be assessed by clinical examination, repeated white blood cell count to detect leucopenia. In high risk population, monitoring for CMV and EBV infections is based on analysis of replication using nucleic acid based assays or antigenemia studies. Prophylactic anti-infectious therapy in high-risk patients has resulted in reduction of the consequences of overimmunosuppression in organ transplantation.

  5. Heart Transplantation in a Patient with Left Isomerism

    Directory of Open Access Journals (Sweden)

    Ji Hyun Bang

    2015-08-01

    Full Text Available We report the case of a 37-year-old man who suffered from biventricular failure due to left isomerism, inferior vena cava interruption with azygos vein continuation, bilateral superior vena cava, double outlet of right ventricle, complete atrioventricular septal defect, pulmonary stenosis, and isolated dextrocardia. Heart transplantation in patients with systemic venous anomalies often requires the correction and reconstruction of the upper & lower venous drainage. We present a case of heart transplantation in a patient with left isomerism, highlighting technical modifications to the procedure, including the unifocalization of the caval veins and reconstruction with patch augmentation.

  6. 78 FR 17419 - National Heart, Lung, and Blood Institute; Notice of Closed Meeting

    Science.gov (United States)

    2013-03-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND.... Mockrin, Ph.D., Director, Division of Extramural Research Activities, National Heart, Lung, and Blood... to the timing limitations imposed by the review and funding cycle. Information is also available on...

  7. 75 FR 66771 - National Heart, Lung, and Blood Institute; Notice of Closed Meetings

    Science.gov (United States)

    2010-10-29

    ... Cancer and COPD. Date: November 19, 2010. Time: 8 a.m. to 5 p.m. Agenda: To review and evaluate grant.... Time: 6 p.m. to 5 p.m. Agenda: To review and evaluate grant applications. Place: Embassy Suites at the..., Scientific Review Officer, Office of Scientific Review, National Heart, Lung, and Blood Institute, 6701...

  8. Haptoglobin 2-2 Genotype, Patient, and Graft Survival in Renal Transplant Recipients

    DEFF Research Database (Denmark)

    Rasmussen, Laust Dupont; Ivar Anders, Eide; Hartmann, Anders

    2017-01-01

    Background: Cardiovascular disease is the leading cause of death in renal transplant recipients. An association between hap- toglobin genotype 2-2 and cardiovascular disease has been found in patients with diabetes mellitus and liver transplant recipients. To date, the role of haptoglobin genotype...... after renal transplantation has not been studied. Methods: In this single-center retrospective cohort study of 1975 adult Norwegian transplant recipients, who underwent transplantation between 1999 and 2011, we estimated the risk of all-cause and cardiovascular mortality and overall and death...... transplant recipients, we could not demonstrate any association between haptoglobin 2-2 genotype and patient or graft survival after renal transplantation....

  9. Haptoglobin 2-2 Genotype, Patient, and Graft Survival in Renal Transplant Recipients

    DEFF Research Database (Denmark)

    Dupont, Laust; Eide, Ivar Anders; Hartmann, Anders

    2017-01-01

    Background: Cardiovascular disease is the leading cause of death in renal transplant recipients. An association between haptoglobin genotype 2-2 and cardiovascular disease has been found in patients with diabetes mellitus and liver transplant recipients. To date, the role of haptoglobin genotype...... after renal transplantation has not been studied. Methods: In this single-center retrospective cohort study of 1975 adult Norwegian transplant recipients, who underwent transplantation between 1999 and 2011, we estimated the risk of all-cause and cardiovascular mortality and overall and death...... transplant recipients, we could not demonstrate any association between haptoglobin 2-2 genotype and patient or graft survival after renal transplantation....

  10. Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients

    Directory of Open Access Journals (Sweden)

    Christini Takemi Emori

    2014-11-01

    Conclusions: Acute exacerbation was a frequent and severe event in HBV-infected renal transplant patients. Prophylactic/preemptive therapy with antiviral drugs should be indicated for all HBsAg-positive renal transplant patients.

  11. Complicated diverticulitis in kidney transplanted patients: analysis of 717 cases.

    Science.gov (United States)

    Scotti, A; Santangelo, M; Federico, S; Carrano, R; La Tessa, C; Carlomagno, N; Palmieri, D G; Calogero, A; Piantadosi, M; Renda, A

    2014-09-01

    This study aims to investigate possible risk factors for diverticulitis in kidney transplant recipients affected by colonic diverticulosis. We investigated 717 patients transplanted between 2000 and 2010. Diverticular disease was endoscopically diagnosed in 17 of 717 examined patients. Eight patients were diagnosed with autosomal dominant polycystic kidney disease (ADPKD); 9 of 17 patients underwent emergency surgery. We performed Hartmann's procedure on all patients, with a second stage performed at least 6 months later. Although the incidence of colonic diverticular perforation in kidney transplanted patients is similar to that observed in the general population, perforation in immunosuppressed patients is associated with a higher morbidity/mortality rate. In our study, the incidence of perforation is 1.25% (9 of 717), with almost half of the cases observed in patients with ADPKD (4 of 9). Such an observation is consistent with published data, in which patients with ADPKD are reported to more frequently develop colonic diverticulosis and its complications. One possible explanation might be related to a belated diagnosis of diverticulitis, which could initially simulate an inflammatory disease as a consequence of renal cysts. Also, steroids seem to be a predisposing factor for colonic perforation in these patients. A timely surgery can significantly reduce mortality. In cases of elective surgery, mortality and morbidity are similar to those of immunocompetent patients; accordingly, this is the goal to be pursued. Early signs and symptoms are often masked by immunosuppressive therapy. In these patients, surgeons should always perform (1) abdominal computed tomography scanning and, in the presence of diverticulitis, reduce or withdraw immunosuppressive therapy; and (2) early surgery, with Hartmann's procedure being, in our opinion, the best choice. Before transplantation, elective surgery for colonic resection should be considered in patients with ADPKD or with a

  12. Belatacept for renal rescue in lung transplant patients.

    Science.gov (United States)

    Timofte, Irina; Terrin, Michael; Barr, Erik; Sanchez, Pablo; Kim, June; Reed, Robert; Britt, Edward; Ravichandran, Bharath; Rajagopal, Keshava; Griffith, Bartley; Pham, Si; Pierson, Richard N; Iacono, Aldo

    2016-04-01

    Renal failure causes morbidity and mortality after lung transplantation and is aggravated by exposure to nephrotoxic immunosuppressant (IS) drugs. We report an off-label experience using belatacept for lung transplant recipients with severe renal insufficiency to reduce nephrotoxic IS exposure. We analyzed data retrospectively from a consecutive series of lung transplant patients with renal insufficiency in whom belatacept treatment was initiated between June 2012 and June 2014 at the University of Maryland Medical Center. Eight patients received belatacept because of acute or chronic renal insufficiency (median) GFR 24 (IQR 18-26). Glomerular filtration rate (GFR) remained stable in two patients and increased in five. One patient with established renal and respiratory failure received only the induction dose of belatacept and died 4 months later of respiratory and multisystem organ failure. Calcineurin inhibitor or sirolimus exposure was safely withheld or reduced without moderate or severe acute rejection during ongoing belatacept in the other seven patients. FEV1 remained stable over the 6-month study interval. Belatacept use appears to permit safe transient reduction in conventional immunosuppressive therapy and was associated with stable or improved renal function in a small retrospective series of lung transplant recipients with acute or chronic renal insufficiency. © 2015 Steunstichting ESOT.

  13. Assessment and Management of Hypertension in Transplant Patients

    Science.gov (United States)

    Burgess, Ellen D.; Cooper, James E.; Fenves, Andrew Z.; Goldsmith, David; McKay, Dianne; Mehrotra, Anita; Mitsnefes, Mark M.; Sica, Domenic A.; Taler, Sandra J.

    2015-01-01

    Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drug-drug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients. PMID:25653099

  14. TRANSPLANTATION

    African Journals Online (AJOL)

    Background: Laparoscopic donor nephrectomy has become the procedure of choice for living donor kidney transplantation in many centres. We report on ... to acute rejection which required exploration and transplant nephrectomy. Reoperation was .... an increased risk of premature graft failure and worsened residual graft ...

  15. Heart and Combined Heart–Kidney Transplantation in Patients With Concomitant Renal Insufficiency and End‐Stage Heart Failure

    National Research Council Canada - National Science Library

    Schaffer, J. M; Chiu, P; Singh, S. K; Oyer, P. E; Reitz, B. A; Mallidi, H. R

    2014-01-01

    Patients requiring combined heart–kidney transplantation have poor waitlist survival, and although early transplant may help improve outcomes, the optimal therapy for these patients remains uncertain...

  16. Relationship between vessel elasticity, erythrocyte oxygen carrying capacity and heart/lung function and quality of life in elderly patients with hypertension%老年高血压患者血管弹性和红细胞携氧能力与其心肺功能和生活质量关系

    Institute of Scientific and Technical Information of China (English)

    蔡晗; 刘刚; 陈欣

    2017-01-01

    Objective:To detect the relationship between vessel elasticity,erythrocyte oxygen carrying capacity and heart/lung function and quality of life.Methods:A hundred subjects were randomly selected and divided into two groups:Observer group of elderly patients with hypertension (n=50),control group of normal aged person (n=50).Comparing two groups:(1)Blood vessel elasticity indexes:Elastic index aorta and small arteries,arterial vascular compliance,vascular stiffness and vascular wall thickness.(2)RBC oxygen capacity indexes:Determination of oxygen saturation of 50% oxygen partial pressure (P50),enzyme-linked immunosorbent assay patient RBC 2,3-glycerol phosphate ester acid (2,3-DPG) and pyruvate kinase (PK) content.(3)Color doppler heart function tests.(4)Static pulmonary function testing.(5) The core quality of life questionnaire (QLQ-C30) was used to assess the quality of life for patients.Test results were statistically analyzed.Results:Large and small artery elasticity indexes of the control group were significantly higher than those in the observation group (P<0.05).The control group was significantly higher than that observed in vascular compliance group (P<0.05),and vascular stiffness in the observation group was significantly higher (P<0.05),arterial intima-media thickness of the observation group was larger than the control group (P<0.05),arterial pulse wave velocity was higher than the old observation group (P<0.05).Peripheral blood of patients in the observation group which was lower than the control group reached P50 (P<0.05),the observation group with 2,3-DPG content and PK were higher (P<0.05).The main indicators of heart and lung function of the observation group were better than the control group (P<0.05),the observation group were superior in physical,role,cognitive,emotional,and social function and the overall quality of life was significantly lower than the control group (P<0.05).Conclusion:For elderly hypertensive patients

  17. Periodontal Management of a Patient Undergoing Liver Transplantation.

    Science.gov (United States)

    Clozza, Emanuele; Segelnick, Stuart L; Sigal, Samuel H; Rovner, Deborah N; Weinberg, Mea A

    2016-01-01

    This case report describes the periodontal management of a patient with end-stage liver disease undergoing liver transplantation. In the first part of this article, all medical and dental findings are reported to elaborate adequate diagnoses. A patient-specific treatment plan was structured given the challenging periodontal and systemic scenarios. The second part describes the periodontal therapy delivered in close interaction with the referring physicians. Last, the article reviews current principles and protocols in managing these patients.

  18. Cardiac evaluation in pediatric patients waiting for liver transplantation

    Directory of Open Access Journals (Sweden)

    Seyed Mohsen Dehghani, Naser Honar, Hamid Amoozegar, Ahad Eshraghian, Mohammad Borzooei, Mohammad Hadi Imanieh, Seyed Ali Malek-Hosseini

    2010-01-01

    Full Text Available Background: Cardiovascular abnormalities are among common complication in patients with cirrhosis waiting for liver transplantation (LT. The aim of the present study was to investigate cardiac abnormalities among pediatric liver transplant candidates.Methods: We prospectively evaluated the pediatric patient aged less than 18 years listed for LT between 2006 and 2008. Besides history taking and physical examination all the patients underwent electrocardiogram, chest radiograph, contrast echocardiography and color Doppler echocardiography, as well as arterial blood gas analyses.Results: Totally 89 patients with mean age of 8.1±4.6 years were included in the study. The most common causes for liver disease were cryptogenic cirrhosis followed by biliary atresia and autoimmune cirrhosis. Clubbing was found in 27 out of 89 patients and was the most common abnormalities in physical examination. In 22 patients (24.7% heart murmur was heard by a pediatric cardiologist. Sixty nine patients (77.5% had normal cardiac findings in chest radiograph. Cardiomegaly was found in 17 (19.1% patients as the most common abnormal finding in chest radiograph. Electrocardiogram showed sinus tachycardia in 16 (18% patients. Eleven patients (12.4% had tricuspid regurgitation as the most common abnormal findings in echocardiography. Thirteen (14.6% patients had positive contrast echocardiography in favor of intrapulmonary shunt.Conclusion: As the leading cause of post transplant death after graft rejection are cardiovascular complications cardiac evaluation should be considered in all pediatric patients before LT to lower morbidity and mortality during and after transplantation.

  19. Patient and alograft survival after transplantation with a living donor ...

    African Journals Online (AJOL)

    BACKGROUND: Late allograft loss remains a key area of concern. This study Was aimed at determining the patient and renal allograft outcome and identifying the factors responsible for survival following transplantation with a living-related donor kidney at the Nairobi Hospital, Kenya. METHODS: Follow-up data for ...

  20. Photodynamic therapy for actinic keratosis in organ transplant patients

    NARCIS (Netherlands)

    Basset-Seguin, N.; Baumann Conzett, K.; Gerritsen, M.J.P.; Gonzalez, H.; Haedersdal, M.; Hofbauer, G.F.; Aguado, L.; Kerob, D.; Lear, J.T.; Piaserico, S.; Ulrich, C.

    2013-01-01

    BACKGROUND: The incidence of actinic keratoses (AK) and non-melanoma skin cancer (NMSC) in organ transplant recipients (OTRs) is significantly higher than in immunocompetent patients. Rates of progression and recurrence following treatment are higher too, in part due to the effects of the

  1. The role of iron in patients after bone marrow transplantation.

    NARCIS (Netherlands)

    Witte, T.J.M. de

    2008-01-01

    Haemopoietic stem cell transplantation (HSCT) is an important intervention for malignant and non-malignant blood diseases. However, HSCT is also associated with considerable morbidity and mortality, some of which may be related to iron overload. Levels of serum iron are elevated in patients

  2. Rhodotorula glutinis fungemia in a liver-kidney transplant patient.

    Science.gov (United States)

    Riedel, D J; Johnson, J K; Forrest, G N

    2008-06-01

    A 54-year-old man underwent simultaneous liver-kidney transplantation. During his prolonged hospitalization, he developed catheter-related fungemia with Rhodotorula glutinis and azole-resistant Candida glabrata. Management of the Rhodotorula fungemia was complicated by his renal insufficiency, hepatic insufficiency, and the concurrent fungemia with multi-azole resistant C. glabrata. He was treated with combination therapy with voriconazole and micafungin with subsequent clearance of the fungemia. Rhodotorula species are emerging as human pathogens with the increasing number of immunosuppressed patients in the last few decades. This is the first report of a R. glutinis fungemia in a solid organ transplant recipient.

  3. Cryptococcal osteomyelitis of the skull in a liver transplant patient.

    Science.gov (United States)

    Pudipeddi, Aviv V; Liu, Ken; Watson, Geoffrey F; Davis, Rebecca J; Strasser, Simone I

    2016-12-01

    Cryptococcus neoformans is an opportunistic fungal pathogen and an important cause of morbidity and mortality in immunocompromised patients. We report a case of osteomyelitis caused by C. neoformans in a liver transplant recipient who presented with a headache and scalp lump after sustaining mild head trauma. There was no evidence of central nervous system involvement or dissemination. This is the first known case report of isolated cryptococcal osteomyelitis in a liver transplant recipient. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Voriconazole-induced periostitis in two post-transplant patients.

    Science.gov (United States)

    Bucknor, Matthew D; Gross, Andrew J; Link, Thomas M

    2013-08-01

    While drug-related periostitis has been known of for many years, the specific association of diffuse periostitis with voriconazole (most frequently in transplant patients) has only been recently explicitly addressed in the literature. Recognition of the radiologic and clinical manifestations of voriconazole-related periostitis is important for helping to narrow an otherwise broad differential diagnosis. We present two cases that illustrate different radiologic presentations of this painful cause of diffuse periostitis. Case 1 features a 60 year-old woman with a history of orthotopic heart transplant who was hospitalized for "full body pain" with progressively worsening bone tenderness involving the humeri, knees, femurs, hips, and hands. Case 2 describes a 48 year-old man with a history of acute lymphoblastic leukemia status post stem cell transplant who presented with diffuse arthralgias involving bilateral ankles, knees, wrists, and elbows.

  5. Timing of dialysis initiation in transplant-naive and failed transplant patients

    Science.gov (United States)

    Molnar, Miklos Z.; Ojo, Akinlolu O.; Bunnapradist, Suphamai; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar

    2017-01-01

    Over the past two decades, most guidelines have advocated early dialysis initiation on the basis of studies showing improved survival in patients starting dialysis early. These recommendations led to an increase in the proportion of patients initiating dialysis with an estimated glomerular filtration rate (eGFR) >10 ml/min/1.73 m2, from 20% in 1996 to 52% in 2008. During this period, patients starting dialysis with an eGFR ≥15 ml/min/1.73 m2 increased from 4% to 17%. However, recent studies have failed to substantiate a benefit of early dialysis initiation and some data have suggested worse outcomes in patients starting dialysis with a higher eGFR. Several reasons for this seemingly paradoxical observation have been suggested, including the fact that patients requiring early dialysis are likely to have more severe symptoms and comorbidities, leading to confounding by indication, as well as biological mechanisms that causally relate early dialysis therapy to adverse outcomes. Dialysis reinitiation in patients with a failing renal allograft encounters similar problems. However, unique factors associated with a failed allograft means that the optimal timing of dialysis initiation in failed transplant patients might differ from that in transplant-naive patients. In this Review, we will discuss studies of dialysis initiation and compare risks and benefits of early versus late dialysis therapy. PMID:22371250

  6. Food safety for the solid organ transplant patient: preventing foodborne illness while on chronic immunosuppressive drugs.

    Science.gov (United States)

    Obayashi, Patricia A C

    2012-12-01

    Issues regarding food safety are seen increasingly in the news; outbreaks of foodborne illness have been associated with public health concerns ranging from mild illness to death. For the solid organ transplant patient, immunosuppressive and antibacterial drugs, which maintain transplant organ function, can expose the transplant patient to increased risk of foodborne illness from bacteria, viruses, fungi, and parasites. This review article describes the clinical consequences, sources of foodborne illness, and food safety practices needed to minimize risks to the solid organ transplant patient who must take lifelong immunosuppressive drugs. All members of the transplant team share responsibility for education of the solid organ transplant patient in preventing infections. The registered dietitian, as part of the transplant team, is the recognized expert in providing food safety education in the context of medical nutrition therapy to solid organ transplant patients, the patients' caregivers, and other healthcare providers.

  7. Limbal autograft and allograft transplantations in patients with corneal burns.

    Science.gov (United States)

    Ozdemir, O; Tekeli, O; Ornek, K; Arslanpençe, A; Yalçindağ, N F

    2004-03-01

    To investigate and compare the surgical outcomes of limbal autograft and limbal allograft transplantations in patients with corneal burns. In total, 20 patients (n=22 eyes) with chemical burn and two patients (n=2 eyes) with thermal burn were included in this study. Limbal autograft or limbal allograft transplantation surgery was performed in all patients. HLA-typing was tested before allograft surgeries. Limbal allografting was performed in all eyes using donor tissue from live relatives. Systemic cyclosporine A was administered for immunosuppression. The corneal surface was successfully reconstructed in all eyes (100%) after limbal autografting, two eyes required additional amniotic membrane transplantation and one eye required allografting. The mean follow-up period for limbal autografts was 13.9 +/- 7.0 months. Limbal allografting failed to reduce corneal vascularity and opacification in five (55.6%) eyes and was successful only in four (44.4%) eyes (mean follow-up 16.2 +/- 11.2 months) (P=0.002). In all, 15 eyes undergoing limbal autografting completed re-epithelialization of the cornea at a mean of 35.6 +/- 60.2 days. The mean epithelial healing time in nine eyes undergoing limbal allografting was 13.0 +/- 7.3 days (P=0.525). After limbal autografting, functional vision (> or =1/10) was attained in 12 (80%) eyes. Only one eye (11.1%) achieved functional vision after limbal allografting (P=0.036). Penetrating keratoplasty was performed in three patients following limbal allografting. No cyclosporine-associated side effects were observed. Limbal autograft transplantation is an effective and safe procedure for unilateral corneal burns. It seems that limbal allograft transplantation is better combined with penetrating keratoplasty for a better visual outcome and higher graft survival rate. Systemic immunosuppression seems to be necessary for limbal allografts even in the presence of HLA-matched donor tissues.

  8. Risk factors of post renal transplant anaemia among Sudanese patients, a study in three renal transplant centres

    Directory of Open Access Journals (Sweden)

    Elmusharaf Khalifa

    2011-08-01

    Full Text Available Abstract Background There is a relative lack of recent information about late post kidney transplantation anaemia (PTA, especially in the developing countries; data are scarce about the prevalence and risk factors of PTA. Sudan was a leading country in Africa and Arab world in kidney transplantation. The first kidney transplantation in Sudan was in 1973. Methods This is a cross-sectional hospital analytic study enrolling all kidney transplanted recipients following in the transplant referral clinics at Ahmed Gassim, Selma and Ibn Sina Hospitals, Khartoum/Sudan, in the period from 1/8/2010 to 1/9/2010, clinical and laboratory data were obtained from 114 patients, anaemia was defined as Hb levels of Results The study showed that 39.5% of the patients were anaemic. Univariate analysis showed that late PTA is significantly associated with not using Erythropoietin (EPO in the pre-transplant period (p = Conclusion The study concluded that late PTA is common and under recognized. Risk factors for late PTA include renal dysfunction, history of rejection, longer duration of transplantation and not using EPO in the pre-transplant period. Renal dysfunction and not using EPO in the pre-transplant period are major predictors of late PTA.

  9. [Sirolimus associated pneumonitis in a hematopoietic stem cell transplant patient].

    Science.gov (United States)

    García, Estefanía; Buenasmañanas, Diana; Martín, Carmen; Rojas, Rafael

    2015-07-06

    Sirolimus (SR) is a lipophilic macrocytic lactone with immunosuppressive properties (mTOR inhibitor) commonly used in solid organ transplantation and recently introduced in the prophylaxis and treatment of graft-versus-host disease. Its numerous side effects include: hyperlipidemia, arthralgias, noncardiac peripheral edema, thrombotic microangiopathy and interstitial pneumonitis. SR-associated pneumonitis is a rare but potentially serious complication due to its increasing utilization in transplant patients. We report the case of a patient undergoing hematopoietic stem cell transplantation with severe respiratory distress and SR therapy. Microbiological tests were all negative and other complications related to transplantation were discarded. The chest computed tomography of high-resolution showed pneumonitis. The SR therapy was interrupted and treatment was started with steroids with resolution of symptoms. SR associated pneumonitis is a potentially fatal side effect. In patients treated with SR and respiratory failure, we must suspect this complication because early recognition along with drug discontinuation and steroid treatment is essential to reverse this complication. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  10. Pharmacokinetic study of mycophenolic acid in Iranian kidney transplant patients

    Directory of Open Access Journals (Sweden)

    Saeed Rezaee

    2013-02-01

    Full Text Available Background: The purpose of this study was to characterize the pharmacokinetic parameters of mycophenolic acid (MPA in Iranian kidney transplant patients. Methods: Plasma MPA concentration of mycophenolate mofetile (MMF 1 gram two times a day was measured in 21 Iranian kidney transplant recipients receiving treatment. Patients who entered the study had been transplanted for more than 3 months and their drug level was supposed to be at steady state. MMF concentration was measured with high-performance liquid chromatography (HPLC. Results: The plasma MPA concentration-time curve was characterized by an early sharp peak at about 1 hour postdose. The mean Area Under Curve (AUC, Cmax and Tmax were 47.0±18.3 µg.h/ml, 18.6±8.5 µg/ml and 1.0±0.5 hours respectively. Conclusion: The plasma MPA concentration-time curve pattern of Iranian patients was similar and consistent with previously reported profiles in other populations taking the same dose. Keywords: Mycophenolate mofetil, Mycophenolic acid, Pharmacokinetics, Area Under Curve, Kidney transplantation

  11. Donor Cell Leukemia in Umbilical Cord Blood Transplant Patients

    Science.gov (United States)

    Crow, Jennifer; Youens, Kenneth; Michalowski, Susan; Perrine, Gail; Emhart, Cassandra; Johnson, Felicia; Gerling, Amy; Kurtzberg, Joanne; Goodman, Barbara K.; Sebastian, Siby; Rehder, Catherine W.; Datto, Michael B.

    2010-01-01

    Donor cell neoplasms are rare complications of treatment regimens that involve stem cell transplantation for hematological malignancies, myelodysplastic processes, or certain genetic or metabolic disorders. We report a case of donor cell leukemia in a pediatric patient with a history of acute myeloid leukemia that manifested as recurrent AML FAB type M5 fourteen months after umbilical cord blood transplantation. Although there was some immunophenotypic drift from the patient's original AML and their posttransplant presentation, the initial pathological impression was of recurrent disease. Bone marrow engraftment analysis by multiplex PCR of short tandem repeat markers performed on the patient's diagnostic specimen showed complete engraftment by donor cells, with a loss of heterozygosity in the donor alleles on chromosome 7. This led to the reinterpretation of this patient's disease as donor-derived leukemia. This interpretation was supported by a routine karyotype and fluorescence in situ hybridization analysis showing loss of chromosome 7 and a male (donor) chromosome complement in this female patient. Also noted was a loss of the patient's presenting chromosomal abnormality, t(11;19)(q23;p13). This case highlights the need for close coordination between all aspects of clinical testing for the transplant patient, including molecular engraftment studies, when distinguishing the very common complication of recurrent disease from the exceedingly rare complication of donor cell leukemia. PMID:20431036

  12. Emerging Research Directions in Adult Congenital Heart Disease: A Report from a National Heart, Lung, and Blood Institute/Adult Congenital Heart Association Working Group

    Science.gov (United States)

    Gurvitz, Michelle; Burns, Kristin M.; Brindis, Ralph; Broberg, Craig S.; Daniels, Curt J.; Fuller, Stephanie M.P.N.; Honein, Margaret A.; Khairy, Paul; Kuehl, Karen S.; Landzberg, Michael J.; Mahle, William T.; Mann, Douglas L.; Marelli, Ariane; Newburger, Jane W.; Pearson, Gail D.; Starling, Randall C.; Tringali, Glenn R.; Valente, Anne Marie; Wu, Joseph C.; Califf, Robert M.

    2016-01-01

    Congenital heart disease (CHD) is the most common birth defect, affecting about 0.8% of live births. Advances in recent decades have allowed >85% of children with CHD to survive to adulthood, creating a growing population of adults with CHD. Little information exists regarding survival, demographics, late outcomes, and comorbidities in this emerging group, and multiple barriers impede research in adult CHD (ACHD). The National Heart, Lung, and Blood Institute and the Adult Congenital Heart Association convened a multidisciplinary Working Group to identify high-impact research questions in ACHD. This report summarizes the meeting discussions in the broad areas of CHD-related heart failure, vascular disease and multisystem complications. High-priority subtopics identified included heart failure in tetralogy of Fallot, mechanical circulatory support/transplantation, sudden cardiac death, vascular outcomes in coarctation of the aorta, late outcomes in single ventricle disease, cognitive and psychiatric issues, and pregnancy. PMID:27102511

  13. Disseminated cutaneous trichosporonosis in an adult bone marrow transplant patient

    Directory of Open Access Journals (Sweden)

    A. M. Y. Yong

    2017-01-01

    Full Text Available The Trichosporon species are yeast-like opportunistic pathogens in immunocompromised patients. Trichosporon asahii infections have been reported in pediatric bone marrow transplant (BMT patients. However, its incidence is low in the adult literature. A 52-year-old Chinese woman who was diagnosed with acute myeloid leukemia received induction chemotherapy and underwent allogenic bone marrow transplant, which was complicated by a relapse and required salvage chemotherapy. She developed persistent non-neutropenic fever secondary to presumed hepatosplenic candidiasis. Antifungal therapy with fluconazole and anidulafungin was administered. She remained febrile and tender dusky nodules appeared over all the four limbs. Histopathological examination and fungal culture identified T. asahii. Oral voriconazole was initiated with complete resolution of her lesions. The Trichosporon species is a frequently isolated yeast species from cancer patients. Voriconazole has become the first choice agent against Trichosporon. We highlight the increased awareness and clinical suspicion required for diagnosis and subsequent management in similar adult patients.

  14. Study of factors affecting the incidence of skin cancer in patients after liver transplant*

    OpenAIRE

    Campos, Gabriela Rached; Boin,Ilka de Fátima Santana Ferreira; de Campos Junior, Ivan Dias; Cintra, Maria Letícia

    2017-01-01

    Abstract: Background: Many factors are currently being identified as potential inductors of skin cancer in patients after a liver transplant, among them, immunosuppressive regimen. Objective: To study the factors that influence the incidence of skin cancer in patients after liver transplant. Methods: We have carried out a retrospective and observational study with 170 transplanted patients who had undergone transplantation from 1997 to 2010. We have adjusted the multiple logistic regressio...

  15. Analysis of hemodialysis patients’ thoughts about kidney transplantation and the national organ transplant system in terms of organ transplantation services management

    Directory of Open Access Journals (Sweden)

    Yasin Uzuntarla

    2017-03-01

    Results: It was determined that the hemodialysis patients responding to the survey were in the 20-95 age group with an average age of 58,64±15,64 years. 87,9% of the patients reported that they had been briefed about kidney transplants, 32,2% of those had been briefed said that the information had been delivered by the dialysis physician, 77,7% stated that they wanted a kidney transplant from a cadaver, 49,5% did not want a kidney transplant from a live donor and 35,5% indicated that the national organ transplant system operated adequately. Furthermore, it was noted that 50,9% of the responders were registered on the waiting lists of kidney transplant centers. Conclusions: It was concluded that it is necessary to provide sufficient information to hemodialysis patients about kidney transplants and the national organ transplant system to steer them to transplant centers. It is anticipated that the results of this study will assist officers of the Ministry of Health, politicians involved in health issues, decision makers and health professionals. [Arch Clin Exp Surg 2017; 6(1.000: 33-37

  16. Aspergillus Pericarditis with Tamponade in a Renal Transplant Patient

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    Sylvia Biso

    2017-01-01

    Full Text Available Aspergillus pericarditis is a rare and life-threatening infection in immunosuppressed patients. It has nonspecific clinical manifestations that often mimic other disease entities especially in patients who have extensive comorbidities. Diagnosis is oftentimes delayed and rarely done antemortem. A high degree of suspicion in immunocompromised patients is necessary for evaluation and timely diagnosis. This is a case of Aspergillus pericarditis with cardiac tamponade in a renal transplant patient with liver cirrhosis. Two months after transplant, he developed decompensation of his cirrhosis from hepatitis C, acute cellular rejection, and Kluyvera bacteremia, followed by vancomycin-resistant Enterococcus faecium (VRE bacteremia. Four months after transplant, the patient presented with lethargy and fluid overload. He subsequently developed shock and ventilator-dependent respiratory failure. An echocardiogram showed pericardial effusion with cardiac tamponade. He had emergent pericardiocentesis that showed purulent drainage. He was started on broad-spectrum antibiotics. Amphotericin B was initiated when the pericardial fluid grew mold that was later identified as Aspergillus fumigatus. The patient quickly decompensated and expired.

  17. Implication of thymoglobulin in kidney transplant patients: review article

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    Sudabeh Alatab

    2015-11-01

    Full Text Available Thymoglobulin is a purified polyclonal immunoglobulin that has been used widely over the last decades in the prevention and treatment of rejection following renal transplantation. This immunoglobulin works against human thymocytes. Since thymoglobulin does not contain the nephrotoxic properties therefore it can be used in induction therapy especially in patients with higher risk of graft rejection such as patients who receive graft from cadavers. Recent research showed also its beneficial role in cross-match-positive transplantation, a role that is mediated through conjunction with inhibitors of terminal complement activation. This immunoglobulin has also been used for treatment of rejection following renal transplantation. Thymoglobulin can have various effects on various Immune system cells including T cells, B cells and also plasma cells. Thymoglobulin also affects the Tcell surface antigens, natural killer-cell antigens, B cell antigens, plasma cell antigens, adhesion molecules and chemokine receptors. Diverse effects of thymoglobulin on the immune system includes: T cell depletion, induce apoptosis in B cell lineage and interference with dendritic cell functional properties. Thymoglobulin can cause acute complications, delayed complications as well as infectious complications. Acute reaction events includes: anaphylaxis, fever, chills, dyspnea, nausea, vomiting and diarrhea. Thymoglobulin also induces cytokine release syndrome manifested by high grade fevers and chills and treated by steroid therapy. Delayed reactions events usually present as serum sickness and infections. Infectious complications are more important and include cytomegalovirus (CMV infection, sepsis, candidiasis, herpes simplex and urinary infections. Thymoglobulin can also induce cytokine release syndrome. It has been thought that thymoglobulin increases the risk of post-transplant lymphoproliferative disorder (PTLD, however, debate still exists whether such an

  18. Fasting ramadan in kidney transplant patients is safe

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    Boobes Yousef

    2009-01-01

    Full Text Available Muslims with renal transplant often ask their doctors whether fasting Ramadan is safe. Scanty studies have addressed this question. This prospective study was undertaken to identify any clinical or biological changes with Muslim fasting. 22 kidney transplant patients with stable kidney functions, who were transplanted for more than one year, and voluntarily chose to fast during Ramadan in 1425 H (October-November 2004, were studied. Total of 22 subjects (10 men and 12 women with a mean age of 47 ± 11.6 years were studied. Full clinical and biological assessment was done before during and after the month of Ramadan fasting. Medications were taken in two divided doses at sunset (time of breaking the fast and pre dawn (before the fast. None of the patients experienced any undue fatigue, or symptoms. Body weight, blood pressure, kidney function tests, blood sugar, lipid profile, and cyclosporine levels remained stable. In conclusion it is safe for renal transplant recipients of more than one year and having stable graft function to fast during the month of Ramadan; however caution is advised for moderate to severe impaired renal function.

  19. Novel Biomarker Approaches for Managing Patients With Cardiac Transplantation.

    Science.gov (United States)

    Kennel, Peter J; Schulze, P Christian

    2015-10-01

    Despite major advances in the medical care of patients following heart transplantation (HTx) and a steady increase in long-term survival, allograft surveillance is still based on endomyocardial biopsy, the gold standard since the 1970s. This invasive procedure calls for less burdening and more cost-effective approaches. In recent years, impressive progress has been made in utilizing blood-based biomarkers for the diagnosis and management of diseases in a variety of fields. Hence, a number of trials have been performed testing the usefulness of circulating molecules or other technical methods to overcome the need for surveillance myocardial biopsy in HTx patients. Here, we review current approaches and the state of research on novel biomarkers for the management of patients following heart transplantation.

  20. Hypertension in post-renal transplant patients: Pilot study

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    Anita Saxena

    2014-01-01

    Full Text Available Post-transplant hypertension is a major risk factor for graft loss and patient survival; therefore, hypertension following renal transplantation must be treated strictly. There seems to be a strong association between hypertension, total body water (TBW and dry weight. In this study, we report the relationship of body water and body composition with hypertension in post-renal transplant patients. Forty-five post-transplant patients were enrolled in the study. Blood pressure (BP was labeled as controlled if BP was 120/80 mm Hg and not under good control if BP was above 120/80 mm Hg. Based on the number of antihypertensive medications a patient was taking, patients were divided into two groups: Group 1 patients on one antihypertensive drug and Group 2 patients on more than one antihypertensive drug. Nutritional status of the patients was assessed. Body composition (water compartments, body fat and lean mass was assessed using bioelectrical impedance analysis (BIA. Patient data were compared with 30 healthy volunteers. In patients, systolic BP was associated with TBW (P = 0.016, extracellular water (ECW Lt; r = 0.99, ECW% (r = 0.78 and diastolic BP with TBW% (P = 0.003, dry weight (r = 0.76 ECW% (r = 0.95 and percent intracellular water (ICW% (r = 0.79. Compared with controls, ECW and ECW% was higher in patients, and the ICW% was less in patients. There was significant difference in the actual weight of the patients and BIA-derived dry weight, although patients were clinically not edematous. The study showed a significant increase in diastolic BP with increase in dry weight. Significant difference in TBW was observed when the patients were grouped on the basis of the antihypertensive medication a patient was taking (one antihypertensive drug versus more than one antihypertensive drug. This study also showed an association between hypertension and overhydration. BIA may be a useful tool for the clinical assessment of overhydration in non

  1. Graft function and nutritional parameters in stable postrenal transplant patients

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    Anita Saxena

    2016-01-01

    Full Text Available Bioelectrical impedance analysis (BIA is a method for the assessment of nutritional status. We studied the effect of graft function on nutritional status in postrenal 45 transplant patients with borderline to good allograft function using BIA. The patients had a mean serum creatinine of 1.42 ± 0.42 mg% and mean glomerular filtration rate (GFR of 45.1 ± 14.1 mL/min. Based on BIA-derived GFR, the patients were divided into two groups; group 1: borderline graft function GFR 4.0 in extracellular water (P <0.015, intracellular water (P <0.002, plasma fluid (P <0.016, interstitial fluid (P <0.016, and body cell mass (P <0.024. Subjective global assessment (SGA scores showed that transplant patients had normal nutritional status, but when compared with healthy individuals as assessed by BIA, there were significant differences in FM, FFM, and body cell mass. In conclusion, BIA was more sensitive to evaluate nutritional depletion than SGA in transplant patients with borderline.

  2. Paediatric heart failure research: role of the National Heart, Lung, and Blood Institute.

    Science.gov (United States)

    Burns, Kristin M

    2015-08-01

    The National Heart, Lung, and Blood Institute, of the National Institutes of Health, is committed to supporting research in paediatric heart failure. The Institute's support of paediatric heart failure research includes both investigator-initiated grants and Institute initiatives. There were 107 funded grants in paediatric heart failure over the past 20 years in basic, translational and clinical research, technology development, and support of registries. Such research includes a broad diversity of scientific topics and approaches. The Institute also supports several initiatives for paediatric heart failure, including the Pediatric Circulatory Support Program, the Pumps for Kids, Infants, and Neonates (PumpKIN) Program, PediMACS, and the Pediatric Heart Network. This review article describes the National Heart, Lung, and Blood Institute's past, present, and future efforts to promote a better understanding of paediatric heart failure, with the ultimate goal of improving outcomes.

  3. Preventing infection from foodborne pathogens in liver transplant patients.

    Science.gov (United States)

    Cabelof, D C

    1994-10-01

    Patients who have had an orthotopic liver transplantation (OLT) experience impaired immune function resulting from the disease process and the therapeutic use of immunosuppressive and antibacterial drugs. Immunoimpairment increases the risk of foodborne illness from bacteria, viruses, fungi, and parasites. This article describes the organisms known to cause clinically important infections and their food sources, the distinctive clinical consequences of the infection in patients who have had an OLT, and methods of preventing foodborne illness in these patients and others. Dietitians are the health care providers typically responsible for teaching OLT patients and their caregivers about safe food handling and appropriate food choices.

  4. Spirometric assessment of lung transplant patients: one year follow-up

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    Paulo M. Pêgo-Fernandes

    2009-06-01

    Full Text Available OBJECTIVE: The purpose of this study was to compare spirometry data between patients who underwent single-lung or double-lung transplantation the first year after transplantation. INTRODUCTION: Lung transplantation, which was initially described as an experimental method in 1963, has become a therapeutic option for patients with advanced pulmonary diseases due to improvements in organ conservation, surgical technique, immunosuppressive therapy and treatment of post-operative infections. METHODS: We retrospectively reviewed the records of the 39 patients who received lung transplantation in our institution between August 2003 and August 2006. Twenty-nine patients survived one year post-transplantation, and all of them were followed. RESULTS: The increase in lung function in the double-lung transplant group was more substantial than that of the single-lung transplant group, exhibiting a statistical difference from the 1st month in both the forced expiratory volume in one second (FEV1 and the forced vital capacity (FVC in comparison to the pre-transplant values (p <0.05. Comparison between double-lung transplant and single lung-transplant groups of emphysema patients demonstrated a significant difference in lung function beginning in the 3rd month after transplantation. DISCUSSION: The analyses of the whole group of transplant recipients and the sub-group of emphysema patients suggest the superiority of bilateral transplant over the unilateral alternative. Although the pre-transplant values of lung function were worse in the double-lung group, this difference was no longer significant in the subsequent months after surgery. CONCLUSION: Although both groups demonstrated functional improvement after transplantation, there was a clear tendency to greater improvement in FVC and FEV1 in the bilateral transplant group. Among our subjects, double-lung transplantation improved lung function.

  5. Long-term follow-up of patients eligible, deferred, or ineligible for heart transplantation.

    Science.gov (United States)

    Chiribiri, Amedeo; Anselmino, Matteo; Del Grosso, Angela; Trevi, Gian Paolo; Bobbio, Marco

    2008-04-01

    When a patient is referred to a heart transplantation center, the patient and the physician should know the predicted long-term survival according to the first transplant committee decision. The aim of the study was to describe the follow-up of patients with heart failure referred to a heart transplantation center according to the initial decision to include (eligible), exclude (ineligible), or postpone (deferred) cardiac transplantation. The study cohort consisted of 852 consecutive patients. Univariate and trend analyses were performed by classification of data into tertiles according to the date of the first visit. The Kaplan-Meier method was used to assess overall survival and probability of receiving a transplant. The Cox hazard model was used to identify predictors of survival. Transplantation incidence in the 3 groups (eligible, deferred, and ineligible) was 60%, 19%, and 5%, respectively. The 1-, 3-, 5-, and 10-year survival rates were 74%, 58%, 49%, and 37% among eligible patients; 87%, 72%, 62%, and 45% among deferred; and 69%, 50%, 39%, and 19% among ineligible patients (p < 0.001). The 10-year survival was 65% for eligible patients who received the transplant and 8.8% for eligible patients who did not receive the transplant. Transplantation was the most powerful predictor of survival. The initial decision identified 3 groups of patients with different survival rates. Heart transplantation increases the survival of eligible patients at a rate similar to that of less sick subjects for whom heart transplantation can be deferred.

  6. Renal transplantation in a patient with Bartter syndrome and glomerulosclerosis

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    Se Eun Lee

    2011-01-01

    Full Text Available Bartter syndrome (BS is a clinically and genetically heterogeneous inherited renal tube disorder characterized by renal salt wasting, hypokalemic metabolic alkalosis and normotensive hyperreninemic hyperaldosteronism. There have been several case reports of BS complicated by focal segmental glomerulosclerosis (FSGS. Here, we have reported the case of a BS patient who developed FSGS and subsequent end-stage renal disease (ESRD and provided a brief literature review. The patient presented with classic BS at 3 months of age and developed proteinuria at 7 years. Renal biopsy performed at 11 years of age revealed a FSGS perihilar variant. Hemodialysis was initiated at 11 years of age, and kidney transplantation was performed at 16 years of age. The post-transplantation course has been uneventful for more than 3 years with complete disappearance of BS without the recurrence of FSGS. Genetic study revealed a homozygous p.Trp(TGG610Stop(TGA mutation in the CLCNKB gene. In summary, BS may be complicated by secondary FSGS due to the adaptive response to chronic salt-losing nephropathy, and FSGS may progress to ESRD in some patients. Renal transplantation in patients with BS and ESRD results in complete remission of BS.

  7. Steroid withdrawal in renal transplant patients: the Irish experience.

    LENUS (Irish Health Repository)

    Phelan, P J

    2010-10-29

    BACKGROUND: Steroid therapy is associated with significant morbidity in renal transplant recipients. However, there is concern that steroid withdrawal will adversely affect outcome. METHODS: We report on 241 renal transplant recipients on different doses of corticosteroids at 3 months (zero, ≤5 mg\\/day, >5 mg\\/day). Parameters analysed included blood pressure, lipid profile, weight change, new onset diabetes after transplantation (NODAT), allograft survival and acute rejection. RESULTS: Elimination of corticosteroids had no impact on allograft survival at 1 year. There were no cases of NODAT in the steroid withdrawal group compared with over 7% in each of the steroid groups. There were no significant improvements in weight gain, blood pressure control or total cholesterol with withdrawal of steroids before 3 months. CONCLUSIONS: In renal transplant patients treated with tacrolimus and mycophenolate, early withdrawal of steroids does not appear to adversely affect allograft outcome at 1 year. It may result in less NODAT.

  8. Voriconazole-induced periostitis: beyond post-transplant patients.

    Science.gov (United States)

    Reber, Joshua D; McKenzie, Gavin A; Broski, Stephen M

    2016-06-01

    Voriconazole-induced periostitis (VIP) is a rare but increasingly encountered entity since Food and Drug Administration (FDA) approval of the second generation antifungal medication in 2002. Literature reports most commonly include transplant recipients on immunosuppressive therapy simultaneously requiring antifungal therapy. Nontransplant patients receiving long-term voriconazole have an equal risk of developing the disease, but may experience a delay in diagnosis due to a lack of familiarity with the process outside of the post-transplant and/or immunosuppressed population. We present a case of VIP in a nontransplant, immunocompetent patient on suppressive antifungal therapy for prior abdominal aortic stent graft fungal infection. Radiologist review of current medications and recognition of periostitis on multiple imaging modalities may hasten the diagnosis and lead to earlier treatment and resolution of symptoms.

  9. Customised component corneal transplantation: a blessing for three patients.

    Science.gov (United States)

    Sati, Alok; Shankar, Sandeep; Jha, Ashok; Gurunadh, Velamakanni Satyanarayana

    2014-08-21

    The existing acute shortage of good quality donor corneas in a developing country like India, prompted us to attempt customised component corneal transplantation. Using this surgical strategy, one corneoscleral button was used for three recipients. Anterior and posterior lamellar discs were used for anterior lamellar keratoplasty and Descemet's stripping endothelial keratoplasty in patients with superficial corneal scar and pseudophakic bullous keratopathy, respectively. From the remnant peripheral corneoscleral rim, a patch graft was taken and used for a case of perforated corneal ulcer. Postoperatively, the two earlier mentioned cases achieved visual acuities of 20/30 and 20/60, respectively, whereas the latter mentioned patient with the patch graft achieved good tectonic stability. This case report highlights the optimal utilisation of a corneoscleral button by customising it for three recipients. Moreover, a patch graft has been introduced in the armamentarium of customised component corneal transplantation for the first time. 2014 BMJ Publishing Group Ltd.

  10. Changes in Exfoliative Cell of Oral Mucosa in Kidney Transplant Patients.

    Science.gov (United States)

    Keles, M; Caglayan, F; Tozoglu, U; Kara, A; Cankaya, E; Dogan, H; Dogan, G E; Uyanik, A; Aydinli, B

    2015-06-01

    The aim of this study was to investigate quantitative cytologic changes in oral mucosal smears collected from kidney transplant patients by modern stereologic methods. We enrolled 32 kidney transplant patients. Smears were obtained from the buccal mucosa transplant patients before and 12 months after kidney transplantation. Smears from each individual were stained using the Papanicolaou method and were analyzed using a stereological method. Statistically, the nuclear volumes and cytoplasmic volumes in the cells of buccal mucosa were markedly higher after kidney transplantation (P < .05). There was a decreased positive cell density in the oral epithelial cells after kidney transplantation compared with before renal transplantation (P < .05). These findings suggest that there are alterations in the oral epithelial cells after kidney transplantation, which are detectable by microscopy and cytomorphometry. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Voriconazole-induced periostitis in two post-transplant patients

    OpenAIRE

    Bucknor, Matthew D.; Gross, Andrew J.; Link, Thomas M.

    2013-01-01

    While drug-related periostitis has been known of for many years, the specific association of diffuse periostitis with voriconazole (most frequently in transplant patients) has only been recently explicitly addressed in the literature. Recognition of the radiologic and clinical manifestations of voriconazole-related periostitis is important for helping to narrow an otherwise broad differential diagnosis. We present two cases that illustrate different radiologic presentations of this painful ca...

  12. Organ Transplant Patients and Fungal Infections

    Science.gov (United States)

    ... Patients Medications that Weaken Your Immune System Outbreaks Rhizopus Investigation CDC at Work Global Fungal Diseases Cryptococcal ... January 25, 2017 Content source: Centers for Disease Control and Prevention National Center for Emerging and Zoonotic ...

  13. Stem Cell Transplant Patients and Fungal Infections

    Science.gov (United States)

    ... Patients Medications that Weaken Your Immune System Outbreaks Rhizopus Investigation CDC at Work Global Fungal Diseases Cryptococcal ... January 25, 2017 Content source: Centers for Disease Control and Prevention National Center for Emerging and Zoonotic ...

  14. Application of thromboelastography in patients after liver transplantation

    Directory of Open Access Journals (Sweden)

    YUAN Hongxiang

    2015-02-01

    Full Text Available ObjectiveTo evaluate the value of thromboelastography (TEG in guiding the proper use of blood components in patients after liver transplantation. MethodsThe blood samples from 35 patients after liver transplantation who visited our hospital from November 2013 to April 2014 were collected, in which TEG and conventional coagulation test were performed. The TEG parameters, such as reaction time of coagulation (R, clot formation time (K, Angle, and the maximum amplitude (MA, and coagulation parameters were subjected to bivariate linear regression analysis. The use of blood components and amount of blood transfusion following TEG′s instruction were compared with the clinical application. Comparison of continuous data was made by paired t test. ResultsActivated partial thromboplastin time and prothrombin time were positively correlated with R (r=0.69 and 0.41, P=0.001 and 0.030, respectively. Fibrinogen was negatively correlated with K (r=-0.03, P=0.008. Platelet was positively correlated with Angle and MA (r=0.46 and 0.68, P=0.029 and 0.000, respectively. Fibrinogen was positively correlated with MA (r=0.33, P=0.040. There was a significant difference in R value of TEG before and after the heparanase neutralization (P=0.027. ConclusionTEG has a clinical value in guiding the proper use of blood components in patients after liver transplantation.

  15. Mucocutaneous findings in pediatric patients with bone marrow transplantation

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    Serap Aksoylar

    2017-03-01

    Full Text Available Background and Design: Bone marrow transplantation (BMT is performed for many malign and non-malign diseases in pediatric patients. Cutaneous signs in transplant patients are usually encountered in the presence of underlying primary diseases or due to the intense conditioning regimens that include chemotherapy and radiotherapy protocols. In this study, it is aimed to define mucocutaneous changes in pediatric patients with BMT. Materials and Methods: A total of 44 patients, in whom BMT was planned between 2010 and 2011, were included in the study. Dermatological examinations were performed at the beginning of the study and were repeated once a week in the first month, once a month in the following 5 months; and once in every 3 months in the last 1.5 years of follow-up. Results: Forty-one patients were completed the study. The mean age of 41 patients was 9.24 years (range: 1-17 years. Of the subjects, 26 (64% were male and 15 (36% were female. Dermatological signs, in order of frequency, were mucositis (75.6%, xeroderma (70.7%, alopecia (46.3%, nail disorders (24.3%, inflammatory skin diseases (24.2%, aphthous stomatitis (22%, cutaneous hyperpigmentation (22%, graft versus host diseases (17.1%, infectious diseases (15.5%, and maculopapular rash (4.8%. Conclusion: Dermatological diseases can be frequently observed in BMT patients. Close monitoring of dermatological signs is important to minimize the complications of the treatment in this patient group.

  16. Survival after lung transplantation for cystic fibrosis in Sweden.

    Science.gov (United States)

    Gilljam, Marita; Nyström, Ulla; Dellgren, Göran; Skog, Ingrid; Hansson, Lennart

    2017-03-01

    In Sweden, lung transplantation has been performed in patients with end-stage lung disease since 1990. We assessed survival after lung transplantation for cystic fibrosis (CF) with focus on early mortality and outcome for patients infected with certain multiresistant bacteria, considered a relative contraindication for lung transplantation. Review of CF and transplant databases and patient charts. The Kaplan-Meier method and log-rank test were used for survival analysis and group comparison. From November 1991 to December 2014, 115 transplantations were performed in 106 CF patients (9 retransplantations): 3 heart-lung, 106 double lung-, 1 double lobar- and 5 single lung transplantations, constituting 13% (115/909) of all lung-transplant procedures performed in Sweden. The mean age at surgery was 31 (SD 10, range 10-61) years and there were 48% females. Overall 1-year survival after lung transplantation for CF was 86.4%, 5-year survival was 73.7% and 10-year survival was 62.4%. The mean and median survival after transplantation were 13.1 (95% confidence interval (CI): 11-15.3) and 14.6 (95% CI: 9.3-19.8) years, respectively, and there was no significant difference for gender or transplant centre. Extracorporeal membrane oxygenation was used as a bridge to transplantation in 11 cases and five patients received reconditioned lungs. Vascular and infectious complications contributed to eight deaths within the first three postoperative months. The mean survival for 14 patients infected pretransplant with Mycobacterium abscessus or Burkholderia cepacia complex was 8.8 (95% CI: 6.1-11.6) years compared to 13.2 (95% CI: 10.9-15.8) years for patients negative for these bacteria. Nineteen patients (14% of all listed), of whom three were listed for retransplantation, died while waiting a median time of 94 days (range 4 days-2.5 years) after listing. Survival after lung transplantation in Sweden is good, also for patients with pretransplant infection with M. abscessus or B

  17. Reactivation of intestinal CMV in a renal transplant patient after 10 years from the transplant

    Directory of Open Access Journals (Sweden)

    Maria Landi

    2013-04-01

    Full Text Available Introduction.We analyzed the clinical case of a 51 years old man, kidney transplanted on December 2002. On April 2011, he had acute rectal bleeding, renal chronic rejection (creatinine 2.9 mg/dl, Hgb 8.7 g/dl, positive anti-CMV antibodies (IgG. A colonoscopy showed diverticulosis of the rectum associated with deepithelialisation. The patient was treated with maintenance immunosuppressive post-transplant therapy. On June 2011, the colonoscopy showed a stenosing lesion of the sigmoid colon, and blood sampling and intestinal biopsy were performed to search Cytomegalovirus (CMV DNA by PCR. Methods. The presence of CMV-DNA was sought by automatic extractor QIACUBE, using QIAamp DNA BLOOD Mini Kit (Qiagen for whole blood and QIAamp DNA Mini Kit (Qiagen for biopsy.The extracted DNA was then amplified by Real Time PCR using Q-CMV RealTime Complete Kit (Nanogen, on instrument Applied Biosystems 7300. Results. At disease onset the viral load in whole blood was 208000 Geq/ml, and biopsy was positive. Antiviral therapy with Ganciclovir led to the negativity of the viral load and remission of symptoms. Conclusions. The clinical case described presented a reactivation of CMV infection in the intestine after more than 10 years from kidney transplantation, while the highest incidence of CMV reactivation usually occurs during the first year. In our opinion, the reactivation can be traced to long-term immunosuppressive therapy (maintenance posttransplant therapy in combination with a state of inflammation of the intestinal mucosa. In fact, patients with IBD treated with steroid drugs, in particular the group of refractory to therapy and thus have a recovery of the inflammatory process, are exposed to reactivation of CMV with intestinal localization.

  18. Heart-lung interactions during positive-pressure ventilation.

    Science.gov (United States)

    Pinsky, M R

    1994-11-01

    Artificial ventilation using intermittent positive airway pressure is the mainstay support of patients in respiratory failure. By maintaining alveolar ventilation and alveolar stability, positive airway pressure can sustain respiratory gas exchange between the lungs and circulation, thereby supporting pulmonary homeostasis in patients who would otherwise be unable to maintain oxygen transfer and CO2 elimination. However, positive-pressure ventilation (PPV) also results in complex cardiovascular interactions. More often than not, these interactions impede blood flow through ventilated lungs and reduce global cardiac output. Although arterial oxygen content is adequately sustained because oxygen delivery is equal to the product of arterial oxygen content and cardiac output, global oxygen delivery may be reduced by PPV because of a decrease in cardiac output. Because a primary function of the cardiovascular-respiratory system is to deliver sufficient amounts of oxygen to meet systemic metabolic demands, measurement of arterial blood gases alone in monitoring ventilatory support is inadequate in assessing the cardiopulmonary effects of PPV. Clear understanding of cardiopulmonary interactions associated with mechanical ventilation is required in the rational management of critically ill ventilator-dependent patients. The hemodynamic effects of mechanical ventilation are complex and cannot be explained in terms of the interactions of single hemodynamic processes and cardiac function. However, when considered in this manner, such interactions can be understood more easily. In most patients it is usually clear which process is dominant, permitting adjustments in overall therapy in order to optimize care. This review identifies these interactions and demonstrates which are dominant in specific clinical scenarios.

  19. Unrelated allogeneic stem-cell transplantation in adult patients – 10-year experience

    Directory of Open Access Journals (Sweden)

    Jožef Pretnar

    2012-12-01

    Conclusion: Unrelated allogeneic stem-cell transplantation is suitable for acute myeloblastic leukemias with unfavorable risk factors. However, results in acute lymphoblastic leukemia are worse. Unrelated transplantation is not efficient as salvage treatment for patients with recurrent disease after autologous transplantation or chemotherapy- resistant relapse.

  20. Obstructive jaundice as a long-term complication in a patient with liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Boll, D.; Thoeni, R.F.

    1981-07-15

    Obstructive jaundice related to stricture and stone in cystic duct was found in a patient 6 years after liver transplantation and cholecystojejunostomy. Complications with biliary drainage following liver transplantation are discussed. In the presence of dilated ducts seen by ultrasound, percutaneous transhepatic cholangiography performed immediately can lead to surgical correction, thus preventing failure of the liver transplant.

  1. Outcomes of Technical Variant Liver Transplantation versus Whole Liver Transplantation for Pediatric Patients: A Meta-Analysis.

    Science.gov (United States)

    Ye, Hui; Zhao, Qiang; Wang, Yufang; Wang, Dongping; Zheng, Zhouying; Schroder, Paul Michael; Lu, Yao; Kong, Yuan; Liang, Wenhua; Shang, Yushu; Guo, Zhiyong; He, Xiaoshun

    2015-01-01

    To overcome the shortage of appropriate-sized whole liver grafts for children, technical variant liver transplantation has been practiced for decades. We perform a meta-analysis to compare the survival rates and incidence of surgical complications between pediatric whole liver transplantation and technical variant liver transplantation. To identify relevant studies up to January 2014, we searched PubMed/Medline, Embase, and Cochrane library databases. The primary outcomes measured were patient and graft survival rates, and the secondary outcomes were the incidence of surgical complications. The outcomes were pooled using a fixed-effects model or random-effects model. The one-year, three-year, five-year patient survival rates and one-year, three-year graft survival rates were significantly higher in whole liver transplantation than technical variant liver transplantation (OR = 1.62, 1.90, 1.65, 1.78, and 1.62, respectively, ptechnical variant liver transplantation. Continuing efforts should be made to minimize surgical complications to improve the outcomes of technical variant liver transplantation.

  2. Vitamin D status in kidney transplant patients

    DEFF Research Database (Denmark)

    Ewers, Bettina; Gasbjerg, Ane; Moelgaard, Christian

    2008-01-01

    BACKGROUND: A high prevalence of vitamin D insufficiency has been found in the general population and in patients with chronic kidney disease. OBJECTIVE: The aim was to examine vitamin D status and determinants and metabolic correlates of serum 25-hydroxyvitamin D in a population of adult Danish......(OH)D], and 1,25-dihydroxyvitamin D [S-1,25(OH)(2)D] were measured. Dietary and supplementary intake of vitamin D, avoidance of solar ultraviolet B exposure, and selected lifestyle factors were assessed in a subgroup (n = 97). RESULTS: Fifty-one percent of the patients had vitamin D insufficiency [S......-25(OH)D 40-75 nmol/L], and an additional 29% had moderate-to-severe vitamin D deficiency [S-25(OH)D vitamin D supplementation (positive association) were independent determinants of S-25(OH)D concentrations...

  3. Desensitization protocol for highly sensitized renal transplant patients: A single-center experience

    OpenAIRE

    Kute, Vivek B.; Vanikar, Aruna V.; Trivedi, Hargovind L; Shah, Pankaj R; Kamal R Goplani; Patel, Himanshu V.; Gumber, Manoj R.; Patel, Rashmi D; Kamal V Kanodia; Kamlesh S Suthar; Trivedi, Varsha B; Pranjal R Modi

    2011-01-01

    Highly sensitized patients are destined to remain untransplanted for long. Early transplantation results in cost-saving, reduced morbidity/mortality and improved quality of life. We carried out a prospective study to evaluate the efficacy and safety of desensitization protocol vis-à-vis patient/graft survival in living donor renal transplantation in highly sensitized patients. Between December 2008 and April 2010, 34 renal transplant (RTx) patients underwent desensitization protocol. An anti-...

  4. Mental health and quality of life in liver transplant and cirrhotic patients with various etiologies

    OpenAIRE

    Pérez San Gregorio, María de los Ángeles; Martín Rodríguez, Agustín; Domínguez Cabello, Elisabeth; Fernández Jiménez, Eduardo; Borda Mas, María de las Mercedes; Bernardos Rodríguez, Ángel

    2012-01-01

    In this study we aimed to: 1) examine whether there were differences in mental health and quality of life of liver transplant recipients according to etiology that led to transplantation (alcoholic cirrhosis, Hepatitis B/C Virus, hepatocellular carcinoma and others); and 2) to compare mental health and quality of life between liver transplant and cirrhotic patients, according to etiologies that most often lead to liver transplantation (alcoholic and Hepatitis C Virus). Two pati...

  5. Survival Benefit of Kidney Transplantation in HIV-infected Patients.

    Science.gov (United States)

    Locke, Jayme E; Gustafson, Sally; Mehta, Shikha; Reed, Rhiannon D; Shelton, Brittany; MacLennan, Paul A; Durand, Christine; Snyder, Jon; Salkowski, Nicholas; Massie, Allan; Sawinski, Deirdre; Segev, Dorry L

    2017-03-01

    To determine the survival benefit of kidney transplantation in human immunodeficiency virus (HIV)-infected patients with end-stage renal disease (ESRD). Although kidney transplantation (KT) has emerged as a viable option for select HIV-infected patients, concerns have been raised that risks of KT in HIV-infected patients are higher than those in their HIV-negative counterparts. Despite these increased risks, KT may provide survival benefit for the HIV-infected patient with ESRD, yet this important clinical question remains unanswered. Data from the Scientific Registry of Transplant Recipients were linked to IMS pharmacy fills (January 1, 2001 to October 1, 2012) to identify and study 1431 HIV-infected KT candidates from the first point of active status on the waiting list. Time-dependent Cox regression was used to establish a counterfactual framework for estimating survival benefit of KT. Adjusted relative risk (aRR) of mortality at 5 years was 79% lower after KT compared with dialysis (aRR 0.21; 95% CI 0.10-0.42; P <0.001), and statistically significant survival benefit was achieved by 194 days of KT. Among patients coinfected with hepatitis C, aRR of mortality at 5 years was 91% lower after KT compared with dialysis (aRR 0.09; 95% CI 0.02-0.46; P < 0.004); however, statistically significant survival benefit was not achieved until 392 days after KT. Evidence suggests that for HIV-infected ESRD patients, KT is associated with a significant survival benefit compared with remaining on dialysis.

  6. Granzyme B producing B-cells in renal transplant patients.

    Science.gov (United States)

    Zhu, Jiqiao; Zeng, Ye; Dolff, Sebastian; Bienholz, Anja; Lindemann, Monika; Brinkhoff, Alexandra; Schedlowski, Manfred; Xu, Shilei; Sun, Ming; Guberina, Hana; Kirchhof, Julia; Kribben, Andreas; Witzke, Oliver; Wilde, Benjamin

    2017-11-01

    A separate subset of Granzyme B (GrB) producing B-cells regulating T-cell mediated immunity has been identified. In the present study, we investigated the role of GrB(+) B-cells in renal transplant patients (RTX). 12 healthy controls (HC) and 26 RTX patients were enrolled. In addition, 19 healthy volunteers treated with cyclosporine A (CsA) were enrolled. GrB(+) B-cells were determined via flow cytometry. RTX Patients showed a diminished fraction of GrB(+) B-cells as compared to HC. CsA treatment of healthy volunteers had no impact on the development of GrB(+) B-cells. RTX patients with a history of allograft rejection showed an increased frequency of GrB(+) B-cells. RTX patients with at least one episode of CMV viremia tended to have lower GrB(+) B-cells as compared to patients without viremic episodes. We demonstrate that treatment with CsA does not impair the development of GrB(+) B-cells. GrB(+) B-cells may have a dual role in renal transplantation as regulatory cells to maintain allospecific tolerance and as effector cells enhancing viral control. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Association between pre-transplant dialysis modality and patient and graft survival after kidney transplantation

    DEFF Research Database (Denmark)

    Kramer, Anneke; Jager, Kitty J; Fogarty, Damian G

    2012-01-01

    Previous studies have found inconsistent associations between pre-transplant dialysis modality and subsequent post-transplant survival. We aimed to examine this relationship using the instrumental variable method and to compare the results with standard Cox regression.......Previous studies have found inconsistent associations between pre-transplant dialysis modality and subsequent post-transplant survival. We aimed to examine this relationship using the instrumental variable method and to compare the results with standard Cox regression....

  8. Outcomes of allogeneic hematopoietic cell transplantation in patients with dyskeratosis congenita.

    Science.gov (United States)

    Gadalla, Shahinaz M; Sales-Bonfim, Carmem; Carreras, Jeanette; Alter, Blanche P; Antin, Joseph H; Ayas, Mouhab; Bodhi, Prasad; Davis, Jeffrey; Davies, Stella M; Deconinck, Eric; Deeg, H Joachim; Duerst, Reggie E; Fasth, Anders; Ghavamzadeh, Ardeshir; Giri, Neelam; Goldman, Frederick D; Kolb, E Anders; Krance, Robert; Kurtzberg, Joanne; Leung, Wing H; Srivastava, Alok; Or, Reuven; Richman, Carol M; Rosenberg, Philip S; Toledo Codina, Jose Sanchez de; Shenoy, Shalini; Socié, Gerard; Tolar, Jakub; Williams, Kirsten M; Eapen, Mary; Savage, Sharon A

    2013-08-01

    We describe outcomes after allogeneic transplantation in 34 patients with dyskeratosis congenita who underwent transplantation between 1981 and 2009. The median age at transplantation was 13 years (range, 2 to 35). Approximately 50% of transplantations were from related donors. Bone marrow was the predominant source of stem cells (24 of 34). The day-28 probability of neutrophil recovery was 73% and the day-100 platelet recovery was 72%. The day-100 probability of grade II to IV acute GVHD and the 3-year probability of chronic graft-versus-host disease were 24% and 37%, respectively. The 10-year probability of survival was 30%; 14 patients were alive at last follow-up. Ten deaths occurred within 4 months from transplantation because of graft failure (n = 6) or other transplantation-related complications; 9 of these patients had undergone transplantation from mismatched related or from unrelated donors. Another 10 deaths occurred after 4 months; 6 of them occurred more than 5 years after transplantation, and 4 of these were attributed to pulmonary failure. Transplantation regimen intensity and transplantations from mismatched related or unrelated donors were associated with early mortality. Transplantation of grafts from HLA-matched siblings with cyclophosphamide-containing nonradiation regimens was associated with early low toxicity. Late mortality was attributed mainly to pulmonary complications and likely related to the underlying disease. Copyright © 2013 American Society for Blood and Marrow Transplantation. All rights reserved.

  9. Amiodarone in cardiac transplant waiting list patients with severe heart failure

    Directory of Open Access Journals (Sweden)

    N. N. Koloskova

    2017-01-01

    Full Text Available Heart transplantation is the «gold standard» of severe heart failure treatment. Sudden arrhythmic death is the leading cause of death among these patients. Amiodarone is the only antiarrhythmic drug with beneficial effect on survival of patients with end-stage heart failure. Given its long half-life, pre-transplant use of amiodarone has been extensively discussed focusing on divergent results regarding morbidity and mortality after heart transplantation. Its adverse clinical events after transplantation remain debatable. This review is aimed at evaluation of the impact of amiodarone pretransplant use on mortality and complications after heart transplantation.

  10. Cardiopulmonary bypass: development of John Gibbon's heart-lung machine.

    Science.gov (United States)

    Passaroni, Andréia Cristina; Silva, Marcos Augusto de Moraes; Yoshida, Winston Bonetti

    2015-01-01

    To provide a brief review of the development of cardiopulmonary bypass. A review of the literature on the development of extracorporeal circulation techniques, their essential role in cardiovascular surgery, and the complications associated with their use, including hemolysis and inflammation. The advancement of extracorporeal circulation techniques has played an essential role in minimizing the complications of cardiopulmonary bypass, which can range from various degrees of tissue injury to multiple organ dysfunction syndrome. Investigators have long researched the ways in which cardiopulmonary bypass may insult the human body. Potential solutions arose and laid the groundwork for development of safer postoperative care strategies. Steady progress has been made in cardiopulmonary bypass in the decades since it was first conceived of by Gibbon. Despite the constant evolution of cardiopulmonary bypass techniques and attempts to minimize their complications, it is still essential that clinicians respect the particularities of each patient's physiological function.

  11. Patient housing barriers to hematopoietic cell transplantation: results from a mixed-methods study of transplant center social workers.

    Science.gov (United States)

    Preussler, Jaime M; Mau, Lih-Wen; Majhail, Navneet S; Bevans, Margaret; Clancy, Emilie; Messner, Carolyn; Parran, Leslie; Pederson, Kate A; Ferguson, Stacy Stickney; Walters, Kent; Murphy, Elizabeth A; Denzen, Ellen M

    2016-03-01

    Hematopoietic cell transplantation (HCT) is performed in select centers in the United States (U.S.), and patients are often required to temporarily relocate to receive care. The purpose of this study was to identify housing barriers impacting access to HCT and potential solutions. A mixed-methods primary study of HCT social workers was conducted to learn about patient housing challenges and solutions in place that help address those barriers. Three telephone focus groups were conducted with adult and pediatric transplant social workers (n = 15). Focus group results informed the design of a national survey. The online survey was e-mailed to a primary social worker contact at 133 adult and pediatric transplant centers in the U.S. Transplant centers were classified based on the patient population cared for by the social worker. The survey response rate was 49%. Among adult programs (n = 45), 93% of centers had patients that had to relocate closer to the transplant center to proceed with HCT. The most common type of housing option offered was discounted hotel rates. Among pediatric programs (n = 20), 90% of centers had patients that had to relocate closer to the transplant center to proceed with HCT. Ronald McDonald House was the most common option available. This study is the first to explore housing challenges faced by patients undergoing HCT in the U.S. from the perspective of social workers and to highlight solutions that centers use. Transplant centers will benefit from this knowledge by learning about options for addressing housing barriers for their patients.

  12. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric

    2009-01-01

    misdiagnosed. Excluding the patients with ischemic cardiomyopathy, 46 of 152 patients (30%) were misdiagnosed before transplantation. CONCLUSIONS: Although cardiac transplantation is a viable treatment option for patients with a variety of cardiac diseases, accurate diagnosis of patients before transplantation...... remains a priority. Accurate diagnosis of particular diseases (sarcoidosis, myocarditis, iron toxicity-associated cardiomyopathy and others) allows for proper treatment before transplantation, which may slow down disease progression and improve patient outcomes. Furthermore, it is important to accurately...... cardiomyopathy is suspected, because the results may alter the diagnosis and modify the treatment strategy....

  13. A novel approach in extracorporeal circulation: individual, integrated, and interactive heart-lung assist (I3-Assist).

    Science.gov (United States)

    Wagner, Georg; Schlanstein, Peter; Fiehe, Sandra; Kaufmann, Tim; Kopp, Rüdger; Bensberg, Ralf; Schmitz-Rode, Thomas; Steinseifer, Ulrich; Arens, Jutta

    2014-04-01

    Extracorporeal life support (ECLS) is a well-established technique for the treatment of different cardiac and pulmonary diseases, e.g., congenital heart disease and acute respiratory distress syndrome. Additionally, severely ill patients who cannot be weaned from the heart-lung machine directly after surgery have to be put on ECLS for further therapy. Although both systems include identical components, a seamless transition is not possible yet. The adaption of the circuit to the patients' size and demand is limited owing to the components available. The project I³-Assist aims at a novel concept for extracorporeal circulation. To better match the patient's therapeutic demand of support, an individual number of one-size oxygenators and heat exchangers will be combined. A seamless transition between cardiopulmonary bypass and ECLS will be possible as well as the exchange of components during therapy to enhance circuit maintenance throughout long-term support. Until today, a novel oxygenator and heat exchanger along with a simplified manufacturing protocol have been established. The first layouts of the unit to allow the spill- and bubble-free connection and disconnection of modules as well as improved cannulas and a rotational pump are investigated using computational fluid dynamics. Tests were performed according to current guidelines in vitro and in vivo. The test results show the feasibility and potential of the concept.

  14. Applicability of liver transplantation in Catalonia at the end of the millennium. A prospective study of adult patient selection for liver transplantation.

    Science.gov (United States)

    Vargas, Víctor; Rimola, Antoni; Casanovas, Teresa; Castells, Lluis; Navasa, Miquel; Baliellas, Carme; Bilbao, Itxarone; Visa, Josep; Jaurrieta, Eduardo; Margarit, Carlos

    2003-04-01

    We prospectively studied the global applicability of liver transplantation in Catalonia, a region with a high rate of organ donation. We followed 232 adult patients assessed as possible candidates for liver transplantation over 12 months in the three hospitals that perform the procedure in this region. The liver disease leading to patient assessment was cirrhosis in most cases, alone (159 patients) or associated with hepatocellular carcinoma (57 patients). After being assessed, 150 patients (65%) were accepted for transplantation and included on the waiting list, and 82 (32%) were excluded. Death during the period of assessment, advanced tumoral disease, early stage of liver disease, and extrahepatic co-morbidities were the most important reasons for exclusion. The median time of assessment of patients accepted for transplantation was 40 days. Of the 150 patients included on the waiting list, 131 (87%) received transplants, 17 (11%) were removed from the list, and two were still waiting for transplantation at the end of the follow-up period. Death and tumor progression were the most important reasons for patients' removal from the waiting list. The median time on the waiting list was 59 days. In conclusion, among liver-transplant candidates the overall applicability of this therapy in Catalonia was relatively low (131 out of 232 transplant candidates finally underwent transplantation, 56%), and inadequate liver-transplant indications and death or tumor progression during the period of assessment or while the patient was on the waiting list were the most frequent reasons why liver transplantations did not proceed.

  15. Outcomes of transplants from patients with small renal tumours, live unrelated donors and dialysis wait-listed patients.

    Science.gov (United States)

    Brook, Nicholas R; Gibbons, Norma; Johnson, David W; Nicol, David L

    2010-05-01

    We report the outcomes of renal transplant patients (n = 43) who received grafts from donors (n = 41) with small (live unrelated transplants (LURTs) (n = 120) and to patient survival on the transplant waiting list for those who did not receive a kidney during this period (n = 153). Patient survival at 1, 3 and 5 years were 92%, 88% and 88% for recipients of tumourectomized kidneys (TKs), 99%, 97% and 97% for LURTs, and 98%, 92% and 74% for dialysis patients waiting for a deceased donor kidney (log rank score 10.4, P = 0.005). One patient experienced a local tumour recurrence at 9 years following transplantation. This patient declined intervention and is currently under active surveillance. Transplantation of tumourectomized kidneys from patients with small, localized, incidentally detected renal tumours results in similar outcomes to conventional LURTs and confers a significant survival advantage for patients who would otherwise be unable to receive a transplant.

  16. Urinary iodine as an iodine deficiency test in lung transplant recipients in order to prevent iodine deficiency disorders.

    Science.gov (United States)

    Stanjek-Cichoracka, Anita; Żegleń, Sławomir; Woźniak-Grygiel, Elżbieta; Laszewska, Anna; Sindera, Piotr; Wojarski, Jacek; Ochman, Marek; Karolak, Wojtek; Zembala, Marian

    2014-10-07

    In Poland, lung transplantation (LTx) as a routine method began in 2004, and since then, the Silesian Center for Heart Disease in Zabrze 85 LTx has performed (54 single-lung transplantations, 30 double-lung transplantations, and 1 heart-lung) transplantation. The recommendation to take vitamin supplements (without specific indication of the iodine content) does not apply to another iodine prophylaxis in patients after lung transplantation, excluding patients with known thyroid disease. The aim of this study was to assess thyroid gland function based on hormones and urinary iodine (UI) concentration in patients after LTx. UI analysis was performed in 19 lung recipients (12 men and 7 women; mean age: 46.2 ± 12.47 years, BMI: 21 ± 2.25) and compared to TSH, free T3, and free T4. Sufficient UI was observed only in 2 (9%) samples. In 12 samples (54.5%), mild iodine deficiency was recorded, in 4 samples (18.2%) moderate iodine deficiency was noted, and in 3 (13.6%) severe iodine deficiency was found. No correlation between BMI and UI, as well as hormones concentration, was observed. No correlation was revealed when analyzed samples were divided by patient sex. Although thyroid gland hormones were in the normal range, we found moderate, mild, and severe iodine deficiency in the majority of analyzed samples. Measurements of urinary iodine in lung transplant recipients should accompany thyroid hormone measurements as an iodine deficiency test and in order to prevent iodine deficiency disorders.

  17. Clinical and epidemiological aspects of cornea transplant patients of a reference hospital

    Directory of Open Access Journals (Sweden)

    Giovanna Karinny Pereira Cruz

    Full Text Available ABSTRACT Objective: clinically characterizing cornea transplant patients and their distribution according to indicated and post-operative conditions of cornea transplantation, as well as estimating the average waiting time. Method: a cross-sectional, descriptive and analytical study performed for all cornea transplants performed at a reference service (n=258. Data were analyzed using Statistical Package for the Social Sciences, version 20.0. Results: the main indicator for cornea transplant was keratoconus. The mean waiting time for the transplant was approximately 5 months and 3 weeks for elective transplants and 9 days for urgent cases. An association between the type of corneal disorder with gender, age, previous surgery, eye classification, glaucoma and anterior graft failure were found. Conclusion: keratoconus was the main indicator for cornea transplant. Factors such as age, previous corneal graft failure (retransplantation, glaucoma, cases of surgeries prior to cornea transplant (especially cataract surgery may be related to the onset corneal endothelium disorders.

  18. Qualitative studies of the food safety knowledge and perceptions of transplant patients.

    Science.gov (United States)

    Chen, Gang; Kendall, Patricia A; Hillers, Virginia N; Medeiros, Lydia C

    2010-02-01

    Organ and stem cell transplant patients are at risk for foodborne illness due to disease and medically induced immunosuppression. The food safety knowledge and informational needs of these groups have not been documented in the literature. The objectives of this study were to assess transplant patients' food safety knowledge and perceptions, to probe the likelihood of practicing safe food handling behavior, and to test an educational strategy for future food safety interventions aimed at transplant patients. Subjects were organ or stem cell transplant patients, or their family care providers. Research was conducted in inpatient or outpatient facilities at a large, Midwestern United States comprehensive cancer and transplant center. Differences in survey data between the organ and stem cell transplant groups were determined by Student's t tests. Ethnographic methods were used to analyze qualitative focus groups and interview data for themes. Organ transplant patients had less motivation to follow food safety recommendations than did stem cell transplant patients, and they were more likely to consume risky foods. Stem cell transplant patients overall had a better understanding of their susceptibility to foodborne illness and had better prepared themselves with the knowledge and behavior changes needed to protect their health. Educational materials aimed at communicating food safety information for transplant patients were evaluated by patients and judged acceptable. This study found that organ transplant and stem cell transplant patients are distinct patient populations, with differing perceptions regarding the seriousness of foodborne illness and willingness to adopt preventative food handling practices. Population differences should be accounted for in food safety educational strategies.

  19. Aortic bypass surgery for asymptomatic patients awaiting a kidney transplant: a word of caution.

    Science.gov (United States)

    Franquet, Q; Terrier, N; Pirvu, A; Rambeaud, J-J; Long, J-A; Janbon, B; Tetaz, R; Malvezzi, P; Jouve, T; Descotes, J-L; Fiard, G

    2018-02-02

    In the presence of severe aorto-iliac calcification, aortic bypass surgery can be mandatory to allow kidney transplantation. The aim of our study was to evaluate the safety and outcomes of this strategy among asymptomatic patients. We retrospectively reviewed the files of all patients that had undergone vascular bypass surgery prior to kidney transplantation between November 2004 and March 2016. All patients undergoing aortic bypass surgery prior to kidney transplantation without any vascular-related symptoms were included. Twenty-one asymptomatic patients were included. Ten patients (48%) have not received a kidney transplant. Four patients died before kidney transplantation, including two deaths related to the bypass surgery (9.5%). Early post-operative morbidity involved 11 cases. Eleven patients (52%) were transplanted. Transplanted patients were significantly younger (median age 60 (56-61) versus 67 (60-72) years, p=0 .04) at the time of bypass and were less frequently treated for coronary heart disease (9% versus 50%, p=0.06). Aortic bypass surgery performed prior to kidney transplantation among asymptomatic patients has significant mortality and morbidity rates. When transplantation is possible, the results are satisfying. Larger studies are required to define the selection criteria, such as age and coronary heart disease. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  20. Imaging spectrum of central nervous system complications of hematopoietic stem cell and solid organ transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Server, Andres [Oslo University Hospital-Rikshospitalet, Section of Neuroradiology, Department of Radiology and Nuclear Medicine, Oslo (Norway); Bargallo, Nuria [Universitat de Barcelona, Section of Neuroradiology, Department of Radiology, Hospital Clinic, Barcelona (Spain); Institut d' investigacions Biomediques August Pi i Sunyer (IDIBARS), Resonance Magnetic Image Core Facility, Barcelona (Spain); Floeisand, Yngvar [Oslo University Hospital-Rikshospitalet, Department of Hematology, Oslo (Norway); Sponheim, Jon [Oslo University Hospital-Rikshospitalet, Section of Gastroenterology, Department of Transplantation Medicine, Oslo (Norway); Graus, Francesc [Universitat de Barcelona, Department of Neurology, Hospital Clinic, Barcelona (Spain); Institut d' investigacions Biomediques August Pi i Sunyer (IDIBARS), Neuroimmunology Program, Barcelona (Spain); Hald, John K. [Oslo University Hospital-Rikshospitalet, Section of Neuroradiology, Department of Radiology and Nuclear Medicine, Oslo (Norway); University of Oslo, Faculty of Medicine, Oslo (Norway)

    2017-02-15

    Neurologic complications are common after hematopoietic stem cell transplantation (HSCT) and solid organ transplantation (SOT) and affect 30-60% of transplant recipients. The aim of this article is to provide a practical imaging approach based on the timeline and etiology of CNS abnormalities, and neurologic complications related to transplantation of specific organs. The lesions will be classified based upon the interval from HSCT procedure: pre-engraftment period <30 days, early post-engraftment period 30-100 days, late post-engraftment period >100 days, and the interval from SOT procedure: postoperative phase 1-4 weeks, early posttransplant syndromes 1-6 months, late posttransplant syndromes >6 months. Further differentiation will be based on etiology: infections, drug toxicity, metabolic derangements, cerebrovascular complications, and posttransplantation malignancies. In addition, differentiation will be based on complications specific to the type of transplantation: allogeneic and autologous hematopoietic stem cells (HSC), heart, lung, kidney, pancreas, and liver. Thus, in this article we emphasize the strategic role of neuroradiology in the diagnosis and response to treatment by utilizing a methodical approach in the work up of patients with neurologic complications after transplantation. (orig.)

  1. Clostridium Difficile and Fecal Microbial Transplant in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Sarvin Sanaie

    2014-07-01

    Full Text Available Critically-ill patients constitute majority of the patients hospitalized in ICU wards (1, 2. This group of patients demands special considerations and measures of care (3-6. Clostridium difficile infection causes dangerous, painful and persistent diarrhea in critically ill patients. Its treatment consists of enteral metronidazol or vancomycin in combination with IV antibiotics cessation. Recently, probiotics have been considered as an alternative treatment for pseudomembranous colitis. In 1958, fecal microbial transplant was first described from healthy individuals to sick patients to displace pathogenic microbes from the intestine by re-establishing a healthy microbial community. Since then, it has gained value as “express stool treatment” or currently known as “fecal transplant”. Last year, FDA classified stool as drug, which typically requires an Investigational New Drug application (IND. However, in July 2013, the FDA issued guidance stating that it would exercise enforcement discretion for physicians administering FMT to treat patients with recurrent Clostridium difficile infection. Accordingly, considering stool as a tissue product or giving it its own classification, as FDA approved for blood, would keep patients safe, ensure broad access and facilitate research (7. It should be taken into consideration that some complications might accompany fecal microbial transplant such as making patients susceptible for conditions like obesity or autoimmune disorders. Safety and quality assurance starts from pre-enrollment donor screening, donor testing (17 serological and stool-based assays, donor monitoring and process control. The composition of the bacterial community has been shown to change when stored at -80oC compared to the samples stored at -20oC and it has been recommended to store the samples of intestinal content at -20oC before use for bacterial community analysis, instead of the current practice at -80oC (7, 8. However, if

  2. [Efficacy of parenteral glutamine in patients undergoing bone marrow transplantation].

    Science.gov (United States)

    Oliva García, J G; Pereyra-García Castro, F; Suárez Llanos, J P; Ríos Rull, P; Breña Atienza, J; Palacio Abizanda, J E

    2012-01-01

    Autologous bone marrow transplant (ABMT) represents a high metabolic stress. Glutamine has proven to be effective in severe catabolic states, although there are controversial studies. To assess the effect of parenteral nutrition (PN) therapy supplemented with glutamine on the occurrence of mucositis and mean hospital stay in patients submitted to ABMT. Retrospective study of patients submitted to ABMT between 2006 and 2009. In 2008, one vial of L-alanyl-L-glutamine (20 g) was added by protocol to the PN formulations of these patients. Thirteen clinical charts since that date (glutamine group) and 13 previous charts (control group) were randomly selected (n = 26). We compared the degree of mucositis and hospital stay in both groups. In the subgroup of glutamine-treated patients, we compare the glutamine dose in the patients developing some degree of mucositis with that of those not having this complication. Mean hospital stay: 27.8 ± 7.4 days (control group) vs. 20.3 ± 5.3 days (glutamine group) (p = 0.01). The severity of mucositis was lower in the glutaminetreated group (p = 0.02). The weight-adjusted dose of L-alanyl-L-glutamine in the patients not developing mucositis was higher than in the other ones (0.32 vs. 0.24 g/kg/day; p = 0.02). Glutamine supplementation reduces the degree of mucositis and hospital stay in patients submitted to autologous bone marrow transplantation. The degree of mucositis is lower in the subgroup of patients receiving higher doses of glutamine.

  3. Successful heart transplantation in patients with total artificial heart infections.

    Science.gov (United States)

    Taimur, Sarah; Sullivan, Timothy; Rana, Mennakshi; Patel, Gopi; Roldan, Julie; Ashley, Kimberly; Pinney, Sean; Anyanwu, Anelechi; Huprikar, Shirish

    2018-02-01

    Data are limited on clinical outcomes in patients awaiting heart transplant (HT) with total artificial heart (TAH) infections. We retrospectively reviewed all TAH recipients at our center. TAH infection was classified as definite if a microorganism was isolated in cultures from the exit site or deep tissues around the TAH; as probable in patients without surgical or microbiologic evidence of infection but no other explanation for persistent or recurrent bloodstream infection (BSI); or possible in patients with clinical suspicion and radiographic findings suggestive of TAH infection, but without surgical intervention or microbiologic evidence. From 2012 to 2015, a total of 13 patients received a TAH, with a median age at implantation of 52 years (range: 28-60). TAH infection occurred in nine patients (seven definite, one probable, one possible) a median of 41 days after implant (range: 17-475). The majority of TAH infections were caused by Staphylococcus species. Seven of nine patients underwent HT (four had pre-HT mediastinal washout, and five had positive HT operative cultures). Three patients had an active BSI caused by the same pathogen causing TAH infection at the time of HT, with one developing a post-HT BSI with the same bacteria. No patient developed post-HT surgical site infection caused by the TAH infection pathogen. No deaths among HT recipients were attributed to infection. TAH infection is frequently associated with BSI and mediastinitis and Staphylococcus was the most common pathogen. A multimodal approach of appropriate pre- and post-HT antimicrobial therapy, surgical drainage, and heart transplantation with radical mediastinal debridement was successful in curing infection. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Changes in heart transplant recipients that parallel the personalities of their donors.

    Science.gov (United States)

    Pearsall; Schwartz; Russek

    2000-03-21

    Context: It is generally assumed that learning is restricted to neural and immune systems. However, the systemic memory hypothesis predicts that all dynamical systems that contain recurrent feedback loops store information and energy to various degrees. Sensitive transplant patients may evidence personal changes that parallel the history of their donors. Objective: To evaluate whether changes following heart transplant surgery parallel the history of the donors. Design: Open-ended interviews with volunteer (1) transplant recipients, (2) recipient families or friends, and (3) donor families or friends. Setting: Hospitals in various parts of the country. Patients: Ten recipients (7 males, 3 females; 7 months to 56 years old), received heart (or heart-lung) transplants (5 males, 5 females; 16 months to 34 years old). Main Outcome Measures: Transcripts of audio taped interviews quoted verbatim. Results: Two to 5 parallels per case were observed between changes following surgery and the histories of the donors. Parallels included changes in food, music, art, sexual, recreational, and career preferences, as well as specific instances of perceptions of names and sensory experiences related to the donors (e.g., one donor was killed by a gun shot to the face; the recipient had dreams of seeing hot flashes of light in his face). Conclusion: The incidence of recipient awareness of personal changes in cardiac transplant patients is unknown. The effects of the immunosuppressant drugs, stress of the surgery, and statistical coincidence are likely insufficient to explain the findings. The plausibility of cellular memory, possibly systemic memory, is suggested.

  5. [Infectious complications in patients undergoing a heart transplant].

    Science.gov (United States)

    Bouza, E; Muñoz, P

    1995-01-01

    Infectious complications are, with rejection, the main cause of morbidity and mortality in heart transplantation recipients. Adequate management of these patients requires an adequate knowledge of risk factors, of most common infectious syndromes and of relevant microorganism, as long as of their resistance pattern. Among the first group, we may mention lower respiratory tract infections, mediastinitis and meningitis, and among the microorganisms, Citomegalovirus, Aspergillus and Toxoplasma gondii. The impressive development of diagnostical techniques and of prophylactic and therapeutical possibilities suggest the convenience of a multidisciplinar approach to these complications.

  6. Mycobacterium haemophilum Masquerading as Leprosy in a Renal Transplant Patient

    Science.gov (United States)

    Copeland, Nathanial K.; Arora, Navin S.; Ferguson, Tomas M.

    2013-01-01

    Opportunistic infections following immunosuppression in solid organ transplant (SOT) patients are common complications with the skin being a common sight of infection. Nontuberculous mycobacteria (NTM) are rare but potential causes of skin infection in SOT patients. We present a case of an adult male immunosuppressed following renal transplantation who presented with an asymptomatic rash for several months. The patient's skin eruption consisted of erythematous papules and plaques coalescing into an annular formation. After failure of the initial empiric therapy, a punch biopsy was performed that demonstrated nerve involvement suspicious for Mycobacterium leprae. However, culture of the biopsy specimen grew acid-fast bacilli that were subsequently identified as M. haemophilum. His rash improved after a prolonged course of clarithromycin and ciprofloxacin. Both organisms are potential causes of opportunistic skin infections and can be difficult to distinguish with similar predilection for skin and other biochemical and genetic similarities. Ultimately they can be distinguished with culture as M. haemophilum will grow in culture and M. leprae will not. This case was unique due to nerve involvement on biopsy which is classically seen on biopsies of leprosy. PMID:24369511

  7. Importance of Liver Biopsy Findings on Prognosis of Kidney Transplant Patients.

    Science.gov (United States)

    Özgün, Gonca; Özdemir, Binnaz Handan; Tunca, Müzeyyen Zeyneb; Börcek, Pelin; Haberal, Mehmet

    2016-11-01

    Chronic hepatitis infection among kidney transplant recipients is not infrequent, with those with hepatitis C virus infection having worse survival. Here, we evaluated liver biopsy changes and its effects on prognosis in kidney transplant recipients. Patients with liver biopsies were selected from 1275 kidney transplant recipients who were treated at Başkent University from January 1990 to December 2012. Demographic and clinical findings were evaluated, including age, sex, liver biopsy findings, amyloid and hemosiderin accumulation, and patient survival. Among 1275 renal transplant patients, only 149 patients had liver biopsies. Of 149 patients, 68 patients (45.3%) had liver biopsy only before and 81 patients had liver biopsy after transplant, with 20 of the 81 patients also having biopsy before transplant. The 81 patients who had a liver biopsy after renal transplant were included in the study. In our patient group, mean follow-up was 166 ± 29 months, female-to-male ratio was 26/55, and mean age was 30.2 ± 9.87 years (range, 15-56 y). Only 2 of 81 liver biopsies (2.4%) were diagnosed as normal or nonspecific. Biopsy findings of the remaining 79 patients (97.6%) showed variable pathologies, including hepatocellular damage and minimal cholestatic changes in 29 patients (35.8%), chronic nonviral hepatitis in 9 (11.1%), and viral hepatitis in 41 (50.6%). The mean time between the first liver biopsy taken before transplant and second biopsy after transplant was 44.5 ± 38.0 months (range, 11-139 mo). Among 81 patients, 6 (7.4%) showed amyloid deposition and 13 (16.0%) showed hemosiderosis. Testing for viral infections is critical in transplant recipients. It is well known that these infections can affect the frequency of rejection episodes and also negatively affect survival in solidorgan transplant recipients. Livers should be evaluated by biopsy even if the variance in liver enzymes or serology is minimal.

  8. Biopsy-diagnosed renal disease in patients after transplantation of other organs and tissues.

    Science.gov (United States)

    Schwarz, A; Haller, H; Schmitt, R; Schiffer, M; Koenecke, C; Strassburg, C; Lehner, F; Gottlieb, J; Bara, C; Becker, J U; Broecker, V

    2010-09-01

    Renal function deteriorates in about half of patients undergoing other transplants. We report the results of 105 renal biopsies from 101 nonrenal transplant recipients (bone marrow 14, liver 41, lung 30, heart 20). Biopsy indications were protracted acute renal failure (9%), creatinine increases (83%), heavy proteinuria (22%), or renal insufficiency before re-transplantation (9%). Histological findings other than nonspecific chronic changes, hypertension-related damage, and signs of chronic CNI toxicity included primary glomerular disease (17%), mostly after liver transplantation (21%) or after bone marrow transplantation (29%), and thrombotic microangiopathy (TMA) namely (10%). TMA had the most serious impact on the clinical course. Besides severe hypertension, one TMA patient died of cerebral hemorrhage, 5 had hemolytic-uremic syndrome, and 6 rapidly developed end-stage renal failure. TMA patients had the shortest kidney survival post-biopsy and, together with patients with acute tubular injury, the shortest kidney and patient survival since transplantation. Nine TMA patients had received CNI, 3 of them concomitantly received an mTOR-inhibitor. CNI toxicity is implicated in most patients with renal failure after transplant of other organs and may play a role in the development of TMA, the most serious complication. However, decreased renal function should not be routinely ascribed to CNI. © 2010 The Authors Journal compilation © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

  9. Iron Overload in Patients Undergoing Hematopoietic Stem Cell Transplantation

    Directory of Open Access Journals (Sweden)

    Vinod Pullarkat

    2010-01-01

    Full Text Available Recipients of hematopoietic stem cell transplantation (HSCT frequently have iron overload resulting from chronic transfusion therapy for anemia. In some cases, for example, in patients with myelodysplastic syndromes and thalassemia, this can be further exacerbated by increased absorption of iron from the gut as a result of ineffective erythropoiesis. Accumulating evidence has established the negative impact of elevated pretransplantation serum ferritin, a surrogate marker of iron overload, on overall survival and nonrelapse mortality after HSCT. Complications of HSCT associated with iron overload include increased bacterial and fungal infections as well as sinusoidal obstruction syndrome and possibly other regimen-related toxicities. Based on current evidence, particular attention should be paid to prevention and management of iron overload in allogeneic HSCT candidates, especially in patients with thalassemia and myelodysplastic syndromes. The pathophysiology of iron overload in the HSCT patient and optimum strategies to deal with iron overload during and after HSCT require further study.

  10. Pre-and-post transplant considerations in patients with nonalcoholic fatty liver disease

    OpenAIRE

    Khullar, Vikas; Dolganiuc, Angela; Firpi, Roberto J

    2014-01-01

    Non-alcoholic fatty liver disease (NAFLD) is currently the third most common indication for liver transplantation in the United States. With the growing incidence of obesity, NAFLD is expected to become the most common indication for liver transplantation over the next few decades. As the number of patients who have undergone transplantation for NAFLD increases, unique challenges have emerged in the management and long-term outcomes in patients. Risk factors such as obesity, hypertension, dia...

  11. Amiodarone in cardiac transplant waiting list patients with severe heart failure

    OpenAIRE

    N. N. Koloskova; V. N. Poptsov; G. M. Salikhova

    2017-01-01

    Heart transplantation is the «gold standard» of severe heart failure treatment. Sudden arrhythmic death is the leading cause of death among these patients. Amiodarone is the only antiarrhythmic drug with beneficial effect on survival of patients with end-stage heart failure. Given its long half-life, pre-transplant use of amiodarone has been extensively discussed focusing on divergent results regarding morbidity and mortality after heart transplantation. Its adverse clinical events after tran...

  12. Prevalence of vancomycin-resistant Enterococcus fecal colonization among kidney transplant patients

    Directory of Open Access Journals (Sweden)

    Barbosa Dulce

    2006-08-01

    Full Text Available Abstract Background End stage renal disease patients are at risk of Vancomycin-Resistant Enterococcus (VRE infections. The first reports of VRE isolation were from hemodialysis patients. However, to date, VRE fecal colonization rates as well as associated risk factors in kidney transplant patients have not yet been established in prospective studies. Methods We collected one or two stool samples from 280 kidney transplant patients and analysed the prevalence of VRE and its associated risk factors. Patients were evaluated according to the post-transplant period: group 1, less than 30 days after transplantation (102 patients, group 2, one to 6 months after transplantation (73 patients and group 3, more than 6 months after transplantation (105 patients. Results The overall prevalence rate of fecal VRE colonization was 13.6% (38/280, respectively 13.7% for Group 1, 15.1% for group 2 and 12.4% for group 3. E. faecium and E. faecalis comprised 50% of all VRE isolates. No immunologic variables were clearly correlated with VRE colonization and no infections related to VRE colonization were reported. Conclusion Fecal VRE colonization rates in kidney transplant patients were as high as those reported for other high-risk groups, such as critical care and hemodialysis patients. This high rate of VRE colonization observed in kidney transplant recipients may have clinical relevance in infectious complications.

  13. Hopelessness, suicide ideation, and depression in chronic kidney disease patients on hemodialysis or transplant recipients.

    Science.gov (United States)

    Andrade, Sibela Vasconcelos; Sesso, Ricardo; Diniz, Denise Helena de Madureira Pará

    2015-01-01

    Hopelessness, suicide ideation and depression symptoms affect life quality and expectancy of chronic kidney disease patients. To verify whether there are differences in hopelessness, suicide ideation and depression symptoms between chronic kidney disease patients on hemodialysis or transplant recipients. We also analyzed the influence of sociodemographic factors in these symptoms. Cross-sectional study in which 50 clinically stable chronic hemodialysis patients and 50 renal transplant patients matched by gender and age. Instruments-Beck Hopelessness Scale (BHS), Beck Scale for Suicide Ideation (BSI) and Beck Depression Inventory (BDI). BHS: 2% of each group scoring > 8 (p = 1.00). BSI: 4% in hemodialysis and 6% of the transplant patients scoring > 1 (p = 1.000). BDI: 20% in hemodialysis and 12% of transplant patients scoring > 14 (p = 0.275). Patients who did not have a labor activity presented more depressive symptoms (average BDI score: 10.5 vs. 7.3, p = 0.027). Transplant patients from deceased donor presented more depressive symptoms compared with those with transplant from living donors (average BDI score: 11.0 vs. 6.7, p = 0.042). There was no difference in the intensity of hopelessness, suicide ideation and depression symptoms between stable hemodialysis and transplant patients. Not performing a labor activity and receiving the transplant from deceased donor lead to more depressive symptoms. The high prevalence of depressive symptoms and the finding of suicide ideation in both modalities of renal replacement therapy point to the need to monitor and care for those patients.

  14. Cardiac Transplantation in a Patient with Septicemia After Prolonged Intraaortic Balloon Pump Support: Implications for Staged Transplantation

    OpenAIRE

    Frazier, O. H.; Cooley, Denton A.; Okereke, O. U. J.; Radovančević, Branislav; Chandler, Linda B.

    1986-01-01

    After initial support with an intraaortic balloon pump, and since the introduction of cyclosporine for immunosuppression, five patients have undergone cardiac transplantation in our institution with good results. Not one of these patients died of sepsis in the immediate postoperative period. We report the clinical course of one such patient to show the advantage of cyclosporine immunosuppression and the value of circulatory support devices in patients awaiting suitable cardiac donors.

  15. [Population pharmacokinetics of tacrolimus in Chinese renal transplant patients].

    Science.gov (United States)

    Zhang, Guan-min; Li, Liang; Chen, Wen-qian; Bi, Shan-shan; Liu, Xiao; Zhang, Xiang-lin; Lu, Wei

    2008-07-01

    The goal of this study is to investigate the population pharmacokinetics of oral tacrolimus in Chinese renal transplant patients and to identify possible relationship between covariates and population parameters. Details of drug dosage history, sampling time and concentration of 802 data points in 58 patients were collected retrospectively. Before analysis, the 58 patients were randomly allocated to either the model building group (n=41) or the validation group (n=17). Population pharmacokinetic data analysis was performed using the nonlinear mixed-effects model (NONMEM) program on the model building group. The pharmacokinetics of tacrolimus was best described by a one compartment model with first-order absorption and elimination. Typical values of apparent clearance (CL/F), apparent volume of distribution (V/F) were estimated. A number of covariates including demographic index, clinical index and coadministration of other drugs were evaluated statistically for their influence on these parameters. The final population model related clearance with POD (post operative days), HCT (haematocrit), AST (aspartate aminotransferase) and coadministration of nicardipine and diltiazem. Predictive performance of the final model evaluated with the validation group showed insignificant bias between observed and model predicted concentrations. Typical value of CL/F and V/F was 21.7 L x h(-1) and 241 L, inter-patient variability (RSD) in CL/F and V/F was 41.6% and 49.7%, respectively. The residual variability (SD) between observed and model-predicted concentrations was 2.19 microg x L(-1). The population pharmacokinetic model of tacrolimus in Chinese renal transplant patients was established and significant covariates on the tacrolimus model were identified.

  16. Patient factors associated with lung transplant referral and waitlist for patients with cystic fibrosis and pulmonary fibrosis.

    Science.gov (United States)

    Liu, Yuan; Vela, Monica; Rudakevych, Tanya; Wigfield, Christopher; Garrity, Edward; Saunders, Milda R

    2017-03-01

    Since 2005, the Lung Allocation Score (LAS) has prioritized patient benefit and post-transplant survival, reducing waitlist to transplant time to fibrosis (CF) and pulmonary fibrosis (PF). We analyzed the times from transplant eligibility to referral, work-up and waitlisting using Kaplan-Meier curves and log-rank tests. Overall, the referral rate for transplant-eligible patients was 64%. Of those referred, approximately 36% reach the lung transplant waitlist. Referred CF patients were significantly more likely to reach the transplant waitlist than PF patients (CF 60% vs PF 22%, p < 0.05). In addition, CF patients had a shorter wait from transplant eligibility to waitlist than PF patients (329 vs 2,369 days, respectively [25th percentile], p < 0.05). Patients with PF and CF both faced delays from eligibility to referral and waitlist. Quality improvement efforts are needed to better identify and refer appropriate patients for lung transplant evaluation. Targeted interventions may facilitate more efficient evaluation completion and waitlist appearance. Copyright © 2017 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  17. Anticarbohydrate Antibody Repertoires in Patients Transplanted with Fetal Pig Islets Revealed by Glycan Arrays

    DEFF Research Database (Denmark)

    Blixt, Klas Ola; Kumagai-Braesch, A.; Tibell, A.

    2009-01-01

    Ten patients with type I diabetes were transplanted with porcine fetal islet-like cell clusters (ICC) between 1990 and 1993. A significant rise in the anti-a-Gal antibody titers was seen posttransplant, but also non-a-Gal-specific antibodies were detected in some patients. We have reanalyzed...... the carbohydrate specificity of antibodies in the sera from seven of these patients taken before transplantation, 1, 6 and 12 months posttransplantation using a glycan array with 200 structurally defined glycans. The main findings were: (i) prepig ICC transplantation patients had antibodies reactive with terminal...... compounds; (ii) the titers of all carbohydrate-specific antibodies detected before transplantation rose after transplantation; (iii) the kinetics of the antibody responses differed between patients; (iv) in some patients antibodies reacting with Gala1,3Lex and several structures terminated with Neu5Gc...

  18. Study of Bacterial Infections Among Patients Receiving Kidney Transplant in Mashhad, Iran.

    Science.gov (United States)

    Mansury, Davood; Khaledi, Azad; Ghazvini, Kiarash; Sabbagh, Mahin Ghorban; Zare, Hosna; Rokni-Hosseini, Mohammad Hossein; Vazini, Hossein

    2017-11-15

    Over the past 2 decades, significant advances have been made in the management of infections after transplant; however, transplant recipients are still at high risk of infectious complications. This study aimed to evaluate the prevalence of bacterial infections and antimicrobial resistance patterns in kidney transplant recipients. This cross-sectional study included 356 patients who received kidney transplants, regardless of the underlying disease, from 2013 to 2015 at the Montaserieh Transplant Hospital (Mashhad, Iran). Clinical samples collected from patients were sent to the microbiology laboratory for culture processing. Typing of bacteria was conducted, and susceptibility testing was performed according to the Clinical and Laboratory Standards Institute guideline by use the of disk diffusion agar method. Data were then analyzed by SPSS software (SPSS: An IBM Company, IBM Corporation, Armonk, NY, USA) using chi-square test. Among 356 kidney recipients (206 men and 150 women), 115 (32.3%) received transplants from living donors and 241 (67.7%) received transplants from deceased donors. Of 356 total patients, 112 patients (31.5%) had an infection at various times after transplant. The most common gram-negative and gram-positive isolated bacteria were Escherichia coli and coagulase-negative Staphylococcus, with prevalence rates of 66.1% and 48.6%. Most of the isolates were resistant against selected antibiotics. Because of the high prevalence of infection among transplant patients, infection prevention should receive more attention, and antibiotic susceptibility should be determined before treatment.

  19. The impact of hemoglobin levels on patient and graft survival in renal transplant recipients.

    LENUS (Irish Health Repository)

    Moore, Jason

    2008-08-27

    It remains unclear whether low hemoglobin levels are associated with increased mortality or graft loss after renal transplantation. This study assessed the relationship of hemoglobin levels with patient and graft survival in 3859 patients with functioning renal transplants more than 6-months posttransplantation.

  20. Unusual Pathology in a Kidney from a Heart-Transplant Patient

    Directory of Open Access Journals (Sweden)

    Marie Larcher

    2017-01-01

    Full Text Available Acute kidney injury (AKI is often observed after heart transplantation. In this setting, acute tubular necrosis is the main histological finding on kidneys. We report the unusual pathology found in a kidney from a heart-transplant patient. The patient experienced several hemodynamic insults, massive transfusion, and implantation of a mechanical circulatory-support device before heart transplantation: there was prolonged AKI after transplantation. A kidney biopsy revealed acute tubular necrosis and renal hemosiderosis, which was probably related to the transfusion and to mechanical circulatory-support device-induced intravascular hemolysis. Assessment of iron during resuscitation could have prevented, at least partly, AKI.

  1. Role of metabolites and calcineurin inhibition on C2 monitoring in renal transplant patients

    DEFF Research Database (Denmark)

    Karamperis, N.; Koefoed-Nielsen, P.; Bagger, Sorensen A.

    2005-01-01

    BACKGROUND: Many transplantation centres have switched to C2 monitoring of cyclosporin-treated renal transplant patients. The rationale is that the C2 correlates best with AUC0-4 (area under the concentration-time curve), which again correlates with rejection and nephrotoxicity. It has also been...... metabolites were added to whole blood from healthy volunteers and the calcineurin phosphatase activity (CaN) was determined. Twenty renal transplant patients at varying times after transplantation had blood samples drawn in the morning before and 1, 2, 3 and 4 h after intake of their usual dose of cyclosporin...

  2. A Characterization of the Oral Microbiome in Allogeneic Stem Cell Transplant Patients

    Science.gov (United States)

    Ames, Nancy J.; Sulima, Pawel; Ngo, Thoi; Barb, Jennifer; Munson, Peter J.; Paster, Bruce J.; Hart, Thomas C.

    2012-01-01

    Background The mouth is a complex biological structure inhabited by diverse bacterial communities. The purpose of this study is to describe the effects of allogeneic stem cell transplantation on the oral microbiota and to examine differences among those patients who acquired respiratory complications after transplantation. Methodology/Principal Findings All patients were consented at the National Institutes of Health, Clinical Center. Bacterial DNA was analyzed from patients' oral specimens using the Human Oral Microbe Identification Microarray. The specimens were collected from four oral sites in 45 allogeneic transplantation patients. Specimens were collected at baseline prior to transplantation, after transplantation at the nadir of the neutrophil count and after myeloid engraftment. If respiratory signs and symptoms developed, additional specimens were obtained. Patients were followed for 100 days post transplantation. Eleven patients' specimens were subjected to further statistical analysis. Many common bacterial genera, such as Streptococcus, Veillonella, Gemella, Granulicatella and Camplyobacter were identified as being present before and after transplantation. Five of 11 patients developed respiratory complications following transplantation and there was preliminary evidence that the oral microbiome changed in their oral specimens. Cluster analysis and principal component analysis revealed this change in the oral microbiota. Conclusions/Significance After allogeneic transplantation, the oral bacterial community's response to a new immune system was not apparent and many of the most common core oral taxa remained unaffected. However, the oral microbiome was affected in patients who developed respiratory signs and symptoms after transplantation. The association related to the change in the oral microbiota and respiratory complications after transplantation will be validated by future studies using high throughput molecular methods. PMID:23144704

  3. Gastrointestinal Endoscopy Is Safe in Patients Before and After Lung or Heart Transplantation.

    Science.gov (United States)

    Lenzen, Henrike; Cieplik, Natascha; Elkharsawi, Ahmed R; Negm, Ahmed A; Avsar, Murat; Bara, Christoph L; Gottlieb, Jens; Manns, Michael P; Lankisch, Tim O

    2015-07-01

    Gastrointestinal complications are common in patients after lung and heart transplantation. Endoscopy is a standard method for the assessment of gastrointestinal morbidities. The aim of this study was to analyze the number and type of complications during endoscopic procedures in patients before and after lung or heart transplantation. A retrospective single centre analysis of endoscopic procedures in patients before and after lung and heart transplantation from May 1999 to September 2012 was performed compared to a control group. Four hundred fifty-nine endoscopic procedures were performed in 175 patients after transplantation (84 lung and 91 heart) and 213 procedures in 160 transplant candidates on the waiting list for lung (n = 126) or heart (n = 34) transplantation. In 26% (n = 56/214) of the endoscopic examinations, an intervention was necessary in the lung transplant group compared to 32% (n = 79/245) in the heart transplant group and 27% (n = 43/160) and 21% (n = 11/53) in the lung and heart transplant candidates, respectively. In the control group, endoscopic interventions were performed in 24% (n = 195/805) of the examinations. Overall, 14 (1%) complications resulted from 1,477 endoscopic examinations. Only four (0.9%) of 459 endoscopic examinations were followed by complications in the transplant recipients, whereas in the control group, 10 complications (1.2%) of 805 endoscopies were documented. No endoscopic complication occurred in the lung and heart transplant candidates. Diagnostic and therapeutic endoscopies can be safely performed after lung and heart transplantation and in patients on the waiting list for these organs.

  4. Amiodarone use in patients listed for heart transplant is associated with increased 1-year post-transplant mortality.

    Science.gov (United States)

    Cooper, Lauren B; Mentz, Robert J; Edwards, Leah B; Wilk, Amber R; Rogers, Joseph G; Patel, Chetan B; Milano, Carmelo A; Hernandez, Adrian F; Stehlik, Josef; Lund, Lars H

    2017-02-01

    Pre-transplant amiodarone use has been postulated as a risk factor for morbidity and mortality after orthotopic heart transplantation (OHT). We assessed pre-OHT amiodarone use and tested the hypothesis that it is associated with impaired post-OHT outcomes. We performed a retrospective cohort analysis of adult OHT recipients from the registry of the International Society for Heart and Lung Transplantation (ISHLT). All patients had been transplanted between 2005 and 2013 and were stratified by pre-OHT amiodarone use. We derived propensity scores using logistic regression with amiodarone use as the dependent variable, and assessed the associations between amiodarone use and outcomes with Kaplan-Meier analysis after matching patients 1:1 based on propensity score, and with Cox regression with adjustment for propensity score. Of the 14,944 OHT patients in the study cohort, 32% (N = 4,752) received pre-OHT amiodarone. Amiodarone use was higher in recent years (29% in 2005 to 2007, 32% in 2008 to 2010, 35% in 2011 to 2013). Amiodarone-treated patients were older and more frequently had a history of sudden cardiac death (27% vs 13%) and pre-OHT mechanical circulatory support. Key donor characteristics and allograft ischemia times were similar between groups. In propensity-matched analyses, amiodarone-treated patients had higher rates of cardiac reoperation (15% vs 13%) and permanent pacemaker (5% vs 3%) after OHT and before discharge. Amiodarone-treated patients also had higher 1-year mortality (hazard ratio 1.15, 95% confidence interval 1.02 to 1.30), but the risks of early graft failure, retransplantation and rehospitalization were similar between groups. Amiodarone use before OHT was independently associated with increased 1-year mortality. The need for amiodarone therapy should be carefully and continuously assessed in patients awaiting OHT. Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  5. Voriconazole-Induced Periostitis & Enthesopathy in Solid Organ Transplant Patients: Case Reports.

    Science.gov (United States)

    Sircar, Monica; Kotton, Camille; Wojciechowski, David; Safa, Kassem; Gilligan, Hannah; Heher, Eliot; Williams, Winfred; Thadhani, Ravi; Tolkoff-Rubin, Nina

    2016-11-01

    Voriconazole is frequently used to treat fungal infections in solid organ transplant patients. Recently, there have been reports suggesting that prolonged voriconazole therapy may lead to periostitis. Here we present two cases of voriconazole-induced periostitis in solid organ transplant patients. Voriconazole was given to two transplant patients-one with a liver transplant and the second with a heart transplant, to treat their fungal infections. Both developed voriconazole-induced toxicity. While undergoing voriconazole therapy, they had incapacitating bone pain. The liver transplant patient had to be taken off voriconazole, and the heart transplant patient succumbed to non-voriconazole related causes. Voriconazole therapy in two solid organ transplant patients resulted in periostitis. We provide potential etiologies underlying voriconazole-induced periostitis, including fluoride toxicity, abnormalities in the pulmonary vascular bed leading to the production of downstream inflammatory mediators, and abnormal pharmacokinetics of hepatic drug metabolism. In addition to monitoring blood voriconazole trough levels, we suggest careful assessment for musculoskeletal pain in patients undergoing voriconazole treatment for two months or more, particularly if their daily dosages of voriconazole exceed 500 mg per day. Appropriate workup should include measurement of alkaline phosphatase, voriconazole trough and fluoride levels as well as a bone scan. Overall, early recognition of voriconazole-induced musculoskeletal toxicity is important for better morbidity outcomes.

  6. Post–Endoscopic Retrograde Cholangiopancreaticography complications in liver transplanted patients, a single-center experience

    DEFF Research Database (Denmark)

    Ambrus, R B; Svendsen, Lars Bo; Hillingsø, J G

    2015-01-01

    BACKGROUND: Complications in the biliary tract occur in 5%-30% after liver transplantation and the main part of the complications is successfully managed with endoscopic retrograde cholangiopancreaticography (ERCP). The incidence and risk factors for post-ERCP complications in liver transplantation...... patients are not well described. Our objective was to define the frequency of post-ERCP complications in liver transplantation patients at the Abdominal Center, Rigshospitalet, the only Liver Transplantation Center in Denmark. METHODS: Retrospective study of all ERCPs performed in liver transplantation...... and cholangitis occurred after two procedures, respectively. Multivariate analysis concerning overall complications identified biliary sphincterotomy (p = 0.006) and time since liver transplantation within 90 days postoperatively (p = 0.044) as risk factors for post-ERCP complications. Specifically concerning...

  7. Primary graft dysfunction after heart transplantation: Incidence, trends, and associated risk factors.

    Science.gov (United States)

    Nicoara, Alina; Ruffin, David; Cooter, Mary; Patel, Chetan B; Thompson, Annemarie; Schroder, Jacob N; Daneshmand, Mani A; Hernandez, Adrian F; Rogers, Joseph G; Podgoreanu, Mihai V; Swaminathan, Madhav; Kretzer, Adam; Stafford-Smith, Mark; Milano, Carmelo A; Bartz, Raquel R

    2017-11-14

    Changes in heart transplantation (HT) donor and recipient demographics may influence the incidence of primary graft dysfunction (PGD). We conducted a retrospective study to evaluate PGD incidence, trends, and associated risk factors by analyzing consecutive adult patients who underwent HT between January 2009 and December 2014 at our institution. Patients were categorized as having PGD using the International Society for Heart & Lung Transplantation (ISHLT)-defined criteria. Variables, including clinical and demographic characteristics of donors and recipients, were selected to assess their independent association with PGD. A time-trend analysis was performed over the study period. Three-hundred seventeen patients met inclusion criteria. Left ventricular PGD, right ventricular PGD, or both, were observed in 99 patients (31%). Risk factors independently associated with PGD included ischemic time, recipient African American race, and recipient amiodarone treatment. Over the study period, there was no change in the PGD incidence; however, there was an increase in the recipient pretransplantation use of amiodarone. The rate of 30-day mortality was significantly elevated in those with PGD versus those without PGD (6.06% vs 0.92%, P = .01). Despite recent advancements, incidence of PGD remains high. Understanding associated risk factors may allow for implementation of targeted therapeutic interventions. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  8. Heart Transplantation in Congenital Heart Disease: In Whom to Consider and When?

    Science.gov (United States)

    Attenhofer Jost, Christine H.; Schmidt, Dörthe; Huebler, Michael; Balmer, Christian; Noll, Georg; Caduff, Rosmarie; Greutmann, Matthias

    2013-01-01

    Due to impressive improvements in surgical repair options, even patients with complex congenital heart disease (CHD) may survive into adulthood and have a high risk of end-stage heart failure. Thus, the number of patients with CHD needing heart transplantation (HTx) has been increasing in the last decades. This paper summarizes the changing etiology of causes of death in heart failure in CHD. The main reasons, contraindications, and risks of heart transplantation in CHD are discussed and underlined with three case vignettes. Compared to HTx in acquired heart disease, HTx in CHD has an increased risk of perioperative death and rejection. However, outcome of HTx for complex CHD has improved over the past 20 years. Additionally, mechanical support options might decrease the waiting list mortality in the future. The number of patients needing heart-lung transplantation (especially for Eisenmenger's syndrome) has decreased in the last years. Lung transplantation with intracardiac repair of a cardiac defect is another possibility especially for patients with interatrial shunts. Overall, HTx will remain an important treatment option for CHD in the near future. PMID:23577237

  9. Hematopoietic stem cell transplantation induces immunologic tolerance in renal transplant patients via modulation of inflammatory and repair processes

    Directory of Open Access Journals (Sweden)

    Wu Duojiao

    2012-08-01

    Full Text Available Abstract Background Inducing donor-specific tolerance in renal transplant patients could potentially prevent allograft rejection and calcineurin inhibitor nephrotoxicity. Combined kidney and hematopoietic stem cell transplant from an HLA-matched donor is an exploratory and promising therapy to induce immune tolerance. Investigtion of molecular mechanisms involved in the disease is needed to understand the potential process of cell therapy and develop strategies to prevent this immunologic rejection. Methods We enrolled nine patients in a clinical study in which cryopreserved donor hematopoietic stem cells were infused on days 2, 4, and 6 after kidney transplantation. One month post-transplant, 4 plasma samples were collected from combined transplants (C + Tx, and 8 plasma samples from patients with kidney transplantation alone (Tx. High abundance proteins in plasma were depleted and the two-dimensional liquid chromatography-tandem mass spectrometry coupled with iTRAQ labeling was utilized to identify the protein profiling between the two groups. Clusters of up- and down-regulated protein profiles were submitted to MetaCore for the construction of transcriptional factors and regulation networks. Results and Discussion Among the 179 identified proteins, 65 proteins were found in C + Tx with at least a 2-fold change as compared with Tx. A subset of proteins related to the complement and coagulation cascade, including complement C3a,complement C5a, precrusors to fibrinogen alpha and beta chains,was significantly downregulated in C + Tx. Meanwhile, Apolipoprotein-A1(ApoA1, ApoC1, ApoA2, ApoE, and ApoB were significantly lower in Tx compared to C + Tx. Gene ontology analysis showed that the dominant processes of differentially expressed proteins were associated with the inflammatory response and positive regulation of plasma lipoprotein particle remodeling. Conclusions Thus, our study provides new insight into the molecular events in

  10. The utility of hand transplantation in hand amputee patients.

    Science.gov (United States)

    Alolabi, Noor; Chuback, Jennifer; Grad, Sharon; Thoma, Achilles

    2015-01-01

    To measure the desirable health outcome, termed utility, and the expected quality-adjusted life years (QALYs) gained with hand composite tissue allotransplantation (CTA) using hand amputee patients and the general public. Using the standard gamble (SG) and time trade-off (TTO) techniques, utilities were obtained from 30 general public participants and 12 amputee patients. The health utility and net QALYs gained or lost with transplantation were computed. A sensitivity analysis was conducted to account for the effects of lifelong immunosuppression on the life expectancy of transplant recipients. Higher scores represent greater utility. Hand amputation mean health utility as measured by the SG and TTO methods, respectively, was 0.72 and 0.80 for the general public and 0.69 and 0.70 for hand amputees. In comparison, hand CTA mean health utility was 0.74 and 0.82 for the general public and 0.83 and 0.86 for amputees. Hand CTA imparted an expected gain of 0.9 QALYs (SG and TTO) in the general public and 7.0 (TTO) and 7.8 (SG) QALYs in hand amputees. A loss of at least 1.7 QALYs was demonstrated when decreasing the life expectancy in the sensitivity analysis in the hand amputee group. Hand amputee patients did not show a preference toward hand CTA with its inherent risks. With this procedure being increasingly adopted worldwide, the benefits must be carefully weighed against the risks of lifelong immunosuppressive therapy. This study does not show clear benefit to advocate hand CTA. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  11. EPIDEMIOLOGY AND ETIOLOGICAL FACTORS OF ERECTILE DYSFUNCTION IN PATIENTS ON DIALYSIS AND AFTER RENAL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    E. A. Efremov

    2011-01-01

    Full Text Available Today the problem of better life quality of patients with end stage renal disease and after renal transplantation and their sexual adaptation is considered to be more impotent. The clinical part of the investigation is the obser- vation of 205 patients – men with terminal stage renal disease. Erectile dysfunction is represented in 91,4% (64 of patients getting haemodialysis, 92,3% (24 of patients getting peritoneal dialysis, 61,5% (67 of patients after renal transplantation. According to International Index of Erectile Function the mean score of erectile function is 16,7 ± 5,2 in haemodialysis patients, 19,46 ± 3,6 in peritoneal dialysis patients, 21,9 ± 5,6 in patients after renal transplantation. The analysis revealed great prevalence of erectile dysfunction and interest in improvement among the patients with end stage renal disease and after renal transplantation

  12. [Comparing quality of life in dialysis patients and patients after kidney transplantation: a questionnaire survey].

    Science.gov (United States)

    Bužgová, Radka; Šmotková, Štěpánka

    2013-01-01

    The aim of the study was to determine and compare quality of life in patients with chronic kidney failure treated with dialysis and those after kidney transplantation. The group comprised 199 patients with chronic kidney failure (99 dialysis patients and 100 patients after kidney transplantation). Data were collected using the WHOQOL-BREF questionnaire for assessing quality of life. Patients after kidney transplantation had statistically significantly higher quality of life scores in all domains than dialysis patients (p quality of life only in the physical health domain (p Dialysis patients had lower quality of life than the normal population in all domains and separate items, the only exception being the environment domain(p Dialysis patients quality of life significantly decreased in all domains with time from the initiation of dialysis therapy (p < 0.05). Information about QoL of patients with renal failure treated by different approaches may help both doctors and patients and their families when making decisions about therapy selection.

  13. Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis.

    Science.gov (United States)

    Dandoy, C E; Ardura, M I; Papanicolaou, G A; Auletta, J J

    2017-08-01

    Bacterial bloodstream infections (BSI) cause significant transplant-related morbidity and mortality following allogeneic hematopoietic cell transplantation (allo-HCT). This manuscript reviews the risk factors for and the bacterial pathogens causing BSIs in allo-HCT recipients in the contemporary transplant period. In addition, it offers insight into emerging resistant pathogens and reviews clinical management considerations to treat and strategies to prevent BSIs in allo-HCT patients.

  14. The development of squamous cell carcinoma in a patient after kidney transplantation: a case report

    OpenAIRE

    Witmanowski, Henryk; Lewandowska, Ma?gorzata; Szychta, Pawe?; Sporny, Stanis?aw; Ryka?a, Jan

    2013-01-01

    In patients with organ transplantation as compared to the general population the risk of cancer is significantly increased. The most common changes are malignant tumors of the skin, constituting 30-65% of malignant tumors found in recipients. Potential risk factors for skin cancer after a transplant operation are: solar radiation, immunosuppressive therapy, genetic factors, infection with HPV and skin cancer transmission before transplantation. In contrast to the immunocompetent population, s...

  15. Outcomes of biventricular mechanical support patients discharged to home to await heart transplantation.

    Science.gov (United States)

    Creaser, Julie W; Rourke, Darlene; Vandenbogaart, Elizabeth; Chaker, Tamara; Nsair, Ali; Cheng, Richard; Fonarow, Gregg; Livingston, Nancy; Howell, Elan; Huie, Newman; Baas, Arnold S; Deng, Mario; Hickey, Ann; Shemin, Richard J; MacLellan, W Robb

    2015-01-01

    The use of left ventricular assist devices has grown rapidly in recent years for patients with end-stage heart failure. A significant proportion of patients require both left- and right-sided support with biventricular assist devices (BiVADs) as a bridge to transplantation. Traditionally, these patients have waited in the hospital until they receive a transplant. The aim of this study was to characterize the clinical course of BiVAD patients discharged to home to await heart transplantation. Between November 2009 and July 2011, 24 adult patients underwent Thoratec paracorporeal BiVAD placement at the University of California Los Angeles, all with an Interagency Registry for Mechanically Assisted Circulatory Support score 1 or 2. The disposition, complications, and rehospitalizations of these subjects were retrospectively reviewed. Fourteen of the 24 patients were successfully discharged to home, with a mean time of 60 ± 27 days from BiVAD implantation to discharge. Ninety-three percent (13/14) of the patients sent home went on to be transplanted. Eleven of the 14 (79%) came in from home to receive their transplant. The mean time from BiVAD implantation to transplantation was 100 ± 65 days. Of the 14 patients discharged to home, there were 18 readmissions in 8 patients. In this small single-center review, we found that complex medical patients with BiVADs can be discharged to home and can await a heart transplant from home under the close management of multidisciplinary acute care and outpatient teams.

  16. Sinusitis in patients undergoing allogeneic bone marrow transplantation – a review

    Directory of Open Access Journals (Sweden)

    Joanna Ewa Drozd-Sokolowska

    Full Text Available Abstract Introduction Sinusitis is a common morbidity in general population, however little is known about its occurrence in severely immunocompromised patients undergoing allogeneic hematopoietic stem cell transplantation. Objective The aim of the study was to analyze the literature concerning sinusitis in patients undergoing allogeneic bone marrow transplantation. Methods An electronic database search was performed with the objective of identifying all original trials examining sinusitis in allogeneic hematopoietic stem cell transplant recipients. The search was limited to English-language publications. Results Twenty five studies, published between 1985 and 2015 were identified, none of them being a randomized clinical trial. They reported on 31–955 patients, discussing different issues i.e. value of pretransplant sinonasal evaluation and its impact on post-transplant morbidity and mortality, treatment, risk factors analysis. Conclusion Results from analyzed studies yielded inconsistent results. Nevertheless, some recommendations for good practice could be made. First, it seems advisable to screen all patients undergoing allogeneic hematopoietic stem cell transplantation with Computed Tomography (CT prior to procedure. Second, patients with symptoms of sinusitis should be treated before hematopoietic stem cell transplantation (HSCT, preferably with conservative medical approach. Third, patients who have undergone hematopoietic stem cell transplantation should be monitored closely for sinusitis, especially in the early period after transplantation.

  17. YOUTUBE videos on oral care of the organ or hematopoietic stem cell transplant patients.

    Science.gov (United States)

    López-Jornet, Pia; Pons-Fuster, Eduardo; Ruiz-Roca, Juan Antonio

    2017-04-01

    Video-sharing websites can be a useful platform for disseminating information. The aim of this study was to evaluate information about the oral health care of the organ transplant and hematopoietic stem cell transplant patients available on YouTube™. The transversal study evaluated the content of YouTube™ videos. The videos were located by entering key search terms in the YouTube™ search engine-oral care/dental management/organ transplant/hematopoietic stem cell transplant patients. The videos were then classified as useful, misleading, or as personal experiences reported by patients. The following information was registered: the source of the video, content, interaction, and overall quality. A total of 50 videos were reviewed; 16 (33.14%) were classed as useful, 22 (44%) were misleading, and 12 (24%) reported patients' personal experiences. Significant differences were found in overall quality (p = 0.012). When interaction variables were analyzed statistically significant differences were found for the following: "I did not like this video" (p ≤ 0.05) and comments (p ≤ 0.05). Several videos reviewed information on oral care of organ transplant and hematopoietic stem cell transplant patients but were sometimes difficult to interpret. Nevertheless, YouTube™ is a tool that can help supply information and promote oral health care education among of organ transplant and hematopoietic stem cell transplant patients.

  18. Pulmonary function impairment in patients undergoing allogeneic hematopoietic cell transplantation.

    Science.gov (United States)

    Piesiak, Pawel; Gorczynska, Ewa; Brzecka, Anna; Kosacka, Monika; Jankowska, Renata

    2013-01-01

    Deterioration of pulmonary function can be the sole symptom of early stages of pulmonary complications following allogeneic hematopoietic cells transplantation (alloHCT). The aim of the study was to evaluate the prevalence and types of pulmonary function abnormalities in allogenic cells recipients. Twenty three (5 children and 18 adults) allogeneic hematopoietic cells recipients who underwent pulmonary function assessment before and 6-12 months after alloHCT were included in the study. Forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), total lung capacity (TLC), and lung diffusion capacity for carbon dioxide (D(L)CO) were determined. Values function impairment before alloHCT: obstructive lung disease (4%), restrictive lung disease (13%), and decreased D(L)CO (17%). In 19 patients (83%) pulmonary function abnormalities were demonstrated after alloHCT. The most common disturbance was a D(L)CO decrease that occurred in 16 patients (70%). In conclusion, frequency of pulmonary function abnormalities in patients after alloHCT is high. A diffusion capacity decrease and restrictive pattern of ventilation insufficiency develop in the majority of patients after alloHCT. It would be reasonable to include pulmonary function testing to standard periodic examination in patients qualified for, and after, alloHCT procedure.

  19. Resilience in patients after allogeneic stem cell transplantation.

    Science.gov (United States)

    Schumacher, Andrea; Sauerland, Cristina; Silling, Gerda; Berdel, Wolfgang E; Stelljes, Matthias

    2014-02-01

    After undergoing allogeneic stem cell transplantation (alloSCT), patients adapt in very different ways to their taxing situation. Some patients cope very well; others almost seem to fail. Psychosocial variables are important factors for successful reintegration. Besides quality of life, resilience may help to understand the variance in individual differences in adaptation after alloSCT. A pilot study at the University Hospital Muenster, Germany, assessed resilience in patients after alloSCT. The sample included 75 patients (leukemia, lymphoma, myeloma, aplastic anemia) aged 20-76 years. The instruments Resilience Scale RS-25, Hospital Anxiety and Depression Scale, General Self-efficacy Scale, and EORTC QLQ-C30 were used. Resilience is positively correlated with quality of life (Spearman's rho 0.587) and social functioning (0.472), negatively with anxiety (-0.491) and depression (-0.577). Dividing the sample at the median resilience score of 144 reveals that high-resilience patients report less anxiety (p = 0.008) and depression (p resilience patients. No effects on resilience were found for age, gender, and primary disease entity. The high correlation of resilience and self-efficacy (r = 0.698) shows the strong relationship between the two concepts. Our results indicate a potential influence of the time span from alloSCT on patients' resilience. Resilience should be considered as a protective psychosocial factor for patients after alloSCT. A high degree of resilience can help patients to adapt to their situation and to resume their everyday life.

  20. Evaluation of pulmonary function in renal transplant recipients and chronic renal failure patients undergoing maintenance hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed E. Abdalla

    2013-01-01

    Conclusion: There is impairment of lung function in patients with CRF undergoing hemodialysis. The main changes are small airway obstruction, reduction in carbon monoxide transfer and diminished 6MWT that were not completely improved in the kidney transplant patients.

  1. NEUTROPHIL CYTOPLASMIC AUTOANTIBODIES AFTER LIVER-TRANSPLANTATION IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS

    NARCIS (Netherlands)

    HAAGSMA, EB; MULDER, AHL; GOUW, ASH; HORST, G; MEERMAN, L; SLOOFF, MJH; KALLENBERG, CGM

    The immunopathogenic importance of neutrophil cytoplasmic autoantibodies in ulcerative colitis and primary sclerosing cholangitis is unknown. These autoantibodies were investigated before and after liver transplantation in 9 patients with primary sclerosing cholangitis. Sera from 10 patients

  2. NEUTROPHIL CYTOPLASMIC AUTOANTIBODIES AFTER LIVER-TRANSPLANTATION IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS

    NARCIS (Netherlands)

    Haagsma, E.B.; MULDER, A.H.L.; Gouw, A.S.H.; MEERMAN, L.; Slooff, M.JH; Kallenberg, Cees; Horst, G.

    1993-01-01

    The immunopathogenic importance of neutrophil cytoplasmic autoantibodies in ulcerative colitis and primary sclerosing cholangitis is unknown. These autoantibodies were investigated before and after liver transplantation in 9 patients with primary sclerosing cholangitis. Sera from 10 patients

  3. Normal to increased thrombin generation in patients undergoing liver transplantation despite prolonged conventional coagulation tests

    NARCIS (Netherlands)

    Lisman, Ton; Bakhtiari, Kamran; Pereboom, Ilona T. A.; Hendriks, Herman G. D.; Meijers, Joost C. M.; Porte, Robert J.

    Background & Aims: Patients with liver disease often show substantial changes in their hemostatic system, which may aggravate further during liver transplantation. Recently, thrombin generation in patients with stable disease was shown to be indistinguishable from controls provided thrombomodulin,

  4. Allogeneic Hematopoietic Stem Cell Transplantation Is Underutilized in Older Patients with Myelodysplastic Syndromes.

    Science.gov (United States)

    Getta, Bartlomiej M; Kishtagari, Ashwin; Hilden, Patrick; Tallman, Martin S; Maloy, Molly; Gonzales, Patrick; Castro-Malaspina, Hugo; Perales, Miguel-Angel; Giralt, Sergio; Tamari, Roni; Klimek, Virginia

    2017-07-01

    Allogeneic hematopoietic stem cell transplantation (HCT) is the only curative treatment for myelodysplastic syndrome (MDS). The proportion of MDS patients referred for transplantation evaluation, those undergoing transplantation, and the reasons for not undergoing transplantation are unknown. In this retrospective analysis, predefined HCT eligibility and indications criteria were applied to 362 unselected patients with newly diagnosed MDS seen by leukemia faculty between 2008 and 2015 at Memorial Sloan Kettering Cancer Center. Two hundred ninety-four patients (81%) were deemed eligible for transplantation and among these, transplantation was considered indicated in 244 (83%). Of these, 158 of 244 (65%) were referred for transplantation evaluation at a median of 3.9 months from diagnosis. Overall 120 of 362 (33%) underwent transplantation at a median of 7.7 months from diagnosis. Metastatic solid-organ malignancy was the major reason for transplantation ineligibility (54%), and death due to MDS, which occurred in 41% of candidates who did not undergo transplantation, was the major reason for not undergoing transplantation. Factors associated with a lower likelihood of referral for transplantation evaluation included age ≥65 (P < .001), ≥2 comorbidities (P = .008), intermediate-1/low risk MDS (P < .001), <5% blasts at diagnosis (overall P < .001), having Medicare/Medicaid health insurance (P < .001), not being married (P = .017), and diagnosis between 2008 and 2011 (P = .035). On multivariate analysis adjusting for all of the previous factors, diagnosis between 2008 and 2011 (P < .001), age ≥65 (P = .001), and <5% blasts at diagnosis (overall P = .031) were associated with a lower likelihood of referral for transplantation evaluation. Factors associated with a lower likelihood of undergoing transplantation included age ≥65 (P < .001), ≥2 comorbidities (P = .003), intermediate-1/low risk MDS (P < .001), <5% blasts (overall P

  5. 75 FR 18849 - Food and Drug Administration/National Heart Lung and Blood Institute/National Science Foundation...

    Science.gov (United States)

    2010-04-13

    ... Integration of Nonclinical and Clinical Models; Public Workshop AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public workshop. SUMMARY: The Food and Drug Administration (FDA) is announcing a public... HUMAN SERVICES Food and Drug Administration Food and Drug Administration/National Heart Lung and Blood...

  6. 76 FR 49775 - Food and Drug Administration/National Heart, Lung, and Blood Institute/National Science...

    Science.gov (United States)

    2011-08-11

    ... and Drug Administration, HHS. ACTION: Notice of public workshop. SUMMARY: The Food and Drug Administration (FDA) is announcing a public workshop entitled ``FDA/NHLBI/NSF Workshop on Computer Methods for... HUMAN SERVICES Food and Drug Administration Food and Drug Administration/National Heart, Lung, and Blood...

  7. 2015 proceedings of the National Heart, Lung, and Blood Institute's State of the Science in Transfusion Medicine symposium

    NARCIS (Netherlands)

    Spitalnik, Steven L.; Triulzi, Darrell; Devine, Dana V.; Dzik, Walter H.; Eder, Anne F.; Gernsheimer, Terry; Josephson, Cassandra D.; Kor, Daryl J.; Luban, Naomi L. C.; Roubinian, Nareg H.; Mondoro, Traci; Welniak, Lisbeth A.; Zou, Shimian; Glynn, Simone; Hendrickson, Jeanne; Zimring, James C.; Yazdanbakhsh, Karina; Delaney, Megan; Ware, Russell E.; Tinmouth, Alan; Doctor, Allan; Migliaccio, Anna Rita; Fergusson, Dean A.; Widness, John A.; Carson, Jeffrey L.; Hess, John; Roback, John D.; Waters, Jonathan H.; Cancelas, Jose A.; Gladwin, Mark T.; Rogers, Mary A. M.; Ness, Paul M.; Rao, Sunil; Watkins, Timothy R.; Spinella, Philip C.; Kaufman, Richard M.; Slichter, Sherrill J.; McCullough, Jeffrey; Blumberg, Neil; Webert, Kathryn E.; Fitzpatrick, Michael; Shander, Aryeh; Corash, Laurence M.; Murphy, Michael; Silberstein, Leslie E.; Dumont, Larry J.; Mitchell, W. Beau; Macdonald, Victor W.; Hoffmeister, Karin M.; Italiano, Joseph E.; Gupta, Anirban Sen; Wu, Yanyun; Cap, Andrew P.; Li, Renhao; Goodrich, Raymond P.; Morrell, Craig N.; Semple, John W.; Kahr, Walter H. A.; Tanaka, Ken; Haas, Thorsten; Sperry, Jason L.; Callum, Jeannie L.; Porte, Robert J.; Mallett, Sue; Gajic, Ognjen; Juffermans, Nicole P.; Karam, Oliver; Vlaar, Alexander P. J.; Looney, Mark R.; Inaba, Ken; Shaz, Beth H.; Hunt, Beverly J.; Cohen, Mitchell J.; Kitchens, Craig S.; Stanworth, Simon J.; Bryant, Barbara J.; Kiss, Joseph E.; Busch, Michael P.; Dodd, Roger Y.; Heddle, Nancy M.; Spencer, Bryan R.; Keller, Anthony J.; Germain, Marc; Goldman, Mindy; Tomasulo, Peter A.; de Kort, Wim; Mast, Alan E.; Francis, Richard O.

    2015-01-01

    On March 25 and 26, 2015, the National Heart, Lung, and Blood Institute sponsored a meeting on the State of the Science in Transfusion Medicine on the National Institutes of Health (NIH) campus in Bethesda, Maryland, which was attended by a diverse group of 330 registrants. The meeting's goal was to

  8. A questionnaire based assessment of numbers, motivation and medical care of UK patients undergoing liver transplant abroad.

    Science.gov (United States)

    Kerr Winter, Ben; Odedra, Anand; Green, Steve

    Medical tourism, where patients travel abroad intentionally to access medical treatment, is a growing trend. Some of these patients travel to undergo organ transplantation. This study aims to quantify the number of UK patients who undergo liver transplantation abroad, assessing their motivations and management. Questionnaires were sent to all seven UK liver transplant units enquiring about liver patients receiving transplant abroad. Included were questions on destination, motivation, and pre and post-transplant care. Responses were received from six of the seven transplant centres (86%). A total of 12 patients were identified as having undergone liver transplantation overseas. The top destinations were India, China and Egypt. Four units responded to questions regarding pre-transplant screening. One unit reported Hepatitis B and C screening not taking place. Four units responded to questions regarding post-transplant antimicrobial therapy. This revealed examples of patients inappropriately not receiving valganciclovir, co-trimoxazole, anti-fungal treatment and Hepatitis B immunoglobulins. UK patients are undergoing liver transplant abroad, albeit in small numbers. Pre and post-transplant management of these patients is of a lower standard than that provided to those undergoing transplantation in the UK. Information transfer between overseas and UK based transplant teams is poor. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Pulmonary artery dissection in a patient with Eisenmenger syndrome treated with heart and lung transplantation

    DEFF Research Database (Denmark)

    Tønder, Niels; Køber, Lars; Hassager, Christian

    2004-01-01

    We report the case of a patient with known Eisenmenger syndrome due to congenital ventricular septal defect, who developed pulmonary artery dissection. The patient was successfully treated with heart and lung transplantation.......We report the case of a patient with known Eisenmenger syndrome due to congenital ventricular septal defect, who developed pulmonary artery dissection. The patient was successfully treated with heart and lung transplantation....

  10. Bilateral endogenous Fusarium solani endophthalmitis in a liver-transplanted patient

    DEFF Research Database (Denmark)

    Jørgensen, Jesper Skovlund; Prause, Jan Ulrik; Kiilgaard, Jens Folke

    2014-01-01

    Endogenous Fusarium endophthalmitis is a rare disease predominantly described in immunocompromised patients often due to leukemia. We report a case of bilateral endogenous Fusarium solani endophthalmitis in a liver-transplanted patient.......Endogenous Fusarium endophthalmitis is a rare disease predominantly described in immunocompromised patients often due to leukemia. We report a case of bilateral endogenous Fusarium solani endophthalmitis in a liver-transplanted patient....

  11. Mediastinal lymphadenopathy in patients undergoing cardiac transplant evaluation.

    Science.gov (United States)

    Pastis, Nicholas J; Van Bakel, Adrian B; Brand, Timothy M; Ravenel, James G; Gilbert, Gregory E; Silvestri, Gerard A; Judson, Marc A

    2011-06-01

    We evaluated the association between hemodynamic parameters of chronic congestive heart failure (CHF) and mediastinal lymphadenopathy (MLA) in heart transplantation (HT) candidates and the effect of HT on MLA. We also described the results of lymph node (LN) biopsies of MLA in the patients. Patients who underwent HT evaluation over an 8-year period and had chest CT scans were evaluated retrospectively. Data collected included LN sizes pre-HT and post-HT, echocardiographic measurements, radionuclide-derived ejection fraction, and right-sided heart catheterization hemodynamics. MLA was defined as LNs > 1 cm in smallest dimension. Of 118 patients, 53 patients had MLA. MLA had weak statistically significant correlations with elevated mean pulmonary artery pressure (MPAP), mitral regurgitation (MR), tricuspid regurgitation (TR), right atrial pressure (RAP), and pulmonary capillary wedge pressure (PCWP). Thirty-six patients with MLA underwent HT, and nine of the 36 had post-HT chest CT scans. All nine patients showed a decrease in LN size post-HT (mean LN diameter pre-HT = 1.16 ± 0.137 cm, post-HT = 0.75 ± 0.32 cm). Seven of 53 patients with MLA underwent biopsies. Four had benign LNs, one had sarcoidosis, and two had lung cancer. MPAP, MR, TR, RAP, and PCWP had weak statistically significant correlations with MLA. HT led to regression of MLA in patients who underwent CT scans post-HT, implying that MLA is related to CHF. However, we also identified clinically important causes of MLA; therefore, biopsy should be considered if enlarged LNs fail to regress after maximal medical management of CHF.

  12. Skin Lesions in Kidney Transplant Patients at San Ignacio Medical Hospital in Bogota, Colombia

    OpenAIRE

    Cuéllar, Isabel; Pontificia Universidad Javeriana; Rodríguez, Edna; Pontificia Universidad Javeriana; García, Paola; Pontificia Universidad Javeriana; Hernández, Carolina; Pontificia Universidad Javeriana; Pinto Ramírez, Jessica Liliana; Pontificia Universidad Javeriana

    2014-01-01

    Introduction: Skin diseases are common in postranplant renal patients. It is important to check patients looking for any skin problem to improveearly diagnoses in this group. Aim: To measure the prevalence of cutaneous manifestations in patients with renal transplant at San Ignacio Medical Hospital in Bogota, Colombia.Methods: 86 patients with kidney transplant were evaluated during 2010 and 2011 at the Transplant Unit in San Ignacio Medical Hospital. Diagnosis of cutaneous diseases were made...

  13. Transplant in a patient with comorbid psychiatric illness: an ethical dilemma.

    Science.gov (United States)

    Boyum, Eric N; Brown, Douglas; Zihni, Ahmed M; Keune, Jason D; Hong, Barry A; Kodner, Ira J; Ray, Shuddhadeb

    2014-11-01

    This article addresses a difficult ethical dilemma that transplant surgeons may potentially encounter: whether a patient with a psychiatric illness is a good candidate for a liver transplant. This case study illustrates the challenges involved when considering the ethical principles of patient self-determination, distributive justice of scarce medical resources, "social worth," and protection of vulnerable patient populations. Are patients with psychiatric illness able to provide consent for transplantation? Is it possible to avoid misallocating valuable donor organs and, at the same time, fairly allocate these resources? This article seeks to answer these questions and provide insight into this ethical dilemma.

  14. Eculizumab before and after allogeneic hematopoietic stem cell transplantation in a patient with paroxysmal nocturnal hemoglobinuria

    Directory of Open Access Journals (Sweden)

    Hakan Göker

    2011-09-01

    Full Text Available Paroxysmal nocturnal hemoglobinuria (PNH is characterized by the triad of intravascular hemolysis, venous thrombosis, and cytopenia. Treatment of PNH is generally supportive. Bone marrow transplantation is the only curative therapy for PNH, but is associated with significant morbidity and mortality. Herein, we present a patient with PNH that received eculizumab, a humanized monoclonal antibody that blocks activation of the terminal complement at C5, before and immediately following allogeneic peripheral stem cell transplantation. Prior to hematopoietic stem cell transplantation eculizumab treatment markedly reduced hemolysis and transfusion requirement; however, 1 d post transplantation a hemolytic episode occured, which was successfully stopped with eculizumab re-treatment. Afterwards the patient did not require additional transfusions. The results of this study indicate that early administration of eculizumab may be a safe and effective therapy for hemolytic episodes associated with allogeneic peripheral stem cell transplantation in patients with PNH.

  15. Fluorescence spectroscopy for assessment of liver transplantation grafts concerning graft viability and patient survival

    Science.gov (United States)

    Vollet Filho, José D.; da Silveira, Marina R.; Castro-e-Silva, Orlando; Bagnato, Vanderlei S.; Kurachi, Cristina

    2015-06-01

    Evaluating transplantation grafts at harvest is essential for its success. Laser-induced fluorescence spectroscopy (LIFS) can help monitoring changes in metabolic/structural conditions of tissue during transplantation. The aim of the present study is to correlate LIFSobtained spectra of human hepatic grafts during liver transplantation with post-operative patients' mortality rate and biochemical parameters, establishing a method to exclude nonviable grafts before implantation. Orthotopic liver transplantation, piggyback technique was performed in 15 patients. LIFS was performed under 408nm excitation. Collection was performed immediately after opening donor's abdominal cavity, after cold perfusion, end of back-table period, and 5 min and 1 h after warm perfusion at recipient. Fluorescence information was compared to lactate, creatinine, bilirubin and INR levels and to survival status. LIFS was sensitive to liver changes during transplantation stages. Study-in-progress; initial results indicate correlation between fluorescence and life/death status of patients.

  16. Rituximab purging and/or maintenance in patients undergoing autologous transplantation for relapsed follicular lymphoma

    DEFF Research Database (Denmark)

    Pettengell, Ruth; Schmitz, Norbert; Gisselbrecht, Christian

    2013-01-01

    The objective of this randomized trial was to assess the efficacy and safety of rituximab as in vivo purging before transplantation and as maintenance treatment immediately after high-dose chemotherapy and autologous stem-cell transplantation (HDC-ASCT) in patients with relapsed follicular lymphoma...

  17. Successful Treatment of Sinusitis by Acanthamoeba in a Pediatric Patient After Allogeneic Stem Cell Transplantation.

    Science.gov (United States)

    Juan, Antonio; Alonso, Laura; Olivé, Teresa; Navarro, Alexandra; Sulleiro, Elena; Sánchez de Toledo, José; Díaz de Heredia, Cristina

    2016-12-01

    Acanthamoeba infections are rare and mostly occur in immunocompromised patients. Most of the reported cases after stem cell transplantation have been diagnosed postmortem. We present the case of a 3-year-old boy with chronic graft versus host disease post hematopoietic transplantation, who was successfully treated for Acanthamoeba.

  18. Long-term quality of life in patients surviving at least 55 months after lung transplantation

    NARCIS (Netherlands)

    Vermeulen, KM; Ouwens, JP; van der Bij, W; Koeter, GH; TenVergert, EM

    2003-01-01

    The aim of this study was to examine the long-term effect of lung transplantation on Health Related Quality of Life by studying 28 patients who survived at least 55 months after lung transplantation. Measures included the Nottingham Health Profile, questions concerning lung-specific problems, the

  19. Nontuberculous Mycobacterial Disease Is Not a Contraindication to Lung Transplantation in Patients With Cystic Fibrosis

    DEFF Research Database (Denmark)

    Qvist, Tavs; Pressler, Tanja; Thomsen, V O

    2013-01-01

    Whether nontuberculous mycobacterial (NTM) disease is a contraindication to lung transplantation remains controversial. We conducted a nationwide study to evaluate the clinical importance of NTM infection among lung transplant patients with cystic fibrosis (CF) in Denmark and to determine if NTM...

  20. [Recurrence of hepatitis caused by hepatitis c virus in patients receiving a liver transplant].

    Science.gov (United States)

    Crespo, J; Casafont, F; Carte, B; Lozano, J L; Fábrega, E; Sánchez-Antolín, G; Dueñas, C; Pons Romero, F

    1997-01-25

    Liver disease due to hepatitis C virus (HCV) is an increasingly frequent indication for liver transplantation. We performed a clinical and virological study of 20 HCV-infected liver transplant recipients to correlate virological markers with histological recurrence of disease. In ninety-four patients who were given transplants for end-stage cirrhosis, IgG and IgM antibodies to HCV and IgM to HCV tested by ELISA; all samples were further examined in a four-antigen recombinant immunoblot assay (2-RIBA). HCV viremia was measured by the conventional nested PCR, HCV genotype was determined by PCR amplification using type-specific primers. We have analyzed de novo infection by HCV, HCV recurrence and the influence of genotype in these recurrence. Nineteen of 20 antibody-positive patients (95%) had HCV RNA before transplantation. All 19 patients who were viremic before transplantation had persistent infection after LT. HCV genotype 1b was the predominant type before and after LT (75%). Ten of the 20 (50%) patients developed histological findings of chronic hepatitis (CH) in liver allografts. HCV recurrent liver disease after LT was not related with HCV genotype. Of 4 deaths after transplant in hepatitis C group, only one was related to recurrent disease. We have not found de novo hepatitis C. Our results indicate the general persistence of hepatitis C virus infection and the excellent short-term prognosis after liver transplantation. Chronic hepatitis by HCV in liver transplant was not related with HCV genotype.

  1. Cross-sectional Assessment of Daily Physical Activity in Chronic Obstructive Pulmonary Disease Lung Transplant Patients

    NARCIS (Netherlands)

    Bossenbrock, Linda; ten Thicken, Nick H. T.; van der Bij, Wim; Verschuuren, Erik A. M.; Koeter, Gerard H.; de Greef, Mathieu H. G.

    Background: information about daily physical activity of chronic obstructive pulmonary disease (COPD) lung transplant patients is relevant for evaluation of the functional recovery of physical capacity after lung transplantation. The objective of this study was to cross-sectionally assess daily

  2. Molecular epidemiology of Enterococcus faecalis in liver transplant patients at University Hospital Groningen

    NARCIS (Netherlands)

    Waar, K; Slooff, MJH; Harmsen, HJM; Degener, JE; Willems, Rob J. L.

    We report the molecular epidemiology of Enterococcus faecalis in liver transplant patients transplanted at the University Hospital Groningen (The Netherlands) as determined by amplified fragment length polymorphism (AFLP) typing. A total of 133 E. faecalis isolates were cultured from the faeces and

  3. Surgical procedures in liver transplant patients: A monocentric retrospective cohort study.

    Science.gov (United States)

    Sommacale, Daniele; Nagarajan, Ganesh; Lhuaire, Martin; Dondero, Federica; Pessaux, Patrick; Piardi, Tullio; Sauvanet, Alain; Kianmanesh, Reza; Belghiti, Jacques

    2017-05-01

    Pre-existing chronic liver diseases and the complexity of the transplant surgery procedures lead to a greater risk of further surgery in transplanted patients compared to the general population. The aim of this monocentric retrospective cohort study was to assess the epidemiology of surgical complications in liver transplanted patients who require further surgical procedures and to characterize their post-operative risk of complications to enhance their medical care. From January 1997 to December 2011, 1211 patients underwent orthotropic liver transplantation in our center. A retrospective analysis of prospectively collected data was performed considering patients who underwent surgical procedures more than three months after transplantation. We recorded liver transplantation technique, type of surgery, post-operative complications, time since the liver transplant and immunosuppressive regimens. Among these, 161 patients (15%) underwent a further 183 surgical procedures for conditions both related and unrelated to the transplant. The most common surgical procedure was for an incisional hernia repair (n = 101), followed by bilioenteric anastomosis (n = 44), intestinal surgery (n = 23), liver surgery (n = 8) and other surgical procedures (n = 7). Emergency surgery was required in 19 procedures (10%), while 162 procedures (90%) were performed electively. Post-operative mortality and morbidity were 1% and 30%, respectively. According to the Dindo-Clavien classification, the most common grade of morbidity was grade III (46%), followed by grade II (40%). Surgical procedures on liver transplanted patients are associated with a significantly high risk of complications, irrespective of the time elapsed since transplantation. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Liver transplant patients have a similar risk of progression as sporadic patients with branch duct intraductal papillary mucinous neoplasms

    Science.gov (United States)

    Lennon, Anne Marie; Victor, David; Zaheer, Atif; Ostovaneh, Mohammad Reza; Jeh, Jessica; Law, Joanna K.; Rezaee, Neda; Molin, Marco Dal; Ahn, Young Joon; Wu, Wenchuan; Khashab, Mouen A.; Girotra, Mohit; Ahuja, Nita; Makary, Martin A.; Weiss, Matthew J.; Hirose, Kenzo; Goggins, Michael; Hruban, Ralph H.; Cameron, Andrew; Wolfgang, Christopher L.; Singh, Vikesh K.; Gurakar, Ahmet

    2015-01-01

    Background Intraductal papillary mucinous neoplasms (IPMNs) have malignant potential, and can progress from low- to high-grade dysplasia to invasive adenocarcinoma. The management of patients with IPMNs is dependent on their risk of malignant progression, with surgical resection recommended for patients with branch duct-IPMN (BD-IPMN) who develop high-risk features. There is increasing evidence that liver transplant patients are at increased risk of extra-hepatic malignancy. However there are few data regarding the risk of progression of BD-IPMNs in liver transplant recipients. The aim of this study was to determine if liver transplant recipients with BD-IPMNs are at higher risk of developing high-risk features than patients with BD-IPMNs who did not receive a transplant. Methods Consecutive patients who underwent a liver transplant with BD-IPMNs were included. Patients with BD-IPMNs with no history of immunosuppression were used as controls. Progression of the BD-IPMNs was defined as development of a high-risk feature (jaundice, dilated main pancreatic duct, mural nodule, cytology suspicious or diagnostic for malignancy, cyst diameter ≥3cm). Results Twenty three liver transplant patients with BD-IPMN were compared with 274 control patients. The median length of follow-up was 53.7 and 24 months in liver transplant and control groups respectively. Four (17.4%) liver transplant patients and 45 (16.4%) controls developed high-risk features (p=0.99). In multivariate analysis, progression of BD-IPMNs was associated with age at diagnosis but not with liver transplantation. Conclusion There was no statistically significant difference in the risk of developing high-risk features between the liver transplant and control groups. PMID:25155689

  5. Renal transplantation in 4 patients with methylmalonic aciduria: a cell therapy for metabolic disease.

    Science.gov (United States)

    Brassier, A; Boyer, O; Valayannopoulos, V; Ottolenghi, C; Krug, P; Cosson, M A; Touati, G; Arnoux, J B; Barbier, V; Bahi-Buisson, N; Desguerre, I; Charbit, M; Benoist, J F; Dupic, L; Aigrain, Y; Blanc, T; Salomon, R; Rabier, D; Guest, G; de Lonlay, P; Niaudet, P

    2013-01-01

    Patients with methylmalonic acidemia (MMA) may develop many complications despite medical treatment, in particular, severe central nervous system damage and chronic kidney disease (CKD). A kidney transplant may partially correct the metabolic dysfunctions. Liver, kidney and combined liver-kidney transplantations have been advocated but no guidelines are available to identify the most suitable organ to transplant. Four patients with MMA (mut° phenotype) received a kidney graft because of repeated metabolic decompensations, with progression to CKD in 3 patients (end-stage kidney disease in two patients and CKD stage III in one patient with an estimated glomerular filtration rate [eGFR] of 40ml/min/1.73m(2)) but normal renal function in one (eGFR of 93ml/min/1.73m(2)) before transplantation. The medium age at transplantation was 7.9y (5-10.2) and the median follow-up was 2.8years (1.8-4.6). Renal transplantation improved the relevant metabolic parameters in 4/4 patients and renal function in the patients with CKD. Plasma and urinary MMA levels immediately decreased and remained normal or subnormal (mean values of plasma MMA before transplantation 1530μmol/L versus 240μmol/L after transplantation, and mean values of urine MMA before transplantation 4700mmol/mol creatinine versus 2300mmol/mol creatinine after transplantation). No further acute metabolic decompensation was observed and protein-intake was increased from 0.60 to 0.83g/Kg/day. One patient transplanted at age 9.7years developed a hepatoblastoma at age 11years with subsequent neurological complications and eventually died. The three other patients are alive. Two of them remained neurologically stable. The 3rd patient who displayed choreoathetosis transiently improved his neurological condition immediately after transplantation and then remained stable. Kidney transplantation represents an interesting alternative therapeutic option in methylmalonic aciduria, for renal complications but also as a "cellular

  6. Bariatric Surgery as a Bridge to Renal Transplantation in Patients with End-Stage Renal Disease.

    Science.gov (United States)

    Al-Bahri, Shadi; Fakhry, Tannous K; Gonzalvo, John Paul; Murr, Michel M

    2017-11-01

    Obesity is a relative contraindication to organ transplantation. Preliminary reports suggest that bariatric surgery may be used as a bridge to transplantation in patients who are not eligible for transplantation because of morbid obesity. The Bariatric Center at Tampa General Hospital, University of South Florida, Tampa, Florida. We reviewed the outcomes of 16 consecutive patients on hemodialysis for end-stage renal disease (ESRD) who underwent bariatric surgery from 1998 to 2016. Demographics, comorbidities, weight loss, as well as transplant status were reported. Data is mean ± SD. Six men and ten women aged 43-66 years (median = 54 years) underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 12), laparoscopic adjustable gastric banding (LAGB, n = 3), or laparoscopic sleeve gastrectomy (LSG, n = 1). Preoperative BMI was 48 ± 8 kg/m 2 . Follow-up to date was 1-10 years (median = 2.8 years); postoperative BMI was 31 ± 7 kg/m 2 ; %EBWL was 62 ± 24. Four patients underwent renal transplantation (25%) between 2.5-5 years after bariatric surgery. Five patients are currently listed for transplantation. Five patients were not listed for transplantation due to persistent comorbidities; two of these patients died as a consequence of their comorbidities (12.5%) more than 1 year after bariatric surgery. Two patients were lost to follow-up (12.5%). Bariatric surgery is effective in patients with ESRD and improves access to renal transplantation. Bariatric surgery offers a safe approach to weight loss and improvement in comorbidities in the majority of patients. Referrals of transplant candidates with obesity for bariatric surgery should be considered early in the course of ESRD.

  7. Outcomes of Foot and Ankle Surgery in Diabetic Patients Who Have Undergone Solid Organ Transplantation.

    Science.gov (United States)

    Zou, Richard H; Wukich, Dane K

    2015-01-01

    Foot and ankle problems are highly prevalent in patients with diabetes mellitus (DM). Increased rates of surgical site infections and noninfectious complications, such as malunion, delayed union, nonunion, and hardware failure, have also been more commonly observed in diabetic patients who undergo foot and ankle surgery. DM is a substantial contributor of perioperative morbidity in patients with solid organ transplantation. To the best of our knowledge, postoperative foot and ankle complications have not been studied in a cohort of diabetic patients who previously underwent solid organ transplantation. The aim of the present study was to evaluate the outcomes of foot and ankle surgery in a cohort of diabetic transplant patients and to compare these outcomes with those of diabetic patients without a history of transplantation. We compared the rates of infectious and noninfectious complications after foot and ankle surgery in 28 diabetic transplant patients and 56 diabetic patients without previous transplantation and calculated the odds ratios (OR) for significant findings. The diabetic transplant patients who underwent foot and ankle surgery in the present cohort were not at an increased risk of overall complications (OR 0.83, 95% confidence interval [CI] 0.33 to 2.08, p = .67), infectious complications (OR 0.54, 95% CI 0.09 to 3.09, p = .49), or noninfectious complications (OR 1.14, 95% CI 0.41 to 3.15, p = .81). Four transplant patients (14.3%) died of non-orthopedic surgery-related events during the follow-up period; however, no deaths occurred in the control group. Diabetic patients with previous solid organ transplantation were not at an increased risk of developing postoperative complications after foot and ankle surgery, despite being immunocompromised. The transplant patients had a greater mortality rate, but their premature death was unrelated to their foot and ankle surgery. Surgeons treating transplant patients can recommend foot and ankle surgery when

  8. Outcomes of Foot and Ankle Surgery in Diabetic Patients Who Have Undergone Solid Organ Transplantation

    Science.gov (United States)

    Zou, Richard H.; Wukich, Dane K.

    2017-01-01

    Foot and ankle problems are highly prevalent in patients with diabetes mellitus (DM). Increased rates of surgical site infections and noninfectious complications, such as malunion, delayed union, nonunion, and hardware failure, have also been more commonly observed in diabetic patients who undergo foot and ankle surgery. DM is a substantial contributor of perioperative morbidity in patients with solid organ transplantation. To the best of our knowledge, postoperative foot and ankle complications have not been studied in a cohort of diabetic patients who previously underwent solid organ transplantation. The aim of the present study was to evaluate the outcomes of foot and ankle surgery in a cohort of diabetic transplant patients and to compare these outcomes with those of diabetic patients without a history of transplantation. We compared the rates of infectious and noninfectious complications after foot and ankle surgery in 28 diabetic transplant patients and 56 diabetic patients without previous transplantation and calculated the odds ratios (OR) for significant findings. The diabetic transplant patients who underwent foot and ankle surgery in the present cohort were not at an increased risk of overall complications (OR 0.83, 95% confidence interval [CI] 0.33 to 2.08, p = .67), infectious complications (OR 0.54, 95% CI 0.09 to 3.09, p = .49), or noninfectious complications (OR 1.14, 95% CI 0.41 to 3.15, p = .81). Four transplant patients (14.3%) died of non–orthopedic surgery-related events during the follow-up period; however, no deaths occurred in the control group. Diabetic patients with previous solid organ transplantation were not at an increased risk of developing postoperative complications after foot and ankle surgery, despite being immunocompromised. The transplant patients had a greater mortality rate, but their premature death was unrelated to their foot and ankle surgery. Surgeons treating transplant patients can recommend foot and ankle surgery when

  9. Seroprevalence for Human Cytomegalovirus in samples from dialysis and kidney transplanted patients

    Directory of Open Access Journals (Sweden)

    Patricia Okubo

    2014-12-01

    Full Text Available he aim of this study was at investigating the seroprevalence of Human Cytomegalovirus in dialysis and kidney transplanted patients and the association with hemodialysis and sex. It is a cross sectional study made in 2011 and 2012 in the county of Maringá, PA, Brazil. The studied population consisted of 203 dialysis patients and 53 kidney transplanted patients and the viral identification was made through serological technique. The study found 96% (195 seropositivity for anti-HCMV IgG in dialysis patients and 100% in the transplanted ones; 5% (10 seropositivity for anti-HCMV-IgM in dialysis patients and 37.7% (20 in transplanted ones. Performing Fisher’s exact test, there was no significant association between the seroprevalence of anti-HCMV with hemodialysis and gender. A large number of infected patients suggest the importance of nursing care to avoid cross-infection during routine procedures.

  10. Transplant Considerations

    Science.gov (United States)

    ... Be The Match® is a global leader in bone marrow transplantation. We conduct research to improve transplant outcomes provide support and resources for patients, and partner with a global network. Learn more. ... stories Valerie Sun - bone marrow transplant patient advocate Jeff and Kim take ...

  11. Surgical site infection in patients submitted to heart transplantation.

    Science.gov (United States)

    Rodrigues, Jussara Aparecida Souza do Nascimento; Ferretti-Rebustini, Renata Eloah de Lucena; Poveda, Vanessa de Brito

    2016-08-29

    to analyze the occurrence and predisposing factors for surgical site infection in patients submitted to heart transplantation, evaluating the relationship between cases of infections and the variables related to the patient and the surgical procedure. retrospective cohort study, with review of the medical records of patients older than 18 years submitted to heart transplantation. The correlation between variables was evaluated by using Fisher's exact test and Mann-Whitney-Wilcoxon test. the sample consisted of 86 patients, predominantly men, with severe systemic disease, submitted to extensive preoperative hospitalizations. Signs of surgical site infection were observed in 9.3% of transplanted patients, with five (62.5%) superficial incisional, two (25%) deep and one (12.5%) case of organ/space infection. There was no statistically significant association between the variables related to the patient and the surgery. there was no association between the studied variables and the cases of surgical site infection, possibly due to the small number of cases of infection observed in the sample investigated. analisar a ocorrência e os fatores predisponentes para infecção de sítio cirúrgico em pacientes submetidos a transplante cardíaco e verificar a relação entre os casos de infecção e as variáveis referentes ao paciente e ao procedimento cirúrgico. estudo de coorte retrospectivo, com exame dos prontuários médicos de pacientes maiores de 18 anos, submetidos a transplante cardíaco. A correlação entre variáveis foi realizada por meio dos testes exato de Fischer e de Mann-Whitney-Wilcoxon. a amostra foi constituída por 86 pacientes, predominantemente homens, com doença sistêmica grave, submetidos a internações pré-operatórias extensas. Apresentaram sinais de infecção do sítio cirúrgico 9,3% dos transplantados, sendo cinco (62,5%) incisionais superficiais, duas (25%) profundas e um (12,5%) caso de infecção de órgão/espaço. Não houve associa

  12. Hematopoietic Stem Cell Transplantation in Primary Immunodeficiency Patients in the Black Sea Region of Turkey.

    Science.gov (United States)

    Yıldıran, Alişan; Çeliksoy, Mehmet Halil; Borte, Stephan; Güner, Şükrü Nail; Elli, Murat; Fışgın, Tunç; Özyürek, Emel; Sancak, Recep; Oğur, Gönül

    2017-12-01

    Hematopoietic stem cell transplantation is a promising curative therapy for many combined primary immunodeficiencies and phagocytic disorders. We retrospectively reviewed pediatric cases of patients diagnosed with primary immunodeficiencies and scheduled for hematopoietic stem cell transplantation. We identified 22 patients (median age, 6 months; age range, 1 month to 10 years) with various diagnoses who received hematopoietic stem cell transplantation. The patient diagnoses included severe combined immunodeficiency (n=11), Chediak-Higashi syndrome (n=2), leukocyte adhesion deficiency (n=2), MHC class 2 deficiency (n=2), chronic granulomatous syndrome (n=2), hemophagocytic lymphohistiocytosis (n=1), Wiskott-Aldrich syndrome (n=1), and Omenn syndrome (n=1). Of the 22 patients, 7 received human leukocyte antigen-matched related hematopoietic stem cell transplantation, 12 received haploidentical hematopoietic stem cell transplantation, and 2 received matched unrelated hematopoietic stem cell transplantation. The results showed that 5 patients had graft failure. Fourteen patients survived, yielding an overall survival rate of 67%. Screening newborn infants for primary immunodeficiency diseases may result in timely administration of hematopoietic stem cell transplantation.

  13. Catheter-associated urinary infection in kidney post-transplant patients

    Directory of Open Access Journals (Sweden)

    Luiz Carlos de Oliveira

    2001-09-01

    Full Text Available CONTEXT: There is still controversy as to the use and dosage of antimicrobial prophylaxis of the urinary infection associated with urethral catheterization in the post renal transplant period. OBJECTIVE: To determine whether patients develop urinary infection during short-term urethral catheterization after renal transplant without routine antimicrobial prophylaxis. DESIGN: Prospective study. SETTING: Kidney Transplantation Unit. SAMPLE: 20 patients submitted to non-complicated kidney transplant, with a normal urinary tract and no risk factors present regarding urinary infection. Aged 15 to 65 years. MAIN MEASUREMENTS: Before the transplant, material from the urethral meatus and urine were collected for culture. After the transplant, in the period during which the patient was with short-term urethral catheterization (4 to 5 days, material from the urethral meatus and urine from the bladder and the collecting bag were taken daily from all recipients for culture. RESULTS: There was a predominance of coagulase-negative Staphylococcus and S. viridans in the normal urethral meatus flora and in the first two days of urethral catheterization. After the second day, there was a predominance of E. coli and E. faecalis. Urinary infection did not occur during the period of urethral catheterization. In the follow up only one female patient (7% had asymptomatic bacteriuria caused by E.coli after the withdrawal of the urethral catheter. CONCLUSIONS: Infection urinary does not occur during the period of urethral catheterization in kidney post-transplant patients. Thus, antimicrobial prophylaxis is not recommended for these patients to prevent urinary infection.

  14. Transplant tourism.

    Science.gov (United States)

    Schiano, Thomas D; Rhodes, Rosamond

    2010-04-01

    Because of the ongoing organ donor shortage, transplant tourism is occurring at an increasing rate both in the USA and abroad. To date, there have been little published data to help guide the programmatic philosophy of the USA transplant centers regarding transplant tourism. We summarize position statements from several transplant societies regarding transplant tourism and specifically transplantation occurring in China (because of the use of executed prisoners as organ donors). Transplant tourism is ever increasing and patients may be at risk for greater post-transplant morbidity as well as inadequate follow up care. Transplant centers require some guidance with regard of how to deal with these patients. Transplant tourism is an increasing reality facing the USA transplant centers. Most professional societies do not condone it yet cannot abrogate a physician's right to care for such patients. Ethical principles mandate transplant physicians provide adequate care for returning transplant tourists. Better ways of assessing the scope of the problem are necessary. Transplant tourism may exist because of the disparity between the need for organ donors and their availability and is thus is likely to continue into the future.

  15. Two cases of patients with renal transplants presenting with anuria due to an infarcted ileal conduit.

    Science.gov (United States)

    Coxon, Jonathan P; Jones, Chris R

    2002-10-01

    Transplanting kidneys into patients with an ileal conduit has become acceptable practice, and is usually well tolerated. We present the cases of two such patients who later presented as emergencies with anuria due to infarction of the ileal conduit. Both required operative intervention, and in both cases the renal function returned to its pre-operative level. The cases illustrate an important differential diagnosis of anuria in this group of transplant patients.

  16. Long-Term Health of Dopaminergic Neuron Transplants in Parkinson's Disease Patients

    Directory of Open Access Journals (Sweden)

    Penelope J. Hallett

    2014-06-01

    Full Text Available To determine the long-term health and function of transplanted dopamine neurons in Parkinson’s disease (PD patients, the expression of dopamine transporters (DATs and mitochondrial morphology were examined in human fetal midbrain cellular transplants. DAT was robustly expressed in transplanted dopamine neuron terminals in the reinnervated host putamen and caudate for at least 14 years after transplantation. The transplanted dopamine neurons showed a healthy and nonatrophied morphology at all time points. Labeling of the mitochondrial outer membrane protein Tom20 and α-synuclein showed a typical cellular pathology in the patients’ own substantia nigra, which was not observed in transplanted dopamine neurons. These results show that the vast majority of transplanted neurons remain healthy for the long term in PD patients, consistent with clinical findings that fetal dopamine neuron transplants maintain function for up to 15–18 years in patients. These findings are critically important for the rational development of stem-cell-based dopamine neuronal replacement therapies for PD.

  17. Is Remote Ischemic Conditioning of Benefit to Patients Undergoing Kidney Transplantation?

    Science.gov (United States)

    Cheungpasitporn, Wisit; Khoury, Nadeen J; Thongprayoon, Charat; Craici, Iasmina M

    2017-10-12

    Renal ischemia-reperfusion injury (IRI), an inevitable event during kidney transplantation procedure, can result in delayed graft function or even primary nonfunction. In addition to strategies to limit IRI such as advancements in organ allocation systems and preservation of organs, and reduction in cold and warm ischemia time, remote ischemic conditioning (RIC) has attracted much attention in recent years. With promising findings and data suggesting a potential benefit of RIC in animal kidney transplantation models, a few clinical trials have investigated the use of RIC in human kidney transplantation. Unfortunately, the findings from these investigations have been inconclusive due to a number of factors such as diverse time points of RIC, limited sample size, and complexity of kidney transplant patients. This brief commentary aims to discuss the effects of RIC on clinical outcomes and proinflammatory cytokines in patients undergoing kidney transplantation.

  18. Invasive Pulmonary Aspergillosis in a Sickle Cell Patient Transplant Recipient: A Successful Treatment

    Directory of Open Access Journals (Sweden)

    Katia Paciaroni

    2015-08-01

    Full Text Available Sickle Cell Anaemia (SCA is the most common inherited blood disorder and is associated with severe morbidity and decreased survival. Allogeneic Haematopoietic Stem Cell Transplantation (HSCT is the only curative approach. Nevertheless the decision to perform a marrow transplant includes the risk of major complications  and mortality transplant related. The infections represent the main cause of mortality for SCA patients undergoing transplant. Invasive Pulmonary Aspergillosis (IPA is a devastating opportunistic infection and remains a significant cause of morbidity and mortality in HSCT recipients. Data regarding IPA in the setting of SCA are lacking. In the present report,  we describe a patient with SCA who developed IPA after allogeneic bone marrow transplant. The fungal infection was treated by systemic antifungal therapy in addition to the surgery, despite  mild chronic GVHD and with continuing immunosuppression therapy. This case shows that IPA occurring in bone marrow recipient with SCA can be successful treated

  19. Survival of patients identified as candidates for intestinal transplantation: a 3-year prospective follow-up

    DEFF Research Database (Denmark)

    Pironi, L.; Forbes, A.; Joly, F.

    2008-01-01

    with parenteral nutrition-related liver failure (P = .364). CONCLUSIONS: The results confirm home parenteral nutrition as the primary therapeutic option for intestinal failure and support the appropriateness and potential life-saving role of timely intestinal transplantation for patients with parenteral nutrition......BACKGROUND & AIMS: The US Medicare indications for intestinal transplantation are based on failure of home parenteral nutrition. The American Society of Transplantation also includes patients at high risk of death from their primary disease or with high morbidity intestinal failure. A 3-year...... prospective study evaluated the appropriateness of these indications. METHODS: Survival on home parenteral nutrition or after transplantation was analyzed in 153 (97 adult, 56 pediatric) candidates for transplantation and 320 (262 adult, 58 pediatric) noncandidates, enrolled through a European multicenter...

  20. Abnormal bone and mineral metabolism in kidney transplant patients--a review

    DEFF Research Database (Denmark)

    Sprague, S.M.; Belozeroff, V.; Danese, M.D.

    2008-01-01

    for English language articles published between January 1990 and October 2006 that contained Medical Subject Headings and key words related to secondary or persistent hyperparathyroidism and kidney transplant. RESULTS: Parathyroid hormone levels decreased significantly during the first 3 months after......BACKGROUND/AIMS: Abnormal bone and mineral metabolism is common in patients with kidney failure and often persists after successful kidney transplant. METHODS: To better understand the natural history of this disease in transplant patients, we reviewed the literature by searching MEDLINE...... transplant but typically stabilized at elevated values after 1 year. Calcium tended to increase after transplant and then stabilize at the higher end of the normal range within 2 months. Phosphorus decreased rapidly to within or below normal levels after surgery and hypophosphatemia, if present, resolved...

  1. Hyperhomocyst(einemia in chronic stable renal transplant patients

    Directory of Open Access Journals (Sweden)

    David José de Barros Machado

    2000-10-01

    Full Text Available PURPOSE: Hyperhomocyst(einaemia is an important risk factor for atherosclerosis, which is currently a major cause of death in renal transplant patients. The aim of this study was to assess the influence of immunosuppressive therapy on homocyst(einemia in renal transplant recipients. METHODS: Total serum homocysteine (by high performance liquid chromatography, creatinine, lipid profile, folic acid (by radioimmunoassay-RIA and vitamin B12 (by RIA concentrations were measured in 3 groups. Group I patients (n=20 were under treatment with cyclosporine, azathioprine, and prednisone; group II (n=9 were under treatment with azathioprine and prednisone; and group III (n=7 were composed of renal graft donors for groups I and II. Creatinine, estimated creatinine clearance, cyclosporine trough level, lipid profile, folic acid, and vitamin B12 concentrations and clinical characteristics of patients were assessed with the aim of ascertaining determinants of hyperhomocyst(einemia. RESULTS: Patient ages were 48.8 ± 15.1 yr (group I, 43.3 ± 11.3 yr (group II; and 46.5 ± 14.8 yr (group III. Mean serum homocyst(eine (tHcy concentrations were 18.07 ± 8.29 mmol/l in renal transplant recipients; 16.55 ± 5.6 mmol/l and 21.44 ± 12.1 mmol/l respectively for group I (with cyclosporine and group II (without cyclosporine (NS. In renal donors, tHcy was significantly lower (9.07 ± 3.06 mmol/l; group I + group II vs. group III, pOBJETIVOS: A hiper-homocisteinemia é um fator de risco importante para aterosclerose e, esta é uma das principais causas de óbito em transplantados renais. O objetivo deste estudo é avaliar a influência da terapêutica imunossupressora na homocisteinemia de receptores de transplante renal. CASUÍSTICA E MÉTODO: Vinte e nove pacientes foram divididos em dois grupos: grupo I (n=20 - pacientes transplantados renais em uso de ciclosporina, azatioprina e prednisona; grupo II (n=9 - pacientes transplantados renais em uso de azatioprina e

  2. Orthotopic Liver Transplantation in Human-Immunodeficiency-Virus-Positive Patients in Germany

    Directory of Open Access Journals (Sweden)

    E. Anadol

    2012-01-01

    Full Text Available Objectives. This summary evaluates the outcomes of orthotopic liver transplantation (OLT of HIV-positive patients in Germany. Methods. Retrospective chart analysis of HIV-positive patients, who had been liver-transplanted in Germany between July 1997 and July 2011. Results. 38 transplantations were performed in 32 patients at 9 German transplant centres. The reasons for OLT were end-stage liver disease (ESLD and/or liver failure due to hepatitis C (HCV (=19, hepatitis B (HBV (=10, multiple viral infections of the liver (=2 and Budd-Chiari-Syndrome. In July 2011 19/32 (60% of the transplanted patients were still alive with a median survival of 61 months (IQR (interquartile range: 41–86 months. 6 patients had died in the early post-transplantation period from septicaemia (=4, primary graft dysfunction (=1, and intrathoracal hemorrhage (=1. Later on 7 patients had died from septicaemia (=2, delayed graft failure (=2, recurrent HCC (=2, and renal failure (=1. Recurrent HBV infection was efficiently prevented in 11/12 patients; HCV reinfection occurred in all patients and contributed considerably to the overall mortality. Conclusions. Overall OLT is a feasible approach in HIV-infected patients with acceptable survival rates in Germany. Reinfection with HCV still remains a major clinical challenge in HIV/HCV coinfection after OLT.

  3. The role of CT in patient management after liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Galanski, M. [Dept. of Radiology, Medical School Hannover (Germany); Drewes, J. [Dept. of Radiology, Medical School Hannover (Germany); Gubernatis, G. [Dept. of Abdominal and Transplantation Surgery, Medical School Hannover (Germany); Chavan, A. [Dept. of Radiology, Medical School Hannover (Germany); Prokop, M. [Dept. of Radiology, Medical School Hannover (Germany)

    1992-04-01

    To evaluate the value of CT in clarifying the nature of complications after orthopedic liver transplantation, we restrospectively evaluated the files of 88 patients in light of the clinical course and all available diagnostic data. The liver tranplantations were performed in the years 1986 and 1987. As a rule, the examinations comprised of continuous 8 mm-thick CT sections of the abdomen. In the majority of the cases, contrast medium was administered for opacification of the bowel loops, either orally or through a tube. Bowel movement was reduced by intravenous (i.v.) Buscopan. In our series an increase in the periportal hypodensities was found to be an unfavourable prognostic sign. A high percentage of patients with this CT finding subsequently progressed to graft failure due to reasons other than graft rejection. Hence in the final analysis, the CT sign is non-specific and does not permit the definitive diagnosis of graft rejection. Nevertheless, CT is important for excluding conditions that demand surgical intervention, in particular abscess formation. (orig./MG)

  4. The role of intraoperative hemodialysis in liver transplant patients.

    Science.gov (United States)

    Sedra, Ashraf H; Strum, Earl

    2011-06-01

    Orthotopic liver transplant (OLT) is a major surgical procedure that can be both challenging and lengthy. One of the common findings in end-stage liver disease is renal failure, whether acute or chronic, which may complicate the intraoperative course. The use of intraoperative hemodialysis is described by several centers to aid during OLT cases with impaired renal function or kidney failure. Unfortunately, there is a paucity of available data, which is limited to sporadic case reports, and only few structured studies in which continuous renal replacement therapy was used versus intraoperative hemodialysis, which is the main focus of this article. The rationale behind the use of intraoperative hemodialysis during OLT in patients with kidney dysfunction or failure is that the procedure is usually complicated by major hemodynamic changes, metabolic derangement, and coagulation abnormalities, which we think can be better managed intraoperatively using hemodialysis. In our institution, we performed over 140 cases of OLT using intraoperative hemodialysis since 2003 until the present. A retrospective cohort study is being conducted during the writing of this article. Preliminary data collection report zero percentage intraoperative mortality and 48 h postoperatively. Hemodialysis is widely acknowledged as a treatment option to stabilize patients with renal failure, and one of the most challenging situations is during OLT in which the role of intraoperative hemodialysis is becoming more important today more than ever before.

  5. Tacrolimus in preventing transplant rejection in Chinese patients – optimizing use

    Directory of Open Access Journals (Sweden)

    Li CJ

    2015-01-01

    Full Text Available Chuan-Jiang Li,1,* Liang Li2,* 1Department of Surgery, Nanfang Hospital, 2Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, People’s Republic of China *The authors contributed equally to this work Abstract: Tacrolimus is a product of fermentation of Streptomyces, and belongs to the family of calcineurin inhibitors. It is a widely used immunosuppressive drug for preventing solid-organ transplant rejection. Compared to cyclosporine, tacrolimus has greater immunosuppressive potency and a lower incidence of side effects. It has been accepted as first-line treatment after liver and kidney transplantation. Tacrolimus has specific features in Chinese transplant patients; its in vivo pharmacokinetics, treatment regimen, dose and administration, and adverse-effect profile are influenced by multiple factors, such as genetics and the spectrum of primary diseases in the Chinese population. We reviewed the clinical experience of tacrolimus use in Chinese liver- and kidney-transplant patients, including the pharmacology of tacrolimus, the immunosuppressive effects of tacrolimus versus cyclosporine, effects of different factors on tacrolimus metabolism on Chinese patients, personalized medicine, clinical safety profile, and patient satisfaction and adherence. This article provides guidance for the rational and efficient use of tacrolimus in Chinese organ-transplant patients. Keywords: tacrolimus, liver transplantation, kidney transplant, Chinese, personalized medicine

  6. Bone marrow transplantation in patients with storage diseases: a developing country experience

    Directory of Open Access Journals (Sweden)

    Lange Marcos C.

    2006-01-01

    Full Text Available Bone marrow transplantation (BMT is a therapeutic option for patients with genetic storage diseases. Between 1979 and 2002, eight patients, four females and four males (1 to 13 years old were submitted to this procedure in our center. Six patients had mucopolysaccharidosis (MPS I in 3; MPS III in one and MPS VI in 2, one had adrenoleukodystrophy (ALD and one had Gaucher disease. Five patients had related and three unrelated BMT donor. Three patients developed graft versus host disease (two MPS I and one MPS VI and died between 37 and 151 days after transplantation. Five patients survived 4 to 16 years after transplantation. Three patients improved (one MPS I; one MPS VI and the Gaucher disease patient, one patient had no disease progression (ALD and in one patient this procedure did not change the natural course of the disease (MPS III.

  7. Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients.

    Science.gov (United States)

    Fullerton, Brenna S; Sparks, Eric A; Hall, Amber M; Duggan, Christopher; Jaksic, Tom; Modi, Biren P

    2016-01-01

    Patient selection for transplant evaluation in pediatric intestinal failure is predicated on the ability to assess long-term transplant-free survival. In light of trends toward improved survival of intestinal failure patients in recent decades, we sought to determine if the presence of biopsy-proven hepatic cirrhosis or the eventual achievement of enteral autonomy were associated with transplant-free survival. After IRB approval, records of all pediatric intestinal failure patients (parenteral nutrition (PN) >90 days) treated at a single intestinal failure center from February 2002 to September 2014 were reviewed. Chi-squared, Mann-Whitney, and log-rank testing were performed as appropriate. Of 313 patients, 174 eventually weaned off PN. Liver biopsies were available in 126 patients (most common indication was intestinal failure associated liver disease, IFALD), and 23 met histologic criteria for cirrhosis. Transplant-free survival for the whole cohort of 313 patients was 94.7% at 1 year and 89.2% at 5 years. Among patients with liver biopsies, transplant-free survival in cirrhotics vs. noncirrhotics was 95.5% vs. 94.1% at one year and 95.5% vs. 86.7% at 5 years (P=0.29). Transplant-free survival in patients who achieved enteral autonomy compared with patients who remained PN dependent was 98.2% vs. 90.3% at one year and 98.2% vs. 76.9% at 5 years (Ppediatric intestinal failure patients. There was no association between histopathological diagnosis of cirrhosis and transplant-free survival in the cohort. These data suggest that automatic transplant referral may not be required for histopathological diagnosis of cirrhosis alone, and that ongoing efforts aimed at achievement of enteral autonomy remain paramount in pediatric intestinal failure. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Diaphragm rupture in a liver transplant patient under chronic immunosuppressive therapy with sirolimus: rare complication after liver transplantation.

    Science.gov (United States)

    Rossetto, Anna; Baccarani, Umberto; Adani, Gian Luigi; Lorenzin, Dario; Bresadola, Vittorio; Terrosu, Giovanni

    2011-03-01

    A diaphragm rupture is a very rare event. A variety of conditions such as coughing, delivery, and vigorous exercise causing a sudden increase of the intra-abdominal pressure can result in diaphragm rupture [1]. The diagnosis can be difficult because of non-specific symptoms and no history of blunt or penetrating trauma. Due to anatomical reasons, diaphragmatic lesions in the left side are more common than those in the right side. Chronic immunosuppressive therapy in transplanted patients, especially with antiproliferative drugs such as mTOR inhibitor, has been considered as a risk factor for the development of incisional hernia [2, 3]. We present the case of diaphragm rupture in a liver transplant patient under chronic immunosuppressive therapy with sirolimus.

  9. Evaluation of Quality of Life and Care Needs of Turkish Patients Undergoing Hematopoietic Stem Cell Transplantation

    Directory of Open Access Journals (Sweden)

    Neslisah Yasar

    2016-01-01

    Full Text Available This descriptive study explored the quality of life and care needs of Turkish patients who underwent hematopoietic stem cell transplantation. The study sample consisted of 100 hematopoietic stem cell transplant patients. Their quality of life was assessed using Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale. The mean patient age was 44.99 ± 13.92 years. Changes in sexual functions, loss of hair, loss of taste, loss of appetite, and sleep disturbances were the most common symptoms. The quality of life of transplant patients was moderately affected; the functional well-being and social/family well-being subscales were the most adversely and least negatively affected (12.13 ± 6.88 dimensions, respectively. Being female, being between 50 and 59 years of age, being single, having a chronic disease, and having a history of hospitalization were associated with lower quality of life scores. Interventions to improve functional status, physical well-being, and emotional status of patients during the transplantation process may help patients cope with treatment-related impairments more effectively. Frequent screening and management of patient symptoms in order to help patients adapt to life following allogeneic hematopoietic stem cell transplantation are crucial for meeting care needs and developing strategies to improve their quality of life.

  10. Factors influencing platelet transfusion refractoriness in patients undergoing allogeneic hematopoietic stem cell transplantation.

    Science.gov (United States)

    Solves, Pilar; Sanz, Jaime; Freiria, Carmen; Santiago, Marta; Villalba, Ana; Gómez, Inés; Montesinos, Pau; Montoro, Juan; Piñana, Jose Luis; Lorenzo, José Ignacio; Puig, Nieves; Sanz, Guillermo F; Sanz, Miguel Ángel; Carpio, Nelly

    2018-01-01

    Hematopoietic stem cell transplantation has been considered a risk factor for development of platelet transfusion refractoriness. The objective of this study was to assess the platelet transfusion refractoriness rate in patients undergoing allogeneic hematopoietic stem cell transplantation from different sources. We retrospectively reviewed the charts and transfusion records of patients who underwent allogeneic stem cell transplantation at our institution between 2013 and 2015. The evaluation of post-transfusion platelet count was assessed for each transfusion given, from day of progenitor infusion to day 30 after transplantation. Of 167 patients included in this study, 101 received peripheral blood stem cell transplantation (PBSCT) and 66 received umbilical cord blood transplantation (UCBT). Overall, the percentage of platelet transfusions with a 14-h CCI lower than 5000 was 59.3%, being these data significantly higher for UCBT (67.6%) than for PBSCT (31.0%). Seventy-eight percent of patients underwent UCBT become refractory, while 38.6% of patients who received PBSCT were refractory. Factors associated to platelet refractoriness were lower CD34+ cell dose infused, higher number of antibiotics used, presence of anti-HLA I antibodies, and reduced-intensity conditioning regimen. Platelet refractoriness is a frequent and complex adverse event and remains a therapeutic challenge in the management of patients undergoing HSCT. There is a higher rate of platelet refractoriness in patients who received UCBT as compared to patients who received PBSCT.

  11. Heart Transplantation in Patients Older than 65 Years: Worthwhile or Wastage of Organs?

    Science.gov (United States)

    Prieto, David; Correia, Pedro; Batista, Manuel; Antunes, Manuel de Jesus

    2015-12-01

    Patients older than 65 years have traditionally not been considered candidates for heart transplantation. However, recent studies have shown similar survival. We evaluated immediate and medium-term results in patients older than 65 years compared with younger patients. From November 2003 to December 2013, 258 patients underwent transplantation. Children and patients with other organ transplantations were excluded from this study. Recipients were divided into two groups: 45 patients (18%) aged 65 years and older (Group A) and 203 patients (81%) younger than 65 years (Group B). Patients differed in age (67.0 ± 2.2 vs. 51.5 ± 9.7 years), but gender (male 77.8 vs. 77.3%; p = 0.949) was similar. Patients in Group A had more cardiovascular risk factors and ischemic cardiomyopathy (60 vs. 33.5%; p transplantation in selected older patients can be performed with survival similar to younger patients, hence should not be restricted arbitrarily. Incidence of infections, graft vascular disease, and malignancies can be reduced with a more personalized approach to immunosuppression. Allocation of donors to these patients does not appear to reduce the possibility of transplanting younger patients. Georg Thieme Verlag KG Stuttgart · New York.

  12. Current Expectations for Cardiac Transplantation in Patients With Congenital Heart Disease.

    Science.gov (United States)

    Kirklin, James K; Carlo, Waldemar F; Pearce, F Bennett

    2016-11-01

    Congenital heart disease accounts for 40% of pediatric heart transplants and presents unique challenges to the transplant team. Suitability for transplantation is defined in part by degree of sensitization, pulmonary vascular resistance, and hepatic reserves. The incremental transplant risk for patients with congenital heart disease occurs within the first 3 months, after which survival is equivalent to transplantation for cardiomyopathy. Single ventricle with prior palliation, and especially the failing Fontan, carry the highest risk for transplantation and are least amenable to bridging with mechanical circulatory support. More effective bridging to transplant with mechanical circulatory support will require improvements in the adverse event profile of available pumps and the introduction of miniaturized continuous flow technology. The major barriers to routine long-term survival are chronic allograft failure and allograft vasculopathy. Despite these many challenges, continuing improvements in the care of pediatric heart transplant patients have pushed the median posttransplant survival past 15 years for children and to 20 years for infants. © The Author(s) 2016.

  13. Cardiopulmonary exercise factors predict survival in patients with advanced interstitial lung disease referred for lung transplantation.

    Science.gov (United States)

    Layton, Aimee M; Armstrong, Hilary F; Kim, Hanyoung P; Meza, Kimbery S; D'Ovidio, Frank; Arcasoy, Selim M

    2017-05-01

    The purpose of this work was to determine if parameters assessed during Cardiopulmonary Exercise Testing (CPET) while using supplemental oxygen can independently predict one-year transplant-free survival in patients with Interstitial Lung Disease (ILD) referred for lung transplant evaluation. We performed a chart review of patients with ILD who completed CPET with 30% FiO2 and gathered spirometry, pulmonary hemodynamic, six-minute walk, and CPET data. The primary end-point was death or lung transplantation within one-year of CPET. The final data set included 192 patients. 79 patients died/underwent transplant, 113 survived transplant-free. Multivariable Cox regression revealed peak workload % predicted, nadir CPET SpO2, and FVC% predicted as independent predictors of one-year transplant-free survival. Of the independent predictors of survival, receiver operating characteristics analysis revealed peak workload %predicted cutoff of 35% to be highly discriminatory, more so than nadir CPET SpO2 or FVC % predicted in identifying patients at risk for one-year mortality or transplant (peak workload % predicted < 35% HR = 4.71, 95% CI = 2.64-8.38 and area under the curve (AUC) = 0.740, nadir CPET SpO2 < 86% HR = 2.27, 95%CI = 1.41-3.68, AUC = 0.645, FVC %predicted <45% HR = 1.82, 95% CI = 1.15-2.87, AUC = 0.624). Peak workload % predicted, nadir CPET SpO2, and FVC% predicted in ILD patients referred for lung transplant evaluation are independently predictive of one-year mortality or need for transplant. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Nonmyeloablative allogeneic hematopoietic transplantation: a promising salvage therapy for patients with non-Hodgkin's lymphoma whose disease has failed a prior autologous transplantation.

    Science.gov (United States)

    Escalón, Maricer P; Champlin, Richard E; Saliba, Rima M; Acholonu, Sandra A; Hosing, Chitra; Fayad, Luis; Giralt, Sergio; Ueno, Naoto T; Maadani, Farzaneh; Pro, Barbara; Donato, Michele; McLaughlin, Peter; Khouri, Issa F

    2004-06-15

    Allogeneic transplantation for patients with lymphoma who experience a recurrence after an autologous transplantation has been considered a hazardous therapeutic choice. We investigated the safety and efficacy of nonmyeloablative stem-cell transplantation in these patients. Patients were required to have chemosensitive or stable disease. Twenty consecutive patients were treated in two sequential trials. Fifteen patients underwent a preparative regimen of fludarabine (30 mg/m(2) daily for 3 days), intravenous cyclophosphamide (750 mg/m(2) daily for 3 days), and rituximab. For the remaining five patients, the conditioning regimen consisted of cisplatin (25 mg/m(2) continuous infusion daily for 4 days), fludarabine (30 mg/m(2) daily for 2 days), and cytarabine (1,000 mg/m(2) daily for 2 days). Tacrolimus and methotrexate were used for graft-versus-host disease prophylaxis. All patients experienced engraftment of donor cells. One patient (5%) experienced grade 2 acute graft-versus-host disease, and no patients experienced a higher grade. One patient experienced disease progression at 115 days post-transplantation and responded to donor lymphocyte infusion. The remaining patients remained disease-free. One patient died at 10.5 months from a fungal infection. With a median follow-up time of 25 months, the estimated 3-year current progression-free survival rate was 95%. These data suggest that nonmyeloablative allogeneic stem-cell transplantation is an effective option in lymphoma patients with chemosensitive or stable disease who experience disease recurrence following autologous transplantation.

  15. Clinical value of APACHE scores in patients who require intensive care before liver transplantation.

    Science.gov (United States)

    Park, Kwang-Min; Kim, Ki-Hun; Lee, Sung-Gyu; Lee, Young-Joo; Hwang, Shin; Ahn, Chul-Soo; Moon, Deok-Bog; Ha, Tae-Yong; Song, Gi-Won; Jung, Dong-Hwan; Kim, Hong Jin

    2008-01-01

    Although many prognostic indices have been used to predict outcomes after liver transplantation, the actual correlations between these indices and outcomes are inconsistent. The APACHE scoring system, which reflects a patient's clinical course, may be a better prognostic indicator of outcomes after liver transplantation. Of 621 liver transplant recipients from January 2000 through December 2004, 41 adult patients with hepatic failure received ICU care prior to liver transplantation. Their records were analyzed retrospectively and the correlation between APACHE score and mortality after liver transplantation was determined. Of the 41 patients with fulminant hepatic failure, 31 survived after liver transplantation. The mean APACHE II scores of the survivors and nonsurvivors differed significantly (22.50+/-5.89 vs 18.19+/-5.89, pAPACHE III scores (100+/-22.6 vs. 78.3+/-23.9, pAPACHE III scores and post-operative ICU stay was 0.14. The areas under the receiver operating characteristic (ROC) curve for APACHE II and APACH III were 0.713 and 0.737, respectively (PAPACHE scoring systems have significant clinical values in predicting the outcomes after urgent liver transplantation in patients with fulminant hepatic failure.

  16. Stem cell transplantation from identical twins in patients with myelodysplastic syndromes

    National Research Council Canada - National Science Library

    Kroger, N; Brand, R; Biezen, A. van; Bron, D; Blaise, D; Hellstrom-Lindberg, E; Gahrton, G; Powles, R; Littlewood, T; Chapuis, B; Zander, A; Koza, V; Niederwieser, D; Witte, T.J.M. de

    2005-01-01

    In a multicentre retrospective EBMT database study, we analysed factors influencing outcome in 38 patients with MDS/sAML who were transplanted with stem cells from their syngeneic twin and compared...

  17. Fecal microbiota transplantation (FMT) for Clostridium difficile infection: focus on immunocompromised patients

    National Research Council Canada - National Science Library

    Di Bella, Stefano; Gouliouris, Theodore; Petrosillo, Nicola

    2015-01-01

    .... Fecal microbiota transplantation (FMT) has proven to be an effective and safe procedure for the treatment of recurrent or refractory CDI in immunocompetent patients by restoring the gut microbiota and resistance to further recurrences...

  18. Xerostomia and chronic oral complications among patients treated with haematopoietic stem cell transplantation

    NARCIS (Netherlands)

    Brand, H.S.; Bots, C.P.; Raber-Durlacher, J.E.

    2009-01-01

    Objective: To assess the severity of xerostomia (subjective dry mouth) in haematopoietic stem cell transplantation (HSCT) patients and to investigate the association of xerostomia with other chronic oral complications. Design: Cross-sectional study. Study participants and methods: Participants were

  19. GVHD (Graft-Versus-Host Disease): A Guide for Patients and Families After Stem Cell Transplant

    Science.gov (United States)

    ... Disease): A guide for patients and families after stem cell transplant The immune system is the body's tool ... and attacking them. When you receive a donor's stem cells (the “graft”), the stem cells recreate the donor's ...

  20. Creatinine and cytokines plasma levels related to HLA compatibility in kidney transplant patients

    Directory of Open Access Journals (Sweden)

    Lorraine V. Alves

    2015-10-01

    Full Text Available ABSTRACTIntroduction:The success of kidney transplantation depends on prevention of organ rejection by the recipient’s immune system, which recognizes alloantigens present in transplanted tissue. Human leukocyte antigen (HLA typing is one of the tests used in pre-renal transplantation and represents one of the most important factors for a successful procedure.Objective:The present study evaluated creatinine and cytokines plasma levels in kidney transplant patients according to pre-transplant HLA typing.Methods:We assessed 40 renal transplanted patients selected in two transplant centers in Belo Horizonte (MG.Results:Patients were distributed into three groups according to HLA compatibility and, through statistical analysis, the group with more than three matches (H3 was found to have significantly lower post-transplant creatinine levels, compared to groups with three or fewer matches (H2 and H1, respectively. The median plasma levels of cytokines interleukin 6 (IL-6, tumor necrosis factor alpha (TNF-α, and interleukin 10 (IL-10 were evaluated according to the number of matches. Pro-inflammatory cytokines (IL-6 and TNF-α were significantly higher in groups with lower HLA compatibility. On the other hand, the regulatory cytokine IL-10 had significantly higher plasma levels in the group with greater compatibility between donor and recipient.Conclusion:These findings allow us to infer that pre-transplant HLA typing of donors and recipients can influence post-transplant renal graft function and may contribute to the development and choice of new treatment strategies.

  1. Comparison of Serum Vitamin D Levels Among Patients With Chronic Kidney Disease, Patients in Dialysis, and Renal Transplant Patients.

    Science.gov (United States)

    Çankaya, E; Bilen, Y; Keleş, M; Uyanık, A; Akbaş, M; Güngör, A; Arslan, Ş; Aydınlı, B

    2015-06-01

    Vitamin D is a hormone with a variety of functions, and its deficiency and insufficiency are commonly seen both in the general population and in patients with chronic renal disease. The aim of this study was to compare vitamin D levels in patients with chronic renal disease who are on hemodialysis, peritoneal dialysis, or no renal replacement therapy and patients who underwent renal transplantation. A total of 169 patients who had not used vitamin D for ≥ 1 year and who had no diabetes mellitus or proteinuria were included in the study. These included: 40 patients with renal transplantation, 40 patients on hemodialysis, 49 patients on peritoneal dialysis, and 40 patients with chronic renal failure stage 1, 2, 3, or 4. 25-Hydroxy vitamin D levels were evaluated in the sera of the patients. 25-Hydroxy vitamin D levels in patients with renal transplantation and in predialysis patients were 12.74 ± 10.24 ng/mL and 11.16 ± 12.25 ng/mL, respectively. The levels were 7.77 ± 6.71 ng/mL and 5.96 ± 4.87 ng/mL in patients on hemodialysis and peritoneal dialysis, respectively. Vitamin D levels are lower in patients on hemodialysis and peritoneal dialysis compared with the patients with renal transplantation for a variety of reasons. In this study, objective results were obtained supporting the administration of vitamin D supplements without glomerular filtration rate measurement in all patient groups with the diagnosis of chronic renal failure in accordance with the guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Uricosuric effect of losartan in patients with renal transplants

    DEFF Research Database (Denmark)

    Kamper, A L; Nielsen, A H

    2001-01-01

    and 10 women, median age 47 years (range, 25-63 years), were studied in an open randomized crossover trial, comparing a 2-week control period with a 2-week period of once-daily administration of 50 mg of losartan. The main outcome measurements were fractional excretion of uric acid (FE(uric acid)) based...... on 24-hr urine collections and plasma uric acid. RESULTS: The median FE(uric acid) was 5.7% (range, 2.4-10.4%) in the control period with a median change of +0.84% (range, -1.15% to +2.77%) in the losartan period (Puric acid was 0.47 mM (0.29-0.69 mM) in the control period with a change......-daily administration of 50 mg of losartan in hypertensive CsA-treated patients with renal transplants caused a 17% increase in FE(uric acid) and an 8% fall in plasma uric acid....

  3. Change in the type of work of postoperative liver transplant patients.

    Science.gov (United States)

    Weng, L-C; Chen, H C; Huang, H L; Wang, Y-W; Lee, W-C

    2012-03-01

    Returning to work has been recognized as an indicator of functional recovery. Few studies have aimed to explore whether one's type of work changes after transplantation. This study aims to describe the change in types of work in liver transplant patients. A retrospective and descriptive study was conducted at a medical center in northern Taiwan. The data were collected by a self-report questionnaire between July and September 2010. Descriptive statistics an correlational analysis were used to analyze the data. A convenience sample of 111 adult liver transplant patients was included in this study. Of the sample, 20 patients remained unemployed, 44 had a change in status by becoming unemployed (n=42) or employed (n=2), and 47 patients remained employed after transplantation. At the time of data collection, 49 (44.1%) liver transplant patients were gainfully employed, a rate that was lower than that of the pretransplantation stage (n=89, 80.2%). The number of workers engaged in manual labor decreased from 40 to 18 between pre- and posttransplantation. Of the 47 still-employed patients, 6 (12.8%) changed their occupation after transplantation. The rate of gainful employment after liver transplantation was low, and those patients who had done manual labor pretransplantation were no longer able to do this type of work and were unemployed. The still-employed patients who worked in management or were professionals did not change their type of work after transplantation; however, service and labor workers did change their type of work. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Successful Transplantation of a Split Crossed Fused Ectopic Kidney into a Patient with End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Kristin L. Mekeel

    2010-01-01

    Full Text Available Potential donors with congenital renal anomalies but normal renal function are often overlooked because of a possible increase in technical difficulty and complications associated with the surgery. However, as the waiting list for a deceased donor kidney transplant continues to grow, it is important to consider these kidneys for potential transplant. This paper describes the procurement of a crossed fused ectopic kidney, and subsequent parenchymal transection prior to transplantation as part of a combined simultaneous kidney pancreas transplant. The transplant was uncomplicated, and the graft had immediate function. The patient is now two years from transplant with excellent function.

  5. Influence of IL-18 and IL-10 Polymorphisms on Tacrolimus Elimination in Chinese Lung Transplant Patients.

    Science.gov (United States)

    Zhang, Xiaoqing; Xu, Jiandong; Fan, Junwei; Zhang, Tao; Li, Yuping; Xie, Boxiong; Zhang, Wei; Lin, Shengtao; Ye, Ling; Liu, Yuan; Jiang, Gening

    2017-01-01

    Aims. The influence of interleukin-10 (IL-10) and interleukin-18 (IL-18) polymorphisms on tacrolimus pharmacokinetics had been described in liver and kidney transplantation. The expression of cytokines varied in different kinds of transplantation. The influence of IL-10 and IL-18 genetic polymorphisms on the pharmacokinetic parameters of tacrolimus remains unclear in lung transplantation. Methods. 51 lung transplant patients at Shanghai Pulmonary Hospital were included. IL-18 polymorphisms (rs5744247 and rs1946518), IL-10 polymorphisms (rs1800896, rs1800872, and rs3021097), and CYP3A5 rs776746 were genotyped. Dose-adjusted trough blood concentrations (C/D ratio, mg/kg body weight) in lung transplant patients during the first 4 postoperative weeks were calculated. Results. IL-18 rs5744247 allele C and rs1946518 allele A were associated with fast tacrolimus metabolism. Combined analysis showed that the numbers of low IL-18 mRNA expression alleles had positive correlation with tacrolimus C/D ratios in lung transplant recipients. The influence of IL-18 polymorphisms on tacrolimus C/D ratios was observed in CYP3A5 expresser recipients, but not in CYP3A5 nonexpresser recipients. No clinical significance of tacrolimus C/D ratios difference of IL-10 polymorphisms was found in our data. Conclusions. IL-18 polymorphisms may influence tacrolimus elimination in lung transplantation patients.

  6. EXHALED AND PLASMA NITRITE: a comparative study among healthy, cirrhotic and liver transplant patients

    Directory of Open Access Journals (Sweden)

    Viviane S AUGUSTO

    2014-03-01

    Full Text Available Context There is a relative lack of studies about exhaled nitrite (NO2- concentrations in cirrhotic and transplanted patients. Objective Verify possible differences and correlations between the levels of NO2-, measured in plasma and exhaled breath condensate collected from patients with cirrhosis and liver transplant. Method Sixty adult male patients, aged between 27 and 67 years, were subdivided into three groups: a control group comprised of 15 healthy volunteers, a cirrhosis group composed of 15 volunteers, and a transplant group comprised of 30 volunteers. The NO2- concentrations were measured by chemiluminescence. Results 1 The analysis of plasma NO2- held among the three groups showed no statistical significance. 2 The comparison between cirrhotic and control groups, control and transplanted and cirrhotic and transplanted was not statistically significant. 3 The measurements performed on of NO2- exhaled breath condensate among the three groups showed no statistical difference. 4 When comparing the control group samples and cirrhotic, control and transplanted and cirrhotic and transplanted, there was no significant changes in the concentrations of NO2-. Conclusion No correlations were found between plasma and exhaled NO2-, suggesting that the exhaled NO2- is more reflective of local respiratory NO release than the systemic circulation.

  7. Influence of IL-18 and IL-10 Polymorphisms on Tacrolimus Elimination in Chinese Lung Transplant Patients

    Directory of Open Access Journals (Sweden)

    Xiaoqing Zhang

    2017-01-01

    Full Text Available Aims. The influence of interleukin-10 (IL-10 and interleukin-18 (IL-18 polymorphisms on tacrolimus pharmacokinetics had been described in liver and kidney transplantation. The expression of cytokines varied in different kinds of transplantation. The influence of IL-10 and IL-18 genetic polymorphisms on the pharmacokinetic parameters of tacrolimus remains unclear in lung transplantation. Methods. 51 lung transplant patients at Shanghai Pulmonary Hospital were included. IL-18 polymorphisms (rs5744247 and rs1946518, IL-10 polymorphisms (rs1800896, rs1800872, and rs3021097, and CYP3A5 rs776746 were genotyped. Dose-adjusted trough blood concentrations (C/D ratio, mg/kg body weight in lung transplant patients during the first 4 postoperative weeks were calculated. Results. IL-18 rs5744247 allele C and rs1946518 allele A were associated with fast tacrolimus metabolism. Combined analysis showed that the numbers of low IL-18 mRNA expression alleles had positive correlation with tacrolimus C/D ratios in lung transplant recipients. The influence of IL-18 polymorphisms on tacrolimus C/D ratios was observed in CYP3A5 expresser recipients, but not in CYP3A5 nonexpresser recipients. No clinical significance of tacrolimus C/D ratios difference of IL-10 polymorphisms was found in our data. Conclusions. IL-18 polymorphisms may influence tacrolimus elimination in lung transplantation patients.

  8. Obesity class does not further stratify outcome in overweight and obese pediatric patients after heart transplantation.

    Science.gov (United States)

    Ryan, Thomas D; Zafar, Farhan; Siegel, Robert M; Villa, Chet R; Bryant, Roosevelt; Chin, Clifford

    2018-01-29

    The effect of obesity stratification on pediatric heart transplant outcomes is unknown. The UNOS database was queried for patients ≥2-5%-≤85 percentile), overweight (BMI=86%-95 percentile), class 1 (BMI=100%-120% of 95 percentile), class 2 (BMI=121%-140% of 95 percentile), and class 3 obesity (BMI>140% of 95 percentile). A total of 5056 individuals were listed for transplant, with 71% normal, 13% overweight, 10% class 1, 4% class 2, and 2% class 3 obesity. Waitlist survival was not different between groups. Post-transplant survival was decreased in overweight and combined obese groups vs normal, with no further difference between overweight and obese classes. Overweight and obese patients had higher listing status and were more likely to have ventilator, inotrope, and mechanical circulatory support at listing. After transplant, there was an association of overweight-obese patients with diabetes and rejection requiring hospitalization. Stricter definition of normal weight reveals overweight-obese status was an independent risk factor for poorer post-transplant survival, without further effect by stratification of weight class. However, because there is no difference in waitlist survival, this study does not allow the selection of absolute weight-based criteria regarding transplant listing and suggests the need to look further for modifiable risk factors post-transplant. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. [Assessment of nutritional status in renal transplant patients during 5 years of follow-up].

    Science.gov (United States)

    Fernández Castillo, Rafael; Fernandez Gallegos, Ruth; Alvarez Serrano, Maria Adelaida; Nuñez Negrillo, Ana María; Navarro Perez, Carmen Flores; Quero Alfonso, Angel I

    2014-11-01

    Weight gain and malnutrition after kidney transplantation is common and the resulting overweight and obesity is associated with serious health complications. By contrast, the prevalence of malnutrition in patients with renal transplantation and its impact on the outcome of kidney transplantation is underestimated. The aim of this study was to evaluate the nutritional status of renal transplant patients and determine if the five-year follow-up, these patients undergo alterations that suggest nutritional deterioration. The sample consisted of 119 renal transplant patients who attended for five years post-transplant consultation. All patients measurements of total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides and ferritin (Ft) were performed. and anthropometric measurements were made of weight, height and BMI. Patients were divided into three groups according to GFR Group 1: nutritional biochemical parameters in general, likewise the nutritional status is closely related, and is directly proportional to the function of the graft. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  10. The role of splenectomy before liver transplantation in biliary atresia patients.

    Science.gov (United States)

    Takahashi, Yoshiaki; Matsuura, Toshiharu; Yanagi, Yusuke; Yoshimaru, Koichiro; Taguchi, Tomoaki

    2016-12-01

    There is currently no unified view regarding whether liver transplantation or splenectomy should be performed for hypersplenism before liver transplantation in biliary atresia (BA) patients. We herein describe the efficacy of splenectomy before liver transplantation. Splenectomy was performed in ten patients with hypersplenism associated with BA. We retrospectively reviewed their perioperative and postoperative courses, the number of leukocytes and thrombocytes, and the MELD score. The mean age was 17.5±7.0years (range 11-31years), and the male-to-female ratio was 1:1. The platelet and leukocyte levels increased after splenectomy and returned to normal levels one month postoperatively. The mean MELD score after splenectomy was significantly decreased after splenectomy: 10±2.1 vs 7.6±1.8. In particular, PT-INR improved. Five patients underwent liver transplantation because of hepatopulmonary syndrome and repeated bouts of cholangitis, whereas the remaining five patients did not undergo liver transplantation because of improvements in the liver function (the mean follow-up period was 56months). The postoperative complications included portal vein thrombosis and intestinal perforation, but the patient survival rates remained at 100%. After splenectomy, both pancytopenia and the liver function clearly improved. Splenectomy should therefore be a treatment option for patients with hypersplenism before liver transplantation. Retrospective Comparative Study - Level III. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Risco cardiovascular em pacientes submetidos ao transplante hepático Cardiovascular risk in patients submitted to liver transplantation

    Directory of Open Access Journals (Sweden)

    Hélem de Sena Ribeiro

    2012-06-01

    Full Text Available OBJETIVO: Determinar a prevalência de risco cardiovascular em pacientes submetidos ao transplante hepático de acordo com o escore de Framingham e avaliar possíveis associações com fatores de risco tradicionais e não tradicionais. MÉTODOS: Estudo transversal em que pacientes submetidos ao transplante hepático foram estratificados quanto ao risco cardiovascular pelo escore de Framingham. Variáveis demográficas, socioeconômicas, clínicas e antropométricas foram coletadas para verificar associação com risco cardiovascular utilizando-se análises estatísticas uni e multivariada. RESULTADOS: Foram avaliados 115 pacientes, dos quais 46,1% apresentaram médio ou alto risco para ocorrência de eventos cardiovasculares em 10 anos. O risco percentual médio dos pacientes avaliados foi de 9,5% ± 7,8%. Sexo masculino (OR: 4,97; IC 95% 1,92-12,85; p OBJECTIVE: To determine the prevalence of cardiovascular risk in patients undergoing liver transplantation according to the Framingham score, and to evaluate possible associations with traditional and non-traditional risk factors. METHODS: Cross-sectional study in which patients undergoing liver transplantation were stratified by cardiovascular risk according to the Framingham score. Demographic, socioeconomic, clinical, and anthropometric variables were collected to assess the association with cardiovascular risk factors using univariate and multivariate statistical analyses. RESULTS: A total of 115 patients were evaluated, of which 46.1% showed medium or high risk for the occurrence of cardiovascular events over ten years. The mean percentage risk of evaluated patients was of 9.5 ± 7.8%. Male gender (OR: 4.97; CI: 1.92-12.85; p < 0.01, older age (OR: 1,09; CI: 1.04-1.13; p < 0.01, and higher BMI at the moment of assessment (1.09; CI: 0.99-1.20; p = 0.03 were factors associated with medium and high cardiovascular risk. A higher percentage of cardiovascular risk was also associated with

  12. Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study.

    Science.gov (United States)

    Lassalle, Mathilde; Fezeu, Léopold K; Couchoud, Cécile; Hannedouche, Thierry; Massy, Ziad A; Czernichow, Sébastien

    2017-01-01

    Obesity has been linked to poor access to medical care. Although scientific evidence suggest that kidney transplantation improves survival and quality of life in obese patients with end-stage renal disease (ESRD), few data exist on the impact of obesity on access to kidney transplantation in this population. We aimed to characterize the relationships between body mass index (BMI) at the start of dialysis, changes in BMI after the start of dialysis, and either access to kidney transplantation or overall mortality in dialysis or transplantation among ESRD patients. Between 2002 and 2011, 19524 dialysis patients with ESRD were included in the study via the French nationwide Renal Epidemiology and Information Network. Data on sociodemographic factors, comorbidities and laboratory test results were recorded upon entry into the registry. BMI were obtained at the start of dialysis and then yearly. Cubic spline regression analyses provided a graphic evaluation of the relationships between BMI at the start of dialysis and outcomes. Joint models were used to evaluate the association between the change over time in BMI and outcomes. During a median follow-up of 20.3 months, 6634 patients underwent kidney transplantation. A BMI >31 kg/m2 at the start of the dialysis was associated with a lower likelihood of receiving a kidney transplant, and the likelihood decreased even further with higher BMI values. For patients with BMI ≥30kg/m2 at the start of the dialysis, a 1 kg/m2 decrease in BMI during follow-up was associated with a 9% to 11% increase in the likelihood of receiving a transplant. There was an L-shaped relationship between BMI at the start of dialysis and overall mortality. We showed that obese patients with ESRD face barriers to the receipt of a kidney transplant without valid reasons. Greater attention to this issue would improve the fairness of the organ allocation process and might improve outcomes for obese patients with ESRD.

  13. The need for endodontic treatment and systemic characteristics of hematopoietic stem cell transplantation patients.

    Science.gov (United States)

    Braga-Diniz, Julia Mourão; Santa-Rosa, Caroline Christine; Martins, Renata de Castro; Silva, Maria Elisa Souza E; Vieira, Leda Quercia; Ribeiro Sobrinho, Antônio Paulino

    2017-07-03

    The aim of this study is to investigate the relationship between the epidemiological and clinical profiles of patients before and after hematopoietic stem cell transplantation (HSCT) and the need for endodontic treatment. The subjects included 188 individuals enrolled in the dental care program for transplanted patients of the School of Dentistry, Federal University of Minas Gerais (Faculdade de Odontologia da Universidade Federal de Minas Gerais, FO-UFMG) from March 2011 through March 2016. The patients were subjected to an HSCT conditioning dental regimen based on a thorough clinical and radiographic evaluation. Intraoral periapical and bite-wing X-rays were obtained, and after evaluation, specific dental treatment was planned and performed. The following demographic and clinical data were collected from the patients' medical records: age, gender, transplantation stage, primary disease, transplant type, medication used, complete blood count at the time of visit, and need for endodontic treatment. The Kolmogorov-Smirnov and the chi-square tests were used. Leukemia (31.3%) and multiple myeloma (17.9%) were the most prevalent primary diseases. Most patients were subjected to allogeneic-related transplantation (83.6%). Most patients exhibited platelet counts and hemoglobin concentrations below the reference values in the pre-transplantation stage, while the neutrophil and platelet counts and the hemoglobin levels were within the reference ranges in the post-transplantation stage. The proportions of individuals requiring endodontic treatment were similar between the pre- and post-transplantation groups: 24.3% and 24.7%, respectively. The systemic conditions of the patients referred for dental treatment were compromised.

  14. Kidney Transplant

    Science.gov (United States)

    ... kidney transplant offers more freedom and a better quality of life than dialysis. In making a decision about whether this is ... transplant, with little or no time spent on dialysis, can lead to better long-term ... life. Who can get a kidney transplant? Kidney patients ...

  15. High Posttransplant Cancer Incidence in Renal Transplanted Patients With Pretransplant Cancer.

    Science.gov (United States)

    Hellström, Vivan; Lorant, Tomas; Döhler, Bernd; Tufveson, Gunnar; Enblad, Gunilla

    2017-06-01

    Patients with previous cancer have increasingly been accepted for renal transplantation. Posttransplant cancer risk and survival rates of these patients are unknown. Our objective was to assess the risk of posttransplant cancer in this patient group. In this retrospective, nested case-control study, we assessed the outcome of all (n = 95) renal transplanted patients with pretransplant cancer diagnoses in the Uppsala-Örebro region, Sweden. The control group was obtained from the Collaborative Transplant Study registry and included European patients without pretransplant cancer. The other control group comprised the entire renal transplanted population in Uppsala. Development of recurrent cancer, de novo cancer, and patient survival were determined. Patients with pretransplant cancer showed higher incidence of posttransplant cancers and shorter survival compared with the control groups (P cancer treatments and favorable prognoses, almost half of the patients experienced a posttransplant cancer. These observations do not justify abstaining from transplanting all patients with previous malignancies, because more than 50% of the patients survive 10 years posttransplantation. A careful oncological surveillance pretransplant as well as posttransplant is recommended.

  16. Combined en bloc liver/pancreas transplantation in two different patients

    Science.gov (United States)

    Chen, Zhi-Shui; Meng, Fan-Ying; Chen, Xiao-Ping; Liu, Dun-Gui; Wei, Lai; Jiang, Ji-Pin; Du, Dun-Feng; Zhang, Wei-Jie; Ming, Chang-Sheng; Gong, Nian-Qiao

    2009-01-01

    Combined en bloc liver/pancreas transplantation (CLPT) was used primarily in the treatment of otherwise non-resectable upper abdominal malignancy. In fact, a more appropriate indication is in patients with liver disease and insulin-dependent diabetes mellitus (IDDM). Here, we report on two successful cases of CLPT at our hospital. One was a patient with non-resectable advanced liver cancer. The recipient survived for 23 mo and finally died of recurrent tumor. The other was a patient with severe biliary complication after orthotopic liver transplantation and preoperative IDDM. We performed CLPT with a modified surgical technique of preserving the native pancreas. He is currently liver-disease- and insulin-free more than 27 mo post-transplant. Based on our experience in two cases of abdominal cluster transplantation, we describe the technical details of CLPT and a modification of the surgical procedure. PMID:19469010

  17. The relation between serum testosterone levels and cardiovascular risk factors in patients with kidney transplantation

    Directory of Open Access Journals (Sweden)

    Hulya Colak

    2014-01-01

    Full Text Available The objective of the study is to evaluate the relationship between serum testos-terone levels and cardiovascular risk factors (CVRF in patients after kidney transplantation and with chronic kidney disease (CKD. Seventy-five male patients, aged between 18 and 68 years, who had kidney transplantation at least six months earlier, were enrolled into the study. Only renal transplant recipients and CKD patients with a creatinine level of 0.05. Serum testosterone levels were independent risk factors affecting IVC collapse index, systolic BP and LA. m-TORi and CNIs drugs might have no negative effect on serum testosterone levels, and improvement of the serum testosterone levels after transplantation might have a positive contribution on cardiac risk factors.

  18. Scandiatransplant acceptable mismatch program (STAMP) a bridge to transplanting highly immunized patients

    DEFF Research Database (Denmark)

    Koefoed-Nielsen, Pernille; Weinreich, I; Bengtsson, M

    2017-01-01

    BACKGROUND: Highly immunized patients are a challenge for organ transplantation programs. One way of increasing the likelihood of transplantation in this group of patients is to expand the possible donations by defining acceptable HLA mismatches. In the Scandiatransplant Acceptable Mismatch Program...... (STAMP), a de-centralized approach has been implemented in 2009. AIMS: The program has been improved during the years from utilizing HLA-A, -B, -DR matching only to include typing of all deceased donors for HLA-A, -B, -C, -DRB1 and -DQB1. The calculation of a transplantability score (TS) has been...... introduced in order to take both HLA and AB0 into consideration resulting in a more realistic picture of the transplantability chance. MATERIALS AND METHODS: Patients were selected for eligibility and results of immunisation status were prepared in each of the 9 tissue typing laboratories, while access...

  19. A systematic review of complicated diverticulitis in post-transplant patients

    NARCIS (Netherlands)

    Oor, J. E.; Atema, J. J.; Boermeester, M. A.; Vrouenraets, B. C.; Ünlü, Ç

    2014-01-01

    Immunosuppression could increase the complication rate in patients with acute diverticulitis. This would justify a low threshold for elective sigmoid resection in these patients after an episode of diverticulitis. Well-documented groups of immunocompromised patients are transplant patients, in which

  20. Refining Current Scientific Priorities and Identifying New Scientific Gaps in HIV-Related Heart, Lung, Blood, and Sleep Research.

    Science.gov (United States)

    Twigg, Homer L; Crystal, Ronald; Currier, Judith; Ridker, Paul; Berliner, Nancy; Kiem, Hans-Peter; Rutherford, George; Zou, Shimian; Glynn, Simone; Wong, Renee; Peprah, Emmanuel; Engelgau, Michael; Creazzo, Tony; Colombini-Hatch, Sandra; Caler, Elisabet

    2017-09-01

    The National Heart, Lung, and Blood Institute (NHLBI) AIDS Program's goal is to provide direction and support for research and training programs in areas of HIV-related heart, lung, blood, and sleep (HLBS) diseases. To better define NHLBI current HIV-related scientific priorities and with the goal of identifying new scientific priorities and gaps in HIV-related HLBS research, a wide group of investigators gathered for a scientific NHLBI HIV Working Group on December 14-15, 2015, in Bethesda, MD. The core objectives of the Working Group included discussions on: (1) HIV-related HLBS comorbidities in the antiretroviral era; (2) HIV cure; (3) HIV prevention; and (4) mechanisms to implement new scientific discoveries in an efficient and timely manner so as to have the most impact on people living with HIV. The 2015 Working Group represented an opportunity for the NHLBI to obtain expert advice on HIV/AIDS scientific priorities and approaches over the next decade.

  1. The need for endodontic treatment and systemic characteristics of hematopoietic stem cell transplantation patients

    Directory of Open Access Journals (Sweden)

    Julia Mourão BRAGA-DINIZ

    2017-07-01

    Full Text Available Abstract The aim of this study is to investigate the relationship between the epidemiological and clinical profiles of patients before and after hematopoietic stem cell transplantation (HSCT and the need for endodontic treatment. The subjects included 188 individuals enrolled in the dental care program for transplanted patients of the School of Dentistry, Federal University of Minas Gerais (Faculdade de Odontologia da Universidade Federal de Minas Gerais, FO-UFMG from March 2011 through March 2016. The patients were subjected to an HSCT conditioning dental regimen based on a thorough clinical and radiographic evaluation. Intraoral periapical and bite-wing X-rays were obtained, and after evaluation, specific dental treatment was planned and performed. The following demographic and clinical data were collected from the patients’ medical records: age, gender, transplantation stage, primary disease, transplant type, medication used, complete blood count at the time of visit, and need for endodontic treatment. The Kolmogorov-Smirnov and the chi-square tests were used. Leukemia (31.3% and multiple myeloma (17.9% were the most prevalent primary diseases. Most patients were subjected to allogeneic-related transplantation (83.6%. Most patients exhibited platelet counts and hemoglobin concentrations below the reference values in the pre-transplantation stage, while the neutrophil and platelet counts and the hemoglobin levels were within the reference ranges in the post-transplantation stage. The proportions of individuals requiring endodontic treatment were similar between the pre- and post-transplantation groups: 24.3% and 24.7%, respectively. The systemic conditions of the patients referred for dental treatment were compromised.

  2. Imaging and 1-day kinetics of intracoronary stem cell transplantation in patients with idiopathic dilated cardiomyopathy.

    Science.gov (United States)

    Lezaic, Luka; Socan, Aljaz; Peitl, Petra Kolenc; Poglajen, Gregor; Sever, Matjaz; Cukjati, Marko; Cernelc, Peter; Vrtovec, Bojan

    2016-07-01

    Stem cell transplantation is an emerging method of treatment for patients with cardiovascular disease. There are few studies completed or ongoing on stem cell therapy in patients with idiopathic dilated cardiomyopathy (IDCM). Information on stem cell homing and distribution in the myocardium after transplantation might provide important insight into effectiveness of transplantation procedure. To assess early engraftment, retention and migration of intracoronarily transplanted stem cells in the myocardium of patients with advanced dilated cardiomyopathy of non-ischaemic origin using stem cell labeling with (99m)Tc-exametazime (HMPAO). Thirty-five patients with IDCM and advanced heart failure were included in the study. Autologous hematopoietic (CD34+) stem cells were harvested by peripheral blood apheresis after bone marrow stimulation, labeled with (99m)Tc-HMPAO, tested for viability and injected into coronary vessel supplying areas of myocardium selected by myocardial perfusion scintigraphy as dysfunctional yet viable. Imaging was performed 1h and 18h after transplantation. Myocardial stem cell retention ranged from 0 to 1.44% on early and 0-0.97% on delayed imaging. Significant efflux of stem cells occurred from site of delivery in this time period (p<0.001). Stem cell viability was not affected by labeling. Stem cell labeling with (99m)Tc-HMPAO is a feasible method for stem cell tracking after transplantation in patients with IDCM. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Transplant tourism to China: the impact on domestic patient-care decisions.

    Science.gov (United States)

    Biggins, Scott W; Bambha, Kiran; Terrault, Norah; Inadomi, John; Roberts, John P; Bass, Nathan

    2009-01-01

    Organ procurement in China has been criticized because of its reliance on executed prisoners as donors. We aimed to assess the influence of perceptions about organ procurement practices in China on domestic patient-care decisions. An anonymous internet administered case-based questionnaire was used to survey a sample of healthcare professionals with affiliations to hepatology and transplantation professional societies. Of 674 completed surveys, the vast majority (93%) of the respondents were physicians, surgeons or allied transplant professionals actively caring for liver transplant patients and 81% practiced in the US. A strong majority believed procurement practices were ethically sound in the US and Europe (87% and 73%) but fare fewer believed that procurement practices were ethically sound in China (4%, p < 0.001). In case-based questions, lack of confidence in the ethical standards of organ procurement in China predicted patient-care decisions. The majority would provide post-transplantation care for patients who underwent liver transplantation at another domestic center, in a foreign country and in China (90%, 78%, and 63%, respectively, p < 0.001) yet respondents who suspected unethical procurement practices in China were more reluctant to do so (p < 0.001). Transplant professionals expressed concern about organ procurement practices in China which influenced their patient-care decision-making.

  4. Prediction of hepatocellular carcinoma biological behavior in patient selection for liver transplantation

    Science.gov (United States)

    Cillo, Umberto; Giuliani, Tommaso; Polacco, Marina; Herrero Manley, Luz Maria; Crivellari, Gino; Vitale, Alessandro

    2016-01-01

    Morphological criteria have always been considered the benchmark for selecting hepatocellular carcinoma (HCC) patients for liver transplantation (LT). These criteria, which are often inappropriate to express the tumor’s biological behavior and aggressiveness, offer only a static view of the disease burden and are frequently unable to correctly stratify the tumor recurrence risk after LT. Alpha-fetoprotein (AFP) and its progression as well as AFP-mRNA, AFP-L3%, des-γ-carboxyprothrombin, inflammatory markers and other serological tests appear to be correlated with post-transplant outcomes. Several other markers for patient selection including functional imaging studies such as 18F-FDG-PET imaging, histological evaluation of tumor grade, tissue-specific biomarkers, and molecular signatures have been outlined in the literature. HCC growth rate and response to pre-transplant therapies can further contribute to the transplant evaluation process of HCC patients. While AFP, its progression, and HCC response to pre-transplant therapy have already been used as a part of an integrated prognostic model for selecting patients, the utility of other markers in the transplant setting is still under investigation. This article intends to review the data in the literature concerning predictors that could be included in an integrated LT selection model and to evaluate the importance of biological aggressiveness in the evaluation process of these patients. PMID:26755873

  5. Italy-Greece cooperation for transplantation of medically urgent Greek patients: is it an effective, efficient model?

    Science.gov (United States)

    Peritore, D; Pretagostini, R; Di Ciaccio, P; Fiaschetti, P; Gabbrielli, F; Oliveti, A; Stabile, D; Ricci, A; Vaia, F; Nanni Costa, A

    2012-09-01

    In 2005 the Italian National Transplant Centre (CNT) signed a cooperation agreement with the Hellenic Transplant Organization (HTO) fostering the transfer and transplantation of urgent Greek liver patients at Italian transplantation centers. So as to not reduce access to transplantation for Italian patients, the agreement provided compensation for organs allocated to Greek transplant recipients. The aim of this study was to analyze the flow of patients from Greece to Italy and the number of received livers to consider the possibility to extend this kind of agreement to other countries, so that this should not penalize Italian recipients. The agreement provides the possibility for Greek patients affected by acute disease to be transferred to Italian transplantation centers participating in the agreement. Until 2008 livers transplanted into Greek recipients were returned through a preferential offer of surplus Greek organs, whereas from 2009 an obligation of payback was introduced. During the reviewed period requests for transfer, transferred patients, and number of patients who later underwent transplantation in Italy were 56, 26, and 23, respectively. Livers offered by the Greek organization that were accepted, transferred, and transplanted in Italy have been 82, 50, and 44, respectively. According to our analysis, the cooperation has had as positive impact for both Greece, which has difficulties transplanting urgent recipient because of the low number of donors, and for Italy, which is not penalized by the use of an organ in a Greek recipients, but is also rewarded for helpfulness. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. HEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERY

    Directory of Open Access Journals (Sweden)

    R. Sh. Saitgareev

    2016-01-01

    Full Text Available Heart Transplantation (HTx to date remains the most effective and radical method of treatment of patients with end-stage heart failure. The defi cit of donor hearts is forcing to resort increasingly to the use of different longterm mechanical circulatory support systems, including as a «bridge» to the follow-up HTx. According to the ISHLT Registry the number of recipients underwent cardiopulmonary bypass surgery increased from 40% in the period from 2004 to 2008 to 49.6% for the period from 2009 to 2015. HTx performed in repeated patients, on the one hand, involves considerable technical diffi culties and high risks; on the other hand, there is often no alternative medical intervention to HTx, and if not dictated by absolute contradictions the denial of the surgery is equivalent to 100% mortality. This review summarizes the results of a number of published studies aimed at understanding the immediate and late results of HTx in patients, previously underwent open heart surgery. The effect of resternotomy during HTx and that of the specifi c features associated with its implementation in recipients previously operated on open heart, and its effects on the immediate and long-term survival were considered in this review. Results of studies analyzing the risk factors for perioperative complications in repeated recipients were also demonstrated. Separately, HTx risks after implantation of prolonged mechanical circulatory support systems were examined. The literature does not allow to clearly defi ning the impact factor of earlier performed open heart surgery on the course of perioperative period and on the prognosis of survival in recipients who underwent HTx. On the other hand, subject to the regular fl ow of HTx and the perioperative period the risks in this clinical situation are justifi ed as a long-term prognosis of recipients previously conducted open heart surgery and are comparable to those of patients who underwent primary HTx. Studies

  7. Relationship between acute rejection and cyclosporine or mycophenolic acid levels in Japanese heart transplantation.

    Science.gov (United States)

    Wada, Kyoichi; Takada, Mitsutaka; Ueda, Takashi; Ochi, Hiroyuki; Kotake, Takeshi; Morishita, Hideki; Hanatani, Akihisa; Nakatani, Takeshi

    2007-03-01

    Cyclosporine (CsA), Mycophenolate mofetil (MMF) and prednisolone (PSL) are widely used for the prevention of acute rejection after heart transplantation. Recently, the serum concentration - time curves (AUC) of CsA and MMF have been demonstrated to be precise predictors of acute rejection. Fourteen heart transplant patients were treated concomitantly with CsA, MMF, and PSL between May 1999 and November 2005 at the National Cardiovascular Center and of them 3 had acute rejection episodes [International Society for Heart & Lung Transplantation grade 3a]. Two patients (man in his 30 s; woman in her 40 s) had acute rejection with a mycophenolic acid (MPA) AUC(0-12 h) cardiac allograft rejection even if the MMF was temporarily stopped. These 3 patients were investigated to evaluate the relationship between acute rejection and pharmacokinetic parameters, including the CsA C0, C2, AUC(0-4 h) and MPA AUC(0-12 h). The findings suggest that a high CsA AUC(0-4 h) may prevent rejection of a cardiac allograft, even if MMF is stopped or drastically reduced.

  8. American Society of Blood and Marrow Transplantation, European Society of Blood and Marrow Transplantation, Blood and Marrow Transplant Clinical Trials Network, and International Myeloma Working Group Consensus Conference on Salvage Hematopoietic Cell Transplantation in Patients with Relapsed Multiple Myeloma

    DEFF Research Database (Denmark)

    Giralt, Sergio; Garderet, Laurent; Durie, Brian

    2015-01-01

    In contrast to the upfront setting in which the role of high-dose therapy with autologous hematopoietic cell transplantation (HCT) as consolidation of a first remission in patients with multiple myeloma (MM) is well established, the role of high-dose therapy with autologous or allogeneic HCT has ...

  9. TGF-β1 gene polymorphism in renal transplant patients with and without gingival overgrowth.

    Science.gov (United States)

    Kozak, M; Kurzawski, M; Wajda, A; Lapczuk, J; Lipski, M; Dziewanowski, K; Drozdzik, M

    2011-05-01

    The incidence of gingival overgrowth among renal transplant patients treated with cyclosporine A ranges from 13% to 84.6%, and the overgrowth is not only esthetic but also a medical problem. We studied the determination of association between TGF-β1 (TGFB1) gene polymorphism and gingival overgrowth in kidney transplant patients medicated with cyclosporin A. Eighty-four kidney transplant patients with gingival overgrowth and 140 control transplant patients without overgrowth were enrolled into the case control study. TGFB1 polymorphism was determined using the PCR-RFLP assay for +869T > C in codon 10 and +915G > C in codon 25 as well as TaqMan real-time PCR assays for promoter -800G>A and -509C > T SNPs. In kidney transplant patients suffering from gingival overgrowth, mean score of gingival overgrowth was 1.38 ± 0.60, whereas in control subjects it was 0.0. The patients with gingival overgrowth were characterized by similar distribution of TGFB1 genotypes and allele in comparison to subjects without gingival overgrowth. Among 16 potentially possible haplotypes of TGFB1 gene, only four were observed in the studied sample of kidney transplant patients: G_C_T_G, G_T_C_G, G_C_C_C, and A_C_T_G, with similar frequency in patients with and without gingival overgrowth. No association between the TGFB1 gene polymorphism and gingival overgrowth was revealed in kidney transplant patients administered cyclosporine A. © 2011 John Wiley & Sons A/S.

  10. The quality of life analysis in renal transplant recipients and dialysis patients.

    Science.gov (United States)

    Chkhotua, A; Pantsulaia, T; Managadze, L

    2011-11-01

    Health-related quality of life (HRQoL) is becoming an important outcome measure in evaluation of various forms of renal replacement therapy (RRT). The Short Form-36 (SF-36), Giessen Subjective Complaints List (GBB-24) and Zerssen's Mood-Scale (Bf-S) are internationally validated questionnaires for the assessment of HRQoL. The goal of the current study was to evaluate and compare the HRQoL of patients on different forms of the RRT. The study population consisted of: 1) 120 patients on hemodialysis (HD); 2) 43 patients on peritoneal dialysis (PD); 3) 9 recipients who lost their grafts and went back to dialysis (PT); 4) 120 age- and sex matched healthy individuals (Controls); and 5) 48 renal transplant recipients (T). The SF-36, GBB-24 and Bf-S questionnaires have been used for the assessment of HRQoL. The mean SF-36 scores were not significantly different between: a) control group and transplant recipients; b) hemo- and peritoneal dialysis patients including previously transplanted patients. The dialysis patients scored significantly worse in all eight SF-36 domains as compared with the transplant recipients and healthy subjects. In all GBB-24 components the transplant recipients scored significantly higher than HD and PD patients. In the following components: "Fatigue tendency", "Limb pain" and "Cardiac complaints", recipients scored significantly higher than the control group subjects. The mood analysis (Bf-S) has shown that the scores of transplant recipients and controls did not differ and were significantly higher than that of the dialysis patients. The HRQoL of patients on hemo- and peritoneal dialysis is similar and lower than that of the general population. Renal transplantation significantly improves HRQoL at least to the level of the healthy individuals. The graft loss is associated with the significant worsening of HRQoL.

  11. Pregnancy outcomes among renal transplant recipients and patients with end-stage renal disease on dialysis.

    Science.gov (United States)

    Saliem, Sara; Patenaude, Valerie; Abenhaim, Haim A

    2016-04-01

    The purpose of our study is to compare pregnancy outcomes between women with a functioning renal transplant and women with end-stage renal disease (ESRD). We carried out a population-based retrospective cohort study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2006 to 2011. Logistic regression analysis was used to estimate the age-adjusted effect of functioning renal transplant vs. ESRD requiring dialysis on pregnancy outcomes. We identified 264 birth records to women with a functional renal transplant and 267 birth records to women with ESRD on dialysis among 5,245,452 births. As compared to women with ESRD on dialysis, renal transplant recipients were less likely to have placental abruption [odds ratio, OR 0.23 (95% confidence interval, CI 0.08-0.70)], to receive blood transfusions [OR 0.17 (95% CI 0.09-0.30)], and to have growth-restricted and small-for-gestational-age babies [OR 0.45 (95% CI 0.23-0.85)]. Renal transplant recipients were more likely to have an instrumental delivery [OR 15.38 (95% CI 1.92-123.3)]. Among renal transplant women, there was a trend towards delivery by cesarean section as compared to patients with ESRD [OR 1.31 (95% CI 0.93-1.85)]. However, these results were not statistically significant. Fetal deaths were less likely to occur in women with a renal transplant [OR 0.41 (95% CI 0.17-0.96)]. There were four maternal deaths among patients with ESRD on dialysis and no maternal deaths among renal transplant patients. Patients with a functional renal graft had an overall lower rate of morbidity and adverse pregnancy complications when compared to patients with ESRD on dialysis.

  12. Native kidney function after renal transplantation combined with other solid organs in preemptive patients.

    Science.gov (United States)

    Mosconi, G; Panicali, L; Persici, E; Conte, D; Cappuccilli, M L; Cuna, V; Capelli, I; Todeschini, P; D'Arcangelo, G Liviano; Stefoni, S

    2010-05-01

    Kidney transplantations combined with other solid organs are progressively increasing in number. There are no guidelines regarding the nephrologic indications for combined transplantations, namely liver-kidney (LKT), or heart-kidney (HKT), in preemptive patients with chronic kidney failure who are not on regular dialysis therapy. The objective of this study was to assess the functional contribution of the native kidneys after preemptive kidney transplantation combined with other solid organs. From 2004, 9 patients (aged 50.3 +/- 8.5 years) with chronic kidney failure (creatinine 2.5 +/- 1.0 mg/dL) caused by polycystic kidney disease (n = 4), vascular nephropathy (n = 2), interstitial nephropathy (n = 1), glomerulonephritis (n = 1), or end-stage kidney disease (n = 1), underwent combined transplantations (8 LKT, 1 HKT). A scintigraphic functional study (Tc-99DMSA or Tc-99mMAG3), was performed at 4 +/- 3 months after transplantation to evaluate the functional contribution of both the native kidneys and the graft. All patients were given immunosuppressive drugs, including a calcineurin inhibitor (tacrolimus/or cyclosporine). At the time of scintigraphy, renal function in all patients was 1.3 +/- 0.3 mg/dL. The functional contribution of the transplanted kidneys was on average 77 +/- 18%. Only in 1 patient was the contribution of the graft organic nephropathy. In light of our experience, a creatinine clearance transplantation. Close clinical and instrumental assessment pretransplant is essential before proceeding with a combined transplant program to exclude functional forms and to optimize the use of organs. Copyright (c) 2010. Published by Elsevier Inc.

  13. Efficacy of Sofosbuvir and Daclatasvir in Patients With Fibrosing Cholestatic Hepatitis C After Liver Transplantation.

    Science.gov (United States)

    Leroy, Vincent; Dumortier, Jérôme; Coilly, Audrey; Sebagh, Mylène; Fougerou-Leurent, Claire; Radenne, Sylvie; Botta, Danielle; Durand, François; Silvain, Christine; Lebray, Pascal; Houssel-Debry, Pauline; Kamar, Nassim; D'Alteroche, Louis; Petrov-Sanchez, Ventzislava; Diallo, Alpha; Pageaux, Georges-Philippe; Duclos-Vallee, Jean-Charles

    2015-11-01

    Fibrosing cholestatic hepatitis (FCH) is a life-threatening disorder that develops in patients with recurrent hepatitis C virus (HCV) infection after liver transplantation. Until recently, therapeutic options have been limited. We evaluated the efficacy and safety of sofosbuvir- and daclatasvir-based regimens. We analyzed data from 23 patients with FCH who participated in a prospective cohort study in France and Belgium of the effects of antiviral agents in patients with recurrence of HCV infection after liver transplantation, from October 2013 through April 2014. Most of the patients had genotype 1 infections that had not responded to previous treatment; 4 patients also were infected with human immunodeficiency virus. Eight patients (37%) had ascites and 15 patients (65%) had bilirubin levels greater than 100 mmol/L; their median serum level of HCV RNA was 7 log IU/mL. The median time between transplantation and treatment initiation was 5 months. Subjects were given either sofosbuvir and daclatasvir (n = 15) or sofosbuvir and ribavirin (n = 8) for 24 weeks. The primary outcome was complete clinical response (survival without re-transplantation, bilirubin level daclatasvir and no significant interactions among drugs. Sofosbuvir therapy with daclatasvir or ribavirin leads to major clinical improvement and high rates of sustained virologic response at week 12 in most patients with recurrence of HCV infection and FCH after liver transplantation. ClinicalTrial.gov no: NCT01944527. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  14. The Prevalence of Cryptosporidium Infection Among Renal Transplanted Patients in Hamadan City, West of Iran

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    Jafari

    2014-04-01

    Full Text Available Background Opportunistic infections have become much more considerable in the last decades, especially in immunocompromised patients and due to the medical interventions. Cryptosporidium is a pathogenic protozoan parasite causing diarrhea in children and some times acts as a life threatening opportunistic pathogen in the immunocompromised adults. Objectives This study aimed to investigate the presence of Cryptosporidium infection among patients undergone renal transplantation, who are at risk for this infection. Patients and Methods This was a cross-sectional study and the sample collection consisted of 180 renal transplanted patients referred to Shaheed-Beheshti Hospital, Hamadan city, Iran. The stool specimens were concentrated using formalin-ether technique and then the fecal smears were prepared from the sediments. Afterwards, the slides were stained using the Ziehl-Neelsen staining method and then examined for the presence of Cryptosporidium oocysts. Results One out of 180 fecal samples was positive for Cryptosporidium infection. The infected patient was a 51-year-old woman who had a renal transplantation six years earlier, with continuous use of CellCept® (mycophenolate mofetil and prednisolone. The patient had been referred to the hospital with gastrointestinal symptoms. Conclusions Based on the results of this study the prevalence of cryptosporidiosis was very low in renal transplanted patients in Hamadan city, Iran. It could be concluded that cryptosporidiosis is not a life threatening risk in this region and it probably showed well post-transplantation hygienic status of the patients and/or low oocysts load in the area.

  15. Ureteric complications in live related donor renal transplantation - impact on graft and patient survival

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    A Srivastava

    2004-01-01

    Full Text Available Objective : The study was performed with an aim to determine the incidence of ureteric complications in live related donor renal transplantation, and to study the effect of ureteric complications on long term graft and patient survival. Patients And Methods: Records of 1200 consecutive live related renal transplants done from 1989-2002 were reviewed. Twenty-six ureteric complications were noted to occur and treatment modalities employed were documented. In the non complication group sufficient data for evaluation was available in 867 patients. Survival analysis were performed using Kaplan-Meier techniques. Results: The overall incidence of urological complications is 2.9%. Complications occurred at a mean interval of 31.9 days after renal transplantation. Ureteric complications occurred in 2% patients with stented and 7.7% patients with non stented anastomosis (p=0.001. Mean follow up following renal transplantation was 37.4 months. Survival analysis showed that ureteric complications did not increase the risk of graft fai lu re or patient death. Conclusions: Ureteric complications in live related donor renal transplantation occurred in 2.9 % patients and did not impair graft and patient survival.

  16. Immunosuppression and Multiple Primary Malignancies in Kidney-Transplanted Patients: A Single-Institute Study.

    Science.gov (United States)

    Santangelo, Michele L; Criscitiello, Carmen; Renda, Andrea; Federico, Stefano; Curigliano, Giuseppe; Dodaro, Concetta; Scotti, Alessandro; Tammaro, Vincenzo; Calogero, Armando; Riccio, Eleonora; Pisani, Antonio; Carlomagno, Nicola

    2015-01-01

    Immunodeficiency is associated with higher cancer incidence. However, it is unknown whether there is a link between immunodeficiency and development of multiple primary malignancies. In the present study we analyse this link focusing on kidney-transplanted patients, as they are at higher risk of developing cancer due to the chronic assumption of immunosuppressants. We followed up 1200 patients who underwent kidney transplantation between 1980 and 2012. A total of 77/1200 kidney-transplanted patients developed cancer and 24 of them developed multiple cancers. Most multiple cancers were synchronous with a nonsignificant association between cancer and rejection episodes. In the general cancer population, one-ninth of patients are at higher risk of developing a second tumor over a lifetime; hence it would be reasonable to conclude that, from a merely theoretical and statistical viewpoint, long-term transplanted patients potentially have a higher risk of developing MPMs. However, data did not confirm this assumption, probably because these patients die before a second primary malignancy appears. Despite many observations on the increased incidence of different tumor types in immunodeficient patients and despite immunosuppression certainly being a predisposing factor for the multicancer syndrome, data so far are not robust enough to justify a correlation between immunodeficiency and multiple primary malignancies in transplanted patients.

  17. Immunosuppression and Multiple Primary Malignancies in Kidney-Transplanted Patients: A Single-Institute Study

    Directory of Open Access Journals (Sweden)

    Michele L. Santangelo

    2015-01-01

    Full Text Available Immunodeficiency is associated with higher cancer incidence. However, it is unknown whether there is a link between immunodeficiency and development of multiple primary malignancies. In the present study we analyse this link focusing on kidney-transplanted patients, as they are at higher risk of developing cancer due to the chronic assumption of immunosuppressants. We followed up 1200 patients who underwent kidney transplantation between 1980 and 2012. A total of 77/1200 kidney-transplanted patients developed cancer and 24 of them developed multiple cancers. Most multiple cancers were synchronous with a nonsignificant association between cancer and rejection episodes. In the general cancer population, one-ninth of patients are at higher risk of developing a second tumor over a lifetime; hence it would be reasonable to conclude that, from a merely theoretical and statistical viewpoint, long-term transplanted patients potentially have a higher risk of developing MPMs. However, data did not confirm this assumption, probably because these patients die before a second primary malignancy appears. Despite many observations on the increased incidence of different tumor types in immunodeficient patients and despite immunosuppression certainly being a predisposing factor for the multicancer syndrome, data so far are not robust enough to justify a correlation between immunodeficiency and multiple primary malignancies in transplanted patients.

  18. Quality of life before autologous stem cells transplantation as prognostic factor in patients with malignant lymphomas

    Directory of Open Access Journals (Sweden)

    Yu. L. Shevchenko

    2014-01-01

    Full Text Available Currently high-doses chemotherapy (HD-PCT + autologous hematopoietic stem cells transplantation (auto-HSCT is the treatment ofchoice in patients with recurrent and progressive lymphomas. Most of quality of life (QoL studies in lymphomas patients received HSCT limited on parameters dynamics assessment in the early and late post-transplant period. Aim of this study was to evaluate the QoL parameters and their prognostic significance in lymphoma patients before transplantation. 124 patients with lymphomas (non-Hodgkin lymphomas – 45 patients, Hodgkin's lymphoma – 79 patients who received HD-PCT + auto-HSCT were included in the study: men – 42.7 % (n = 53, women – 57.3 % (n = 71, median age – 34 years (19–65 years. Patients’ heterogeneity before transplantation regarding quality of life has been revealed. Almost 1/3 of patients showed a significant reduction in the integral index of QoL. Insignificant differences between patients with chemosensitivity and chemoresistant lymphomas regarding QoL before HD-PCT + auto-HSCT were shown. We also analyzed the outcomes of studied patients received HD-PCT + auto-HSCT. With a median follow-up of 18 months, overall survival after transplantation was 72 % (95 % CI 56–84; event-free survival – 64 % (95 % CI 53,3–73,2.Overall and event-free survivals were significantly higher in patients with chemosensitive lymphoma compared with chemoresistance tumor. Differences in the survival rates between patients with no or negligible decrease of QoL integral index and with significant reduction of it also were found. Revealed differences in overall and event-free survival between the groups allowed the first group considered as patients with a favorable prognosis, and the second group – as patients with poor prognosis regarding the transplantation outcome.

  19. Quality of life before autologous stem cells transplantation as prognostic factor in patients with malignant lymphomas

    Directory of Open Access Journals (Sweden)

    Yu. L. Shevchenko

    2014-07-01

    Full Text Available Currently high-doses chemotherapy (HD-PCT + autologous hematopoietic stem cells transplantation (auto-HSCT is the treatment ofchoice in patients with recurrent and progressive lymphomas. Most of quality of life (QoL studies in lymphomas patients received HSCT limited on parameters dynamics assessment in the early and late post-transplant period. Aim of this study was to evaluate the QoL parameters and their prognostic significance in lymphoma patients before transplantation. 124 patients with lymphomas (non-Hodgkin lymphomas – 45 patients, Hodgkin's lymphoma – 79 patients who received HD-PCT + auto-HSCT were included in the study: men – 42.7 % (n = 53, women – 57.3 % (n = 71, median age – 34 years (19–65 years. Patients’ heterogeneity before transplantation regarding quality of life has been revealed. Almost 1/3 of patients showed a significant reduction in the integral index of QoL. Insignificant differences between patients with chemosensitivity and chemoresistant lymphomas regarding QoL before HD-PCT + auto-HSCT were shown. We also analyzed the outcomes of studied patients received HD-PCT + auto-HSCT. With a median follow-up of 18 months, overall survival after transplantation was 72 % (95 % CI 56–84; event-free survival – 64 % (95 % CI 53,3–73,2.Overall and event-free survivals were significantly higher in patients with chemosensitive lymphoma compared with chemoresistance tumor. Differences in the survival rates between patients with no or negligible decrease of QoL integral index and with significant reduction of it also were found. Revealed differences in overall and event-free survival between the groups allowed the first group considered as patients with a favorable prognosis, and the second group – as patients with poor prognosis regarding the transplantation outcome.

  20. Fecal microbiota transplantation (FMT) for Clostridium difficile infection: focus on immunocompromised patients.

    Science.gov (United States)

    Di Bella, Stefano; Gouliouris, Theodore; Petrosillo, Nicola

    2015-04-01

    Clostridium difficile infection (CDI) is an emerging problem worldwide associated with significant morbidity, mortality, recurrence rates and healthcare costs. Immunosuppressed patients, including HIV-seropositive individuals, solid organ transplant recipients, patients with malignancies, hematopoietic stem cell transplant recipients, and patients with inflammatory bowel disease are increasingly recognized as being at higher risk of developing CDI where it may be associated with significant complications, recurrence, and mortality. Fecal microbiota transplantation (FMT) has proven to be an effective and safe procedure for the treatment of recurrent or refractory CDI in immunocompetent patients by restoring the gut microbiota and resistance to further recurrences. During the last two years the first data on FMT in immunocompromised patients began to appear in the medical literature. Herein we summarize the use of FMT for the treatment of CDI with a focus on immunocompromised patients. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  1. [The therapeutic drug monitoring network server of tacrolimus for Chinese renal transplant patients].

    Science.gov (United States)

    Deng, Chen-Hui; Zhang, Guan-Min; Bi, Shan-Shan; Zhou, Tian-Yan; Lu, Wei

    2011-07-01

    This study is to develop a therapeutic drug monitoring (TDM) network server of tacrolimus for Chinese renal transplant patients, which can facilitate doctor to manage patients' information and provide three levels of predictions. Database management system MySQL was employed to build and manage the database of patients and doctors' information, and hypertext mark-up language (HTML) and Java server pages (JSP) technology were employed to construct network server for database management. Based on the population pharmacokinetic model of tacrolimus for Chinese renal transplant patients, above program languages were used to construct the population prediction and subpopulation prediction modules. Based on Bayesian principle and maximization of the posterior probability function, an objective function was established, and minimized by an optimization algorithm to estimate patient's individual pharmacokinetic parameters. It is proved that the network server has the basic functions for database management and three levels of prediction to aid doctor to optimize the regimen of tacrolimus for Chinese renal transplant patients.

  2. Dengue fever in renal transplant patients: a systematic review of literature.

    Science.gov (United States)

    Weerakkody, Ranga Migara; Patrick, Jean Ansbel; Sheriff, Mohammed Hussain Rezvi

    2017-01-13

    Dengue fever in renal transplanted patients has not been studied well, and we review all the literature about episodes dengue fever in renal transplant patients. The aim was to describe clinico-pathological characteristics, immunosuppressive protocols, need renal outcome and mortality. PubMed, LILACS, Google Scholar and Research Gate were searched for "Dengue" and "Renal/Kidney Transplantation" with no date limits. Hits were analyzed by two researchers separately. Fever, myalgia, arthralgia and headache was significantly lower than normal population, while pleural effusions and ascites were observed more. Incidence of severe dengue is significantly higher among transplant patients in this review, as well as they had a significantly higher mortality (8.9% vs 3.7%, p = 0.031). Age, period after transplantation and immunosuppressive profile had no effect on disease severity, mortality or graft out come. Presence of new bleeding complications and ascites was associated with more severe disease (p dengue fever in renal transplanted patients differ from the general population. Some degree of graft dysfunction is common during the illness, but only a minority develops graft failure.

  3. Health promoting behaviors, quality of life, and hospital resource utilization of patients receiving kidney transplants.

    Science.gov (United States)

    Houle, Nancy; Bohannon, Richard W; Frigon, Linda; Maljanian, Rose; Nieszczezewski, Jessica

    2002-02-01

    Despite the value of kidney transplantation for patients with renal failure, transplantation is sometimes accompanied by untoward consequences and considerable resource utilization. The identification of modifiable factors contributing to resource utilization is, therefore, important. This exploratory study of kidney transplant patients had two purposes: (a) to describe health-promoting behaviors and health-related quality of life (HRQOL) pretransplant and hospital resource utilization posttransplant and (b) to investigate relationships between these and other variables. Subjects were 44 patients who (before transplantation) completed the Health-Promoting Lifestyle Profile (HPLP) to quantify health-promoting behavior and the Medical Outcome Study Short Form (SF)-36 to measure HRQOL. Hospital resource utilization was characterized using transplant length of stay and charges and posttransplant emergency department visits, readmissions, and charges. The HPLP scores of the subjects were similar to those reported for middle-aged adults and patients with other diseases. The SF-36 subscale and summary scores were lower than those reported for the general population. Hospital resource utilization varied widely. Significant correlations were found between 52.9% of the HPLP and SF-36 scores. However, no HPLP score correlated significantly with any utilization measure. Of the SF-36 measures, only vitality correlated significantly with most utilization measures (greater vitality was associated with less posttransplant utilization). While many aspects of health-promoting behavior and HRQOL are related before transplant, neither HPLP, SF-36, nor any other measured variable strongly and consistently predicted hospital resource utilization.

  4. Oral infections and their influence on medical rehabilitation in kidney transplant patients.

    Science.gov (United States)

    Schander, Kerstin; Jontell, Mats; Johansson, Peter; Nordén, Gunnela; Hakeberg, Magnus; Bratel, John

    2009-01-01

    Infections seem to be the most common life-threatening complication of long-term immunosuppressive therapy following organ transplantation. Although sparse scientific evidence, potential oral infections are considered to contribute to these complications. The aim of this study was to examine whether there is an association between oral infections and rejections after kidney transplantation. A group of 46 kidney transplant candidates was enrolled. The patients were examined clinically and radiographically for dental caries, periodontal disease, mucosal lesions/infections, and general oral health problems. Examinations were conducted the day before transplantation, and one year post transplantation. Fifteen (32.6%) patients developed acute rejections during the first year. Six of these patients (40%) presented with oral opportunistic infections (candida or herpes infections of the oral mucosa). The number of dental infections and semi-impacted teeth were low. When rejections were related to probing pocket depths (PPDs) > or = 4 mm and apical lesions together, statistical significance was not reached (p=0.075, OR=3.17 [0.87; 11.55]). Similar results were obtained when PPDs > or = 4 mm, apical lesions, semi-impacted teeth, and opportunistic mucosal infections were compared to rejections. The results of the present study do not support that opportunistic oral mucosal infections or dental-related infections seem to increase the risk of rejection in kidney transplanted patients.

  5. The therapeutic role of exercise in patients with orthotopic heart transplant.

    Science.gov (United States)

    Badenhop, D T

    1995-07-01

    January 1995 marked the 27th anniversary of the performance of the first human cardiac transplant in the United States. This followed nearly a decade of laboratory work developing and validating the technique involved. During the past 26 yr, cardiac transplantation has evolved from what was initially considered a radical and experimental form of therapy to one that is currently viewed in most of the world as a valid form of advanced therapy for end-stage heart disease. Today, many patients go home to medical personnel who may not be familiar with all the medical parameters associated with a patient's condition after cardiac transplantation. If patients with a heart transplant are to live in the community and work and enjoy themselves, their ability to lead healthy and active lives needs to be recognized and facilitated by professionals in the field of cardiac rehabilitation. The purpose of this article is to review the clinical considerations related to the physiology of the transplanted human heart. A review of studies conducted to investigate the acute and chronic responses to exercise in the transplanted human heart is presented. Recommendations for exercise testing, exercise prescription, and exercise programming for this patient population based on current data are presented.

  6. One hundred percent three-year graft and patient survival: kidney transplantation at Saint Joseph Hospital of Orange.

    Science.gov (United States)

    Ruzics, Ervin P; Abe, Marlene; Escobedo, Wendy; Gull, Paula; Weil, Marya

    2010-01-01

    We report 99 consecutive renal transplants between 7/1/04 and 6/30/07 with 100% 3-year graft survival, statistically higher than expected per the SRTR (p one with Thymoglobulin (p = 0.01). Immunosuppression, infection prophylaxis and surveillance, and all medical and social issues potentially impacting graft or patient survival were managed by the transplant center for the first year minimum, and as long as clinically indicated post-transplant. Patients were educated to have all subsequent medical and social issues triaged by the transplant center for the life of the transplant.

  7. The Safety of Neuromuscular Blockade Reversal in Patients With Cardiac Transplantation.

    Science.gov (United States)

    Barbara, David W; Christensen, Jon M; Mauermann, William J; Dearani, Joseph A; Hyder, Joseph A

    2016-12-01

    Neuromuscular blockade (NMB) reversal with neostigmine and glycopyrrolate has been reported to cause cardiac arrest in patients with a history of cardiac transplantation. The purpose of this study was to examine the safety of NMB reversal with acetylcholinesterase inhibitors and muscarinic anticholinergics in these patients. We queried the medical records of a large tertiary referral center for patients with a history of prior heart transplantation who underwent anesthesia including receipt of NMB reversal. Patient records were reviewed to investigate maximal decrease in heart rate (HR) after NMB reversal and incidence of death and cardiac arrest. Seventy-seven heart transplant patients underwent 118 subsequent anesthetics during which they received neostigmine and glycopyrrolate for NMB reversal. No patients had active pacemakers at the time of their anesthetics. Mean time from heart transplantation to NMB reversal was 2.9 ± 3.2 (median, 1.9; range, 0.01- 12.5) years. After NMB reversal, no patients received atropine or epinephrine, suffered cardiac arrest, or died within 30 days. Mean HR decrease, defined as the difference between the HR immediately before NMB reversal and the lowest HR within 5 minutes thereafter, after NMB reversal was 0.5 ± 3.2 with median 0 (range, -8 to 17) beats per minute. Mean HR decrease was not associated with transplantation type (biatrial versus bicaval, P = 0.2029) or with increasing duration of time from cardiac transplantation (P = 0.0874). Although rare cases of cardiac arrest after NMB reversal have been reported, our experience would support the safety of neostigmine and glycopyrrolate in cardiac transplantation patients.

  8. SURGICAL CORRECTION OF HEART VALVE DISEASE WITH CARDIOPULMONARY BYPASS IN PATIENTS AFTER RENAL TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    D. A. Belokurov

    2013-01-01

    Full Text Available Aim. Evaluation of the possibility heart valve replacement in renal transplant recipients from a position of safe- ty for graft function. Materials and methods. 5 patients, heart valve replacement was performed with a func- tioning kidney transplant at a satisfactory its function. The average age of patients at the time of cardiac surgery was 38,8 ± 12,6 years, among whom were two (40% men and 3 (60% women. The interval between renal transplantation and heart surgery was 40,3 ± 44,1 (2 to 120 months. Prior to kidney transplantation, all patients were on renal replacement therapy with hemodialysis program for 50,2 ± 48,6 months. In 4 of the 5 patients of heart disease was the cause of infective endocarditis. Results. Average time IR was 81,2 ± 21,7 minutes , the average time of aortic clamping 63,6 ± 20,9 minutes and hypothermia during CPB 29,2 ± 3,2 °C. All patients were implanted with double-leaf mechanical prostheses "MedEng-2" and "SarboMedics". All 5 patients in sa- tisfactory condition were discharged from the hospital. The average duration of the postoperative period was 14,2 ± 3,4 days. All patients had relatively smooth flow after surgery, no infectious complications, a satisfactory renal transplant function and prosthetic heart valves. In the late period in four patients and transplant graft func- tion is satisfactory in terms of the observation of 5 years, 3 years and 6 months after surgery. Conclusion. Our experience shows the possibility of successful correction of heart defects in IR in renal transplant recipients. 

  9. A problem-solving education intervention in caregivers and patients during allogeneic hematopoietic stem cell transplantation.

    Science.gov (United States)

    Bevans, Margaret; Wehrlen, Leslie; Castro, Kathleen; Prince, Patricia; Shelburne, Nonniekaye; Soeken, Karen; Zabora, James; Wallen, Gwenyth R

    2014-05-01

    The aim of this study was to determine the effect of problem-solving education on self-efficacy and distress in informal caregivers of allogeneic hematopoietic stem cell transplantation patients. Patient/caregiver teams attended three 1-hour problem-solving education sessions to help cope with problems during hematopoietic stem cell transplantation. Primary measures included the Cancer Self-Efficacy Scale-transplant and Brief Symptom Inventory-18. Active caregivers reported improvements in self-efficacy (p education; caregiver responders also reported better health outcomes such as fatigue. The effect of problem-solving education on self-efficacy and distress in hematopoietic stem cell transplantation caregivers supports its inclusion in future interventions to meet the multifaceted needs of this population.

  10. Predictability of survival models for waiting list and transplant patients: calculating LYFT.

    Science.gov (United States)

    Wolfe, R A; McCullough, K P; Leichtman, A B

    2009-07-01

    'Life years from transplant' (LYFT) is the extra years of life that a candidate can expect to achieve with a kidney transplant as compared to never receiving a kidney transplant at all. The LYFT component survival models (patient lifetimes with and without transplant, and graft lifetime) are comparable to or better predictors of long-term survival than are other predictive equations currently in use for organ allocation. Furthermore, these models are progressively more successful at predicting which of two patients will live longer as their medical characteristics (and thus predicted lifetimes) diverge. The C-statistics and the correlations for the three LYFT component equations have been validated using independent, nonoverlapping split-half random samples. Allocation policies based on these survival models could lead to substantial increases in the number of life years gained from the current donor pool.

  11. Allogeneic stem cell transplantation for patients harboring T315I BCR-ABL mutated leukemias

    DEFF Research Database (Denmark)

    Nicolini, Franck Emmanuel; Basak, Grzegorz W; Soverini, Simona

    2011-01-01

    T315I(+) Philadelphia chromosome-positive leukemias are inherently resistant to all licensed tyrosine kinase inhibitors, and therapeutic options remain limited. We report the outcome of allogeneic stem cell transplantation in 64 patients with documented BCR-ABL(T315I) mutations. Median follow......-up was 52 months from mutation detection and 26 months from transplantation. At transplantation, 51.5% of patients with chronic myeloid leukemia were in the chronic phase and 4.5% were in advanced phases. Median overall survival after transplantation was 10.3 months (range 5.7 months to not reached [ie......, still alive]) for those with chronic myeloid leukemia in the blast phase and 7.4 months (range 1.4 months to not reached [ie, still alive]) for those with Philadelphia chromosome-positive acute lymphoblastic leukemia but has not yet been reached for those in the chronic and accelerated phases of chronic...

  12. Poor Sleep in Organ Transplant Recipients: Self-Reports and Actigraphy

    OpenAIRE

    Reilly-Spong, Maryanne; Park, Taehwan; Gross, Cynthia R.

    2013-01-01

    Solid organ transplant recipients are at increased risk for poor sleep due to pharmacotherapy and co-morbidities, but sleep problems are often unrecognized and untreated. Study aims were to measure rates of occurrence, characteristics and correlates of poor sleep in recipients. The Pittsburgh Sleep Quality Index (PSQI) and sleep parameters measured by wrist actigraphy were obtained at baseline from 143 kidney, liver, heart, lung or pancreas transplant recipients enrolled in a psychosocial int...

  13. [Health education in transplant patients and their families in an intensive care unit].

    Science.gov (United States)

    Pueyo-Garrigues, M; San Martín Loyola, Á; Caparrós Leal, M C; Jiménez Muñoz, C

    2016-01-01

    Health Education (HE) is extremely important in transplant patients and their families in order to promote suitable self-care in this new stage of life. Intensive Care Units offer various opportunities by nurses in order to improve their Health Education. This process could start in this unit where the interaction between nurse and family is constant. The HE of transplant patient includes three dimensions: Knowledge: information about self-care in order to have a healthy way of life, and getting some information on how to reduce anxiety in patients and their families; Skills: as regards the abilities to properly apply the Health Education, where the families are really important; and finally Attitudes: ambivalent attitudes that are experienced by transplant patients. The objective is to describe the level of development of HE for critical transplant patients and their families from Intensive Care Units. A non-systematic literature review was performed in Pubmed and CINHAL data bases. In conclusion, it is emphasised that the skill of the HE nurse in an Intensive Care Units is important to promote lifestyles appropriate to the cognitive, affective, and psychomotor needs of transplant patients. Its implementation entails positive effects on clinical outcomes of the patient, decreased morbidity and mortality, costs, and health resources. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  14. Irritable bowel syndrome in renal transplant patients: prevalence, link with quality of life, anxiety, and depression.

    Science.gov (United States)

    Gungor, Ozkan; Kircelli, Fatih; Turan, Mehmet Nuri; Cetin, Ozgul; Elbi, Hayriye; Tatar, Erhan; Sertoz, Ozen Onen; Toz, Huseyin

    2012-01-01

    Gastrointestinal complications are common in renal transplant recipients and may arise from any part of the gastrointestinal tract. Irritable bowel syndrome (IBS) is highly common in the general population, but the status is not known in renal transplant patients. In this study, we evaluated the prevalence of IBS and its association with health-related quality of life (HRQOL), anxiety, and depression in renal transplant patients. One hundred and ninety-eight patients were enrolled in this study. Sociodemographic and laboratory variables were recorded. Severity of depressive and anxiety symptoms and HRQOL were assessed by the Beck Depression Inventory, State-Trait Anxiety Inventory, and Short Form 36 (SF-36), respectively. Diagnosis of IBS was based on Rome III criteria. The mean age was 38 ± 10 years and 61% were male. The mean transplant duration was 62 ± 54 months. Among 198 patients, 55 (27%) had IBS. Patients with IBS had lower SF-36 scores and had higher depressive and anxiety symptoms than patients without IBS. IBS is highly prevalent in renal transplant patients. The presence of IBS is closely related with HRQOL anxiety and depression.

  15. Prevention of diabetes I. type and health promotion, education of diabetics and patients after pancreas transplantation

    OpenAIRE

    MRÁZ, Marek

    2011-01-01

    The bachelor theses attend to people with diabetes mellitus Type 1 and patients after pancreas transplantation. The first chapters of theoretical part deal with pancreas anatomy, matter of disorder, its medication, belated complications, movement and nutrition connected with diabetes. The last chapter of this part is about pancreas transplantation. The practical part shows importance of education and knowledge of diabetics. It deals with life quality of diabetics who undergo pancreas transpla...

  16. [The perception of the purpose and sense of life among cystic fibrosis patients after lung transplantation].

    Science.gov (United States)

    Debska, Grazyna; Cepuch, Grazyna; Pawlik, Lidia

    2011-01-01

    Patients with cystic fibrosis keep struggling with their disease despite the improvement of their lung function after lung transplantation. Also, they often have to define and verify their purpose and sense of life once again. Therefore, an attempt to search answers to the questions: what health is, what one is expecting form his/her life, and what value this life after lung transplantation has for him/her; seems significant.

  17. Cutaneous alternariosis in a renal transplant patient successfully treated with posaconazole: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Rajinder Bajwa

    2017-03-01

    Full Text Available Cutaneous alternariosis is an uncommon fungal infection that most commonly presents in organ transplant patients on immunosuppressive therapy. There are no clinical trials or guidelines to guide treatment of this condition, however itraconazole is the most commonly used antifungal in published cases. Here we report on a case of cutaneous alternariosis in a renal transplant recipient treated with a newer antifungal, posaconazole. A review of published reports of cutaneous alternariosis since 2008 is also discussed.

  18. Autologous Stem Cell Transplantation in Patients with Acute Myeloid Leukemia: a Single-Centre Experience

    Directory of Open Access Journals (Sweden)

    Kakucs Enikő

    2013-04-01

    Full Text Available Introduction: Autologous haemopoietic stem cell transplantation (SCT is an important treatment modality for patients with acute myeloid leukemia with low and intermediate risk disease. It has served advantages over allogenic transplantation, because it does not need a matched donor, there is no graft versus host disease, there are less complications and a faster immune reconstitution than in the allo-setting. The disadvantage is the lack of the graft versus leukaemia effect.

  19. Captopril-induced deterioration of graft function in patients with a transplant renal artery stenosis

    NARCIS (Netherlands)

    van Son, W. J.; van der Woude, F. J.; Tegzess, Adam M.; Donker, A. J. M.; Slooff, M. J. H.; van der Slikke, L. B.; Hoorntje, S. J.

    1983-01-01

    We evaluated nine captopril-treated patients with transplant renal artery stenosis. Captopril treatment always resulted in a dramatic decrease in renal function; in two patients complete anuria developed. Only in two patients with a stenosis in one out of two renal arteries was a satisfactory fall

  20. CARDIAC TRANSPLANTATION IN YOUNG PATIENT WITH DILATED CARDIOMYOPATHY AND SECONDARY ANTIPHOSPHOLIPID SYNDROME

    Directory of Open Access Journals (Sweden)

    E. V. Shlyakhto

    2013-01-01

    Full Text Available Patients with congestive heart failure have an increased incidence of thromboembolic events. The choice of me- dical management in patients with antiphospholipid antibodies and generalized thrombosis due to hypercoagula- bility is complex issue. We report heart transplant outcome in 15 years old patient with dilated cardiomyopathy and secondary anti-phospholipid syndrome. 

  1. An interactive CD-ROM to inform patients about Stem Cell Transplantation

    NARCIS (Netherlands)

    Mank, A.; Molenaar, S.

    2008-01-01

    Objective: Cancer patients receiving chemotherapy or a Stem Cell Transplantation (SCT) are in need of information about their disease, treatment options and side effects. Patient education usually has to be given within limited time. Under these circumstances,, patients may find it difficult to

  2. Cardiac Arrest in a Heart Transplant Patient Receiving Dexmedetomidine During Cardiac Catheterization.

    Science.gov (United States)

    Schwartz, Lawrence Israel; Miyamoto, Shelley D; Stenquist, Scott; Twite, Mark David

    2016-06-01

    Dexmedetomidine is an α-2 agonist with a sedative and cardiopulmonary profile that makes it an attractive anesthetic in pediatric cardiac patients. Cardiac transplant patients may suffer from acute cellular rejection of the cardiac conduction system and, therefore, are at an increased risk of the electrophysiological effect of dexmedetomidine. We present such a patient who had a cardiac arrest while receiving dexmedetomidine during cardiac catheterization. Because acute cellular rejection of the cardiac conduction system is difficult to diagnose, dexmedetomidine should be used with caution in pediatric heart transplant patients. © The Author(s) 2015.

  3. Pseudomembranous colitis in four patients with cystic fibrosis following lung transplantation.

    Science.gov (United States)

    Yates, B; Murphy, D M; Fisher, A J; Gould, F K; Lordan, J L; Dark, J H; Corris, P A

    2007-06-01

    Pseudomembranous colitis is an uncommon complication in patients with cystic fibrosis, despite the use of multiple high-dose antibiotic regimens and the frequency of hospital admissions. Four patients from a total of 137 patients with cystic fibrosis undergoing lung transplantation are described who developed fulminant pseudomembranous colitis. Initial presentation was variable and the mortality rate was 50% despite urgent colectomy. In one case the presenting abdominal distension was thought to be due to meconium ileus equivalent. It is concluded that Clostridium difficile colitis may be a difficult diagnosis in patients with cystic fibrosis and follows a fulminant course after lung transplantation.

  4. Pediatric liver transplantation - ethical dilemmas in a disabled patient.

    Science.gov (United States)

    Toker, A; Salzer, L

    2012-09-01

    Allocation of medical resources, especially resources with absolute scarcity such as organs for transplant, is a difficult task. Medical, surgical, and ethical considerations should be evaluated. In solid organ transplantation, ethics committees are the gate keepers that deal with moral philosophy when moral values are in conflict. Often, no good solution to a dilemma in these medical ethics exists. Our case presents split living liver donation for retransplantation in a mentally disabled girl, with few medical ethics principles at stake. © 2011 John Wiley & Sons A/S.

  5. Prostatectomy for localized prostate cancer to prepare for renal transplantation in end-stage renal disease patients.

    Science.gov (United States)

    Tillou, Xavier; Chahwan, Charles; Le Gal, Sophie; Bensadoun, Henri; Doerfler, Arnaud

    2014-11-06

    Surgical difficulties of renal transplantation related to prostate cancer (PC) treatment and the results of renal transplantation after radical prostatectomy are currently poorly known, as well as oncological follow-up before and after renal transplantation. We performed a retrospective study including all patients diagnosed with PC before renal transplantation in our department. Nineteen patients were included between August 2003 and December 2013. The mean age at diagnosis of PC was 61.7 years (range 51.4-71.1). PSA mean level at diagnosis was 8.5 ng/ml (range 4.8-20). Fourteen had a retro-pubic and 5 a laparoscopic prostatectomy. Three patients underwent radiotherapy for positive surgical margins or extra-capsular extension. Fourteen patients were transplanted. The mean time lapse between prostatectomy and kidney transplantation was 32.8 months (range 14-71). Seven recipients (50%) were transplanted less than 24 months after prostatectomy. Post-transplantation surgical complications were not significantly related to dissection difficulties (p=0.2). No recurrence of PC was observed after renal transplantation, with a mean follow-up of 38 months (range 6-77.9). Prostate cancer discovered before renal transplantation should be treated by radical prostatectomy to assess recurrence risk. If the PC is at low risk of recurrence, it seems possible to shorten the 2-year period of oncologic follow-up before transplantation called for in current recommendations.

  6. Long-Term Impact of Different Immunosuppressive Drugs on QT and PR Intervals in Renal Transplant Patients.

    Science.gov (United States)

    Ikitimur, Baris; Cosansu, Kahraman; Karadag, Bilgehan; Cakmak, Huseyin Altug; Avci, Burcak Kilickiran; Erturk, Emre; Seyahi, Nurhan; Ongen, Zeki

    2015-09-01

    Sudden cardiac deaths due to arrhythmias are thought to be an important cause of mortality in patients with renal transplants. Exposure to immunosuppressive drugs may lead to QT or PR interval abnormalities which may consequently cause arrhythmias. Our study investigated the long term impact of four different immunosuppressive drugs on PR and corrected QT intervals (QTc) in renal transplant patients The study population consisted of 98 kidney transplant recipients. Study patients were receiving immunosuppressive management with tacrolimus, cyclosporine A, everolimus or azathioprine according to the local protocols. QTc and PR intervals obtained from the most recent post-transplant electrocardiograms were compared with the pre-transplant intervals dated before the transplantation procedure. Post-transplant QTc intervals had prolonged significantly in comparison to the pre-transplant QTc intervals in all groups. However, there were no significant differences between the immunosuppressive agents with regard to post-transplant QTc interval prolongation (p > 0.05). There were no significant differences between the groups with regard to the pre and post-transplant PR interval changes (p > 0.05). QT interval prolongation, a marker of risk for arrhythmias and sudden death, is highly prevalent among kidney transplant patients receiving different classes of immunosuppressive drugs. © 2014 Wiley Periodicals, Inc.

  7. Depression and quality of life in patients living 10 to 18 years beyond heart transplantation.

    Science.gov (United States)

    Fusar-Poli, Paolo; Martinelli, Valentina; Klersy, Catherine; Campana, Carlo; Callegari, Aliria; Barale, Francesco; Viganò, Mario; Politi, Pierluigi

    2005-12-01

    The purpose of this study was to advance current understanding of factors that influence long-term quality-of-life (QoL) outcomes after heart transplantation, by addressing the influence of depression on perceived health status. Data were collected from all recipients (n = 137) still alive at >10 years after transplantation. They completed the Short Form Health Survey (SF-36) inventory and the Beck Depression Inventory (BDI) questionnaire, while objective measures of health status were retrieved from medical records. All instruments used had acceptable reliability and validity. Data were analyzed using descriptive statistics, general linear regression models and survival analysis. We assessed 137 patients who received transplants between November 1985 and June 1994 in Pavia and have survived 10 to 18 years after transplantation (mean 13.64 years, SD 2.25). They rated their health as good and only the physical QoL (PCS) was impaired when compared with the general population. Thirty-two percent of patients experienced mood depressive symptoms in the long term after transplantation, indicating a low perceived QoL. Higher educational qualification (p = 0.049), being unemployed and receiving a disability pension (p = 0.001), high triglycerides levels (p = 0.020) and lack of physical activity (p < 0.001) were predictors of high BDI scores. Assessment of depression levels and better understanding of risk factors for psychiatric disorders in the long term after transplantation could be of benefit in predicting negative outcomes and allowing future developments in patient management.

  8. Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation.

    Science.gov (United States)

    Pompili, Maurizio; Francica, Giampiero; Ponziani, Francesca Romana; Iezzi, Roberto; Avolio, Alfonso Wolfango

    2013-11-21

    Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT). The most used treatments include transarterial chemoembolization and radiofrequency ablation. Surgical resection has also been successfully used as a bridging procedure, and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function. The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation, reducing HCC recurrence after transplantation, and improving post-transplant overall survival. To date, no data from prospective randomized studies are available; however, for HCC patients listed for LT within the Milan criteria, prolonging the waiting time over 6-12 mo is a risk factor for tumor spread. Bridging treatments are useful in containing tumor progression and decreasing dropout. Furthermore, the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT. Lastly, although a definitive conclusion can not be reached, the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival. Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT. Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging.

  9. Evaluation of polyomavirus BK reactivation in lupus patients who underwent kidney transplantation

    Directory of Open Access Journals (Sweden)

    Cristina Costa

    2012-06-01

    Full Text Available Background. A pathogenic role for polyomavirus BK in systemic lupus erythematosus (SLE has been proposed, however no study evaluated the occurrence of BK replication in renal transplant recipients according to the underlying disease leading to transplantation and its potential impact. Methods. The occurrence of BK reactivation was serially evaluated in 468 renal transplant recipients, including 11 patients with SLE as underlying disease (overall, 2370 serum and 2370 urine specimens; 65 from SLE patients. Results. Considering the overall occurrence of viral reactivation (viremia and/or viruria, 26/65 (40% specimens were positive in four SLE patients (36.3% versus 331/2143 (15.4% in 130/227 (57.3% non-SLE patients. A patient transplanted for class III lupus nephritis evidenced sustained BK viremia and viruria (with viremia values potentially indicative of polyomavirus-associated nephropathy in the absence of clinical features of renal dysfunction or recurrence of lupus nephritis. Conclusions. Further studies on larger populations and for a longer follow-up should be required to evaluate the impact of BKV reactivation in renal transplant patients with SLE as underlying disease, as well as the potential therapeutic implications.

  10. Modulation of splanchnic circulation: Role in perioperative management of liver transplant patients.

    Science.gov (United States)

    Mukhtar, Ahmed; Dabbous, Hany

    2016-01-28

    Splanchnic circulation is the primary mechanism that regulates volumes of circulating blood and systemic blood pressure in patients with cirrhosis accompanied by portal hypertension. Recently, interest has been expressed in modulating splanchnic circulation in patients with liver cirrhosis, because this capability might produce beneficial effects in cirrhotic patients undergoing a liver transplant. Pharmacologic modulation of splanchnic circulation by use of vasoconstrictors might minimize venous congestion, replenish central blood flow, and thus optimize management of blood volume during a liver transplant operation. Moreover, splanchnic modulation minimizes any high portal blood flow that may occur following liver resection and the subsequent liver transplant. This effect is significant, because high portal flow impairs liver regeneration, and thus adversely affects the postoperative recovery of a transplant patient. An increase in portal blood flow can be minimized by either surgical methods (e.g., splenic artery ligation, splenectomy or portocaval shunting) or administration of splanchnic vasoconstrictor drugs such as Vasopressin or terlipressin. Finally, modulation of splanchnic circulation can help maintain perioperative renal function. Splanchnic vasoconstrictors such as terlipressin may help protect against acute kidney injury in patients undergoing liver transplantation by reducing portal pressure and the severity of a hyperdynamic state. These effects are especially important in patients who receive a too small for size graft. Terlipressin selectively stimulates V1 receptors, and thus causes arteriolar vasoconstriction in the splanchnic region, with a consequent shift of blood from splanchnic to systemic circulation. As a result, terlipressin enhances renal perfusion by increasing both effective blood volume and mean arterial pressure.

  11. Hematopoietic stem cell transplantation with conditioning regimens containing melphalan in pediatric patients with acute lymphoblastic leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Matsuyama, Takaharu; Kato, Koji [Nagoya First Red Cross Hospital (Japan). Children' s Medical Center; Hanada, Ryoji [Saitama Children' s Medical Center, Iwatsuki (Japan)] [and others

    2002-07-01

    A multicenter comparative study was carried out to investigate the efficacy and safety of hematopoietic stem cell transplantation with conditioning regimens containing melphalan in pediatric patients with acute lymphoblastic leukemia. One hundred twenty three patients at a variety of remission stages were eligible for study participation. Eighty-nine were transplanted with allogeneic grafts and 34 patients with autologous grafts (23 cases with bone marrow and 11 cases with peripheral blood stem cells). Conditioning regimens used were as follows: melphalan and busulfan for 40 patients, melphalan, busulfan and TBI for 44 patients, other regimens for 39 patients. To accelerate engraftment G-CSF (lenograstim) was administered as a 1-hour or 24-hour drip infusion daily at 5 {mu}g/kg from day 5 until hematological recovery. The five year disease free survival (DFS) was 63% for 42 patients at CR1, 41% for 41 patients at CR2 and 33% for 40 patients at other stages. There was no significant difference in the DFS between allogeneic-transplantation and autologous-transplantation in all disease stages. In patients at remission stage for CR1 and CR2, the 5-year DFS by conditioning regimen was 63% for regimen with melphalan and busulfan, 54% for regimen with melphalan, busulfan and TBI and 54% for regimens with melphalan and TBI. There was no significant difference in the DFS between the groups. Serious complications such as renal failure were observed in 11%, veno-occlusive disease in 9%, and interstitial pneumonia in 9%. The most dominating cause of death was relapse in the disease (48% of deaths) which was most commonly observed in autologous transplantation. Contrary to that, treatment related toxic death was the most frequent cause of deaths in allogeneic-transplantation. (author)

  12. Soluble Co-Signaling Molecules Predict Long-Term Graft Outcome in Kidney-Transplanted Patients

    Science.gov (United States)

    Melendreras, Susana G.; Martínez-Camblor, Pablo; Menéndez, Aurora; Bravo-Mendoza, Cristina; González-Vidal, Ana; Coto, Eliecer; Díaz-Corte, Carmen; Ruiz-Ortega, Marta; López-Larrea, Carlos; Suárez-Álvarez, Beatriz

    2014-01-01

    Co-signaling molecules are responsible for full T-cell activation after solid organ transplantation. Their increased expression can lead to the release of a soluble form that can modulate the immune response post-transplantation. We analyzed the presence of co-signaling molecules (sCD30, sCD40, sCD137, sCTLA-4, sCD80, sCD28, sCD40L, sPD-1, and sPD-L1) in serum from kidney-transplanted patients (n = 59) obtained at different times (before transplantation, and 15 days, 3 months and 1 year post-transplantation) and their contribution to graft outcome was evaluated using principal component analysis. Before transplantation, high levels of soluble co-signaling molecules (mainly sCD30, sCD137 and sCD40) were detected in all patients. These molecules were modulated soon after receiving an allograft but never attained similar levels to those of healthy controls. A signature based on the determination of six soluble co-stimulatory (sCD30, sCD40, sCD137 and sCD40L) and co-inhibitory (sPD-1 and sPD-L1) molecules at 3 months post-transplantation allowed a group of patients to be identified (27.12%) with a worse long-term graft outcome. Patients with high levels of soluble molecules showed a progressive and gradual deterioration of kidney function (increased creatinine and proteinuria levels and decreased estimated glomerular filtration rate) over time and a higher risk of graft loss at 6 years post-transplantation than patients with low levels of these molecules (62.55% versus 5.14%, psoluble co-signaling molecules in kidney-transplanted patients whose quantification at 3 months post-transplantation might be a useful biomarker of immune status and help to predict long-term graft evolution. PMID:25478957

  13. Motion – Patients with Primary Sclerosing Cholangitis Should Undergo Early Liver Transplantation: Arguments against the Motion

    Directory of Open Access Journals (Sweden)

    Jeffrey S Crippin

    2002-01-01

    Full Text Available Liver transplantation is an accepted form of treatment for patients with primary sclerosing cholangitis (PSC and can provide long term survival. Cholangiocarcinoma occurs in 10% to 20% of patients with PSC, is difficult to diagnose and has a poor prognosis. It has been proposed that liver transplantation be undertaken early in the course of the PSC, before cancer develops. Such a proposal would have significant implications for the method of assigning priority to patients awaiting liver transplantation. Other patients on the waiting list would experience further delays, while there is no proven benefit for PSC patients. Few patients with this disease are removed from the waiting list because they developed cancer. If one were to state that PSC patients warrant special consideration because of the hypothetical risk of cholangiocarcinoma, the same argument could be applied to patients with hepatitis C and other causes of cirrhosis, who are at increased risk of hepatocellular carcinoma. The transplant allocation system is applied in an equitable fashion to patients with a large variety of liver diseases. Alteration of this system to benefit a small number of patients with PSC would violate the principles on which it was created, and cannot be justified.

  14. HCC influence on patient survival after liver transplantation for HDV cirrhosis.

    Science.gov (United States)

    Imvrios, Georgios; Vrochides, Dionisios; Papanikolaou, Vasilios; Fouzas, Ioannis; Antoniadis, Nikolaos; Giakoustidis, Dimitrios; Ntinas, Achilleas; Kardassis, Dimitrios; Akriviadis, Evangelos; Vasiliadis, Themistokles; Goulis, Ioannis; Katsika, Eleni; Moutsianos, Georgios; Patsiaoura, Kalliopi; Tsoulfas, Georgios; Takoudas, Dimitrios

    2011-01-01

    The effect of hepatocellular cancer (HCC) in patients transplanted for hepatitis B and D virus (HB/DV) cirrhosis is not well studied. Our aim was to study the long-term survival outcomes of patients who underwent liver transplantation for HB/DV cirrhosis with and without HCC. A total of 231 primary, adult, single- organ liver transplants were performed from 1990 to 2007. HB/DV was the cause of cirrhosis in 36 patients. Nine patients died during the first 3 postoperative months from surgical complications. The study group comprised the remaining 27 patients. The median follow-up was 1515 days. The mean patient survival was 3760 days (95% CI: 3013-4507). Six patients were diagnosed with HCC. The mean patient survival was 3011 days (95% CI: 2344-3679) and 4036 days (95% CI: 3002-5070) for recipients without and with HCC, respectively. For the same groups, the incidence of microbial infections was 61.9% and 33.3%, respectively (p=0.219). HCC has not recurred in any of the six patients. The mean long-term survival after liver transplantation for HB/DV and HCC surpassed 11 years. The superior survival of HCC patients is difficult to explain. The increased number (almost double) of microbial infections in the non- HCC population might be held accountable.

  15. Association between daily hemodialysis, access to renal transplantation and patients' survival in France.

    Science.gov (United States)

    Pladys, Adélaïde; Vigneau, Cécile; Hourmant, Maryvonne; Duneau, Gabrielle; Couchoud, Cécile; Bayat, Sahar

    2016-12-01

    Daily hemodialysis improves patients' quality of life and blood purification, but its effect on survival remains controversial. The aim of this study was to analyze the association between daily hemodialysis and renal transplantation and survival in France. This was an observational cohort study based on the French REIN registry. All incident patients ≥18 y/o who started daily hemodialysis in France between 2003 and 2012 were included. Using a propensity score, 575 patients on daily hemodialysis were matched with 1696 patients receiving thrice-weekly hemodialysis. Survival analysis was performed using the Cox model. Access to the renal transplant waiting list and renal transplantation were analyzed using the Fine and Gray model. Daily hemodialysis was not independently associated with reduced access to transplant waiting list, whereas, major comorbidities remained associated with restricted waitlisting after multivariate analysis adjusted for confounding factors. After being waitlisted, the cumulative incidence of renal transplantation was lower for the daily hemodialysis than for the thrice-weekly hemodialysis group (SHR = 0.72, 95%CI: 0.56-0.91). The risk of death was significantly higher in the daily hemodialysis group (HRadjusted  = 1.58, 95%CI: 1.4-1.8). Major comorbidities were associated with higher risk of death and lower likelihood of receiving a renal transplant during the follow-up period. Our study showed that in France, the likelihood of undergoing renal transplantation after being waitlisted was lower for patients on daily hemodialysis than those on thrice-weekly hemodialysis. Moreover, daily hemodialysis was associated with higher risk of death, even after taking into account age and all major comorbidities. This article is protected by copyright. All rights reserved.

  16. Early polymerase chain reaction detection of Chagas disease reactivation in heart transplant patients.

    Science.gov (United States)

    da Costa, Priscilla Almeida; Segatto, Marcela; Durso, Danielle Fernandes; de Carvalho Moreira, Wagson José; Junqueira, Lucas Lodi; de Castilho, Fábio Morato; de Andrade, Silvio Amadeu; Gelape, Cláudio Léo; Chiari, Egler; Teixeira-Carvalho, Andréa; Junho Pena, Sergio Danilo; Machado, Carlos Renato; Franco, Gloria Regina; Filho, Geraldo Brasileiro; Vieira Moreira, Maria da Consolação; Mara Macedo, Andréa

    2017-07-01

    Heart transplantation is a valuable therapeutic option for Chagas disease patients with severe cardiomyopathy. During patient follow-up, the differential diagnosis between cardiac transplant rejection and Chagas disease infection reactivation remains a challenging task, which hinders rapid implementation of the appropriate treatment. Herein we investigate whether polymerase chain reaction (PCR) strategies could facilitate early detection of Trypanosoma cruzi (T cruzi) in transplanted endomyocardial biopsies (EMBs). In this study we analyzed 500 EMB specimens obtained from 58 chagasic cardiac transplant patients, using PCR approaches targeted to nuclear (rDNA 24Sα) and kinetoplastid (kDNA) markers, and compared the efficiency of these approaches with that of other tests routinely used. T cruzi DNA was detected in 112 EMB specimens derived from 39 patients (67.2%). The first positive result occurred at a median 1.0 month post-transplant. Conventional histopathologic, blood smear and hemoculture analyses showed lower sensitivity and higher median time to the first positive result. Patient follow-up revealed that 31 of 39 PCR-positive cases presented clinical reactivation of Chagas disease at different time-points after transplantation. PCR techniques showed considerable sensitivity (0.82) and specificity (0.60), with area under the receiver operating characteristic (ROC) curves of 0.708 (p = 0.001). Moreover, PCR techniques anticipated the clinical signs of Chagas disease reactivation by up to 36 months, with a median time of 6 months and an average of 9.1 months. We found a good association between the PCR diagnosis and the clinical signs of the disease, indicating that the PCR approaches used herein are suitable for early diagnosis of Chagas disease reactivation, with high potential to assist physicians in treatment decisions. For this purpose, an algorithm is proposed for surveillance based on the molecular tests. Copyright © 2017 International Society for the

  17. Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia.

    Science.gov (United States)

    Patzer, Rachel E; Plantinga, Laura C; Paul, Sudeshna; Gander, Jennifer; Krisher, Jenna; Sauls, Leighann; Gibney, Eric M; Mulloy, Laura; Pastan, Stephen O

    2015-08-11

    Dialysis facilities in the United States are required to educate patients with end-stage renal disease about all treatment options, including kidney transplantation. Patients receiving dialysis typically require a referral for kidney transplant evaluation at a transplant center from a dialysis facility to start the transplantation process, but the proportion of patients referred for transplantation is unknown. To describe variation in dialysis facility-level referral for kidney transplant evaluation and factors associated with referral among patients initiating dialysis in Georgia, the US state with the lowest kidney transplantation rates. Examination of United States Renal Data System data from a cohort of 15,279 incident, adult (18-69 years) patients with end-stage renal disease from 308 Georgia dialysis facilities from January 2005 to September 2011, followed up through September 2012, linked to kidney transplant referral data collected from adult transplant centers in Georgia in the same period. Referral for kidney transplant evaluation within 1 year of starting dialysis at any of the 3 Georgia transplant centers was the primary outcome; placement on the deceased donor waiting list was also examined. The median within-facility percentage of patients referred within 1 year of starting dialysis was 24.4% (interquartile range, 16.7%-33.3%) and varied from 0% to 75.0%. Facilities in the lowest tertile of referral (31.3%). In multivariable, multilevel analyses, factors associated with lower referral for transplantation, such as older age, white race, and nonprofit facility status, were not always consistent with the factors associated with lower waitlisting. In Georgia overall, a limited proportion of patients treated with dialysis were referred for kidney transplant evaluation between 2005 and 2011, but there was substantial variability in referral among facilities. Variables associated with referral were not always associated with waitlisting, suggesting that

  18. Barriers to kidney transplantation among adult Sudanese patients on maintenance hemodialysis in dialysis units in Khartoum state

    Directory of Open Access Journals (Sweden)

    Hisham H Abdelwahab

    2013-01-01

    Full Text Available Kidney transplantation remains the preferred modality of treatment for patients with end-stage renal disease. In Sudan, kidney transplantation accounted for 28% of the total provided renal replacement therapies. A cross-sectional, hospital-based study was conducted in hemodialysis (HD units in Khartoum State during the period from September 2010 to January 2011. It aimed to determine the main reasons for the currently low renal transplantation rate. Data were obtained by direct interviewing using a specifically pre-coded and pre-tested questionnaire following a pilot study. A total of 462 adult HD patients were randomly selected from the various HD units in Khartoum State; these patients accounted for 16.9% of the total HD population in Khartoum State. The mean age of the study patients was 48.5 ± 23.6 years and 312 (67.5% were males. Upon interviewing, only 316 patients (68.4% said that they had been counseled for kidney transplantation. One hundred and twenty-two patients (26.4% were on the active transplant list; of these, 50% preferred to have their kidney transplantation performed abroad, mostly due to the availability of commercial transplantation and/or a presumed better outcome. The low renal transplantation rate was due to financial constraints in 112 patients (24.2%, lack of medical fitness in 97 patients (21% and absence of a suitable kidney donor in 92 patients (20%, while 56 patients (12% were still having misperceptions regarding transplantation and preferred to continue on dialysis. To improve the kidney transplantation rate in Khartoum State, the Sudan program for organ transplantation is expected to take more initiatives to promote and improve the outcome of kidney transplants inside the country and, accordingly, regain the patients′ confidence on the health system.

  19. SIGNIFICANCE OF THERAPY MONITORING OF IMMUNOSUPPRESSIVE MEDICINES IN RENAL TRANSPLANTATION PATIENTS

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    Vidojko Đorđević

    2009-04-01

    Full Text Available Immunosuppressive medicines are characterized by specific pharmacokinetic profile which requires therapy monitoring by means of measuring their blood concentrations. Therapy monitoring, by means of determining blood concentration of the medicine, enables application of an optimal individual immunosuppressive therapy. Due to its variable pharmacokinetics, and small therapeutic index and potential interaction with numerous other medicines, the post-operative monitoring of immunosuppressive medicines is an essential element of therapy protocol for renal transplantation patients. Therapy monitoring represents an efficient way to reduce adverse effects of immunosuppressive medicines and to prevent transplantation rejection, by means of adapting the doses in renal transplantation patients. Determining the concentration of immunosuppressive medicines is of special importance in the modified dosing for patients with renal insufficiency. Pharmacokinetic analysis is important for proper interpretation of immunosuppressive medicines' blood concentrations. The interpretation of the received results must be multidisciplinary, considering that there are numerous factors of variability of patients and immunosuppressive medicines.

  20. Concurrent cutaneous, visceral and ocular leishmaniasis caused by Leishmania (Viannia braziliensis in a kidney transplant patient

    Directory of Open Access Journals (Sweden)

    Gontijo Célia MF

    2002-01-01

    Full Text Available Although cases of leishmaniasis co-infection have been described in acquired immunodeficiency syndrome patients as well as those who have undergone organ transplants, to our knowledge, the present report is the first documented case of simultaneous cutaneous, visceral and ocular leishmaniasis due to Leishmania (Viannia braziliensis in a transplant patient. The patient had been using immunosuppressive drugs since receiving a transplanted kidney. The first clinical signs of leishmaniasis included fever, thoracic pain, hepatosplenomegaly, leucopenia and anemia. The cutaneous disease was revealed by the presence of amastigotes in the skin biopsy. After three months, the patient presented fever with conjunctive hyperemia, intense ocular pain and low visual acuity. Parasites isolated from iliac crest, aqueous humor and vitreous body were examined using a range of molecular techniques. The same strain of L. (V. braziliensis was responsible for the different clinical manifestations. The immunosuppressive drugs probably contributed to the dissemination of Leishmania.

  1. A Rare Reason of Ileus in Renal Transplant Patients With Peritoneal Dialysis History: Encapsulated Peritoneal Sclerosis.

    Science.gov (United States)

    Gökçe, Ali Murat; Özel, Leyla; İbişoğlu, Sevinç; Ata, Pınar; Şahin, Gülizar; Gücün, Murat; Kara, V Melih; Özdemir, Ebru; Titiz, M İzzet

    2015-12-01

    Encapsulating peritoneal sclerosis is a rare complication of long-term peritoneal dialysis ranging from moderate inflammation of peritoneal structures to severe sclerosing peritonitis and encapsulating peritoneal sclerosis. Complicated it, ileus may occur during or after peritoneal dialysis treatment or after kidney transplant. We sought to evaluate 3 posttransplant encapsulating peritoneal sclerosis through clinical presentation, radiologic findings, and outcomes. We analyzed 3 renal transplant patients with symptoms of encapsulating peritoneal sclerosis admitted posttransplant to our hospital with ileus between 2012 and 2013. Conservative treatment was applied to the patients whenever necessary to avoid surgery. One patient improved with medical therapy. Surgical treatment was delayed and we decided it as a last resort, in 2 cases with no response to conservative treatment for a long time. Finally, patients with peritoneal dialysis history should be searched carefully before renal transplant for intermittent bowel obstruction story.

  2. Pathology of heart, lung, liver and kidney in broilers under chronic heat stress

    Directory of Open Access Journals (Sweden)

    Worapol Aengwanich

    2005-05-01

    Full Text Available The purpose of this experiment was to investigate pathological changes in broilers under chronic heat stress. Fifteen birds (n = 15, twenty-eight days old were kept at 33 + 1oC environmental temperature for 21 days. While broilers were maintained in environmental temperature at 33 + 1 oC, body temperature, respiratory rate and urine excretion rose. Macroscopic and microscopic lesions of heart, lung, liver and kidney were examined. Right atrium hypertrophy with excessive blood accumulation, heart enlargement and right ventricular hypertrophy were observed in 12 out of 15 broilers (80%. Congestion, edema and hyperemia in lung were present in all broilers. Yellow and pale livers were observed in 4 out of 15 broilers (26.67%. Kidneys were highly affected i.e. generalized edema and hemorrhage in subrenal capsule. Under microscopic examination of heart, massive myofibrillar degeneration with hemorrhage, general fatty degeneration /or/ vacuolation of myofibers and diffused myocarditis containing organisms were found in some areas. The principal histopathologic lesions in the lung were related to vein and arteriole massive congestion. Massive hemorrhage was largely observed in parabronchus and alveoli of all broilers. Liver cells showed “fatty degeneration” with dilation of sinusoid of all broilers. Besides, necrosis with heterophils and lymphocytes was observed in some parts of the liver, especially in the centritubular region. In the kidney, leukocytes such as heterophils accumulated in many inflammatory areas. Fatty degeneration was observed in renal tubular epithelia of all broilers. Glomeruli were damaged. A space between renal papillae increased and accumulated water. Moreover, ureters in 9 out of 15 (60% birds showed sac-like expansion “ureteral pseudobladder”. These sacs were filled with urine and similar to bladder in mammals.

  3. Tacrolimus in preventing transplant rejection in Chinese patients – optimizing use

    Science.gov (United States)

    Li, Chuan-Jiang; Li, Liang

    2015-01-01

    Tacrolimus is a product of fermentation of Streptomyces, and belongs to the family of calcineurin inhibitors. It is a widely used immunosuppressive drug for preventing solid-organ transplant rejection. Compared to cyclosporine, tacrolimus has greater immunosuppressive potency and a lower incidence of side effects. It has been accepted as first-line treatment after liver and kidney transplantation. Tacrolimus has specific features in Chinese transplant patients; its in vivo pharmacokinetics, treatment regimen, dose and administration, and adverse-effect profile are influenced by multiple factors, such as genetics and the spectrum of primary diseases in the Chinese population. We reviewed the clinical experience of tacrolimus use in Chinese liver- and kidney-transplant patients, including the pharmacology of tacrolimus, the immunosuppressive effects of tacrolimus versus cyclosporine, effects of different factors on tacrolimus metabolism on Chinese patients, personalized medicine, clinical safety profile, and patient satisfaction and adherence. This article provides guidance for the rational and efficient use of tacrolimus in Chinese organ-transplant patients. PMID:25609922

  4. Ethical dilemmas in patient selection for a new kidney transplant program in Guyana, South America.

    Science.gov (United States)

    Guy, S R; Womble, A L; Jindal, T R; Doyle, A; Friedman, E A; Elster, E A; Falta, E M; Jindal, R M

    2013-01-01

    We describe ethical/moral issues in patient selection in a new living donor kidney transplant program in Guyana, South America. Over 3 years, we screened 450 patients with chronic kidney disease among which 70 were suitable for kidney transplantation. There were five patients whose evaluations raised possible ethical dilemmas: one had nonadherence to dialysis; two of Guyanese origin living abroad wished to have the transplant performed in Guyana; a minor wished to donate to her mother; and another subject was considering commercialization of the transplant process. Since inception of the renal replacement program in 2008, we have completed 13 living kidney transplantations, 17 peritoneal dialysis placements, and 20 vascular access procedures. In the five patients wherein faced ethical dilemmas, three were rejected for consideration despite having living donors: one was nonadherent, the second excluded due to an attempt to commercialize the process, and the third, a minor who wished to donate to the mother. The other two patients were considered Guyanese ex-patriots acceptable for the program. The consequence of kidney failure in Guyana prior to introduction of renal replacement therapy was a virtual death sentence. These cases illustrate ethical dilemmas serving to throw into stark relief the implications of decisions made in a developing country versus those in a developing country. Published by Elsevier Inc.

  5. Preparation and Support of Patients through the Transplant Process: Understanding the Recipients' Perspectives

    Directory of Open Access Journals (Sweden)

    Oliver Mauthner

    2012-01-01

    Full Text Available Preparation for heart transplant commonly includes booklets, instructional videos, personalized teaching sessions, and mentorship. This paper explores heart transplant recipients’ thoughts on their preparation and support through the transplant process. Twenty-five interviews were audio-/videotaped capturing voice and body language and transcribed verbatim. Coding addressed language, bodily gesture, volume, and tone in keeping with our visual methodology. Recipients reported that only someone who had a transplant truly understands the experience. As participants face illness and life-altering experiences, maintaining a positive attitude and hope is essential to coping well. Healthcare professionals provide ongoing care and reassurance about recipients’ medical status. Mentors, family members, and close friends play vital roles in supporting recipients. Participants reported that only heart transplant recipients understood the experience, the hope, and ultimately the suffering associated with living with another persons’ heart. Attention needs to be focused not solely on the use of teaching modalities, but also on the development of innovative support networks. This will promote patient and caregiver engagement in self-management. Enhancing clinicians’ knowledge of the existential aspects of transplantation will provide them with a nuanced understanding of the patients’ experience, which will ultimately enhance their ability to better prepare and support patients and their caregivers.

  6. Pancreas Islet Transplantation for Patients With Type 1 Diabetes Mellitus: A Clinical Evidence Review.

    Science.gov (United States)

    2015-01-01

    Type 1 diabetes mellitus is caused by the autoimmune destruction of pancreatic beta (β) cells, resulting in severe insulin deficiency. Islet transplantation is a β-cell replacement therapeutic option that aims to restore glycemic control in patients with type 1 diabetes. The objective of this study was to determine the clinical effectiveness of islet transplantation in patients with type 1 diabetes, with or without kidney disease. We conducted a systematic review of the literature on islet transplantation for type 1 diabetes, including relevant health technology assessments, systematic reviews, meta-analyses, and observational studies. We used a two-step process: first, we searched for systematic reviews and health technology assessments; second, we searched primary studies to update the chosen health technology assessment. The Assessment of Multiple Systematic Reviews measurement tool was used to examine the methodological quality of the systematic reviews and health technology assessments. We assessed the quality of the body of evidence and the risk of bias according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. Our searched yielded 1,354 citations. One health technology assessment, 11 additional observational studies to update the health technology assessment, one registry report, and four guidelines were included; the observational studies examined islet transplantation alone, islet-after-kidney transplantation, and simultaneous islet-kidney transplantation. In general, low to very low quality of evidence exists for islet transplantation in patients with type 1 diabetes with difficult-to-control blood glucose levels, with or without kidney disease, for these outcomes: health-related quality of life, secondary complications of diabetes, glycemic control, and adverse events. However, high quality of evidence exists for the specific glycemic control outcome of insulin independence compared with

  7. Risk factors for frequent readmissions and barriers to transplantation in patients with cirrhosis.

    Directory of Open Access Journals (Sweden)

    Swaytha Ganesh

    Full Text Available Hospital readmission rate is receiving increasing regulatory scrutiny. Patients with cirrhosis have high hospital readmissions rates but the relationship between frequent readmissions and barriers to transplantation remains unexplored. The goal of this study was to determine risk factors for frequent readmissions among patients with cirrhosis and identify barriers to transplantation in this population.We retrospectively reviewed medical records of 587 patients with a confirmed diagnosis of cirrhosis admitted to a large tertiary care center between May 1, 2008 and May 1, 2009. Demographics, clinical factors, and outcomes were recorded. Multivariate logistic regression was performed to identify risk factors for high readmission rates. Transplant-related factors were assessed for patients in the high readmission group.The 587 patients included in the study had 1557 admissions during the study period. A subset of 87 (15% patients with 5 or more admissions accounted for 672 (43% admissions. The factors associated with frequent admissions were non-white race (OR = 2.45, p = 0.01, diabetes (OR = 2.04, p = 0.01, higher Model for End-Stage Liver Disease (MELD score (OR = 35.10, p30 and younger age (OR = 0.98, p = 0.02. Among the 87 patients with ≥5 admissions, only 14 (16% underwent liver transplantation during the study period. Substance abuse, medical co-morbidities, and low (<15 MELD scores were barriers to transplantation in this group.A small group of patients with cirrhosis account for a disproportionately high number of hospital admissions. Interventions targeting this high-risk group may decrease frequent hospital readmissions and increase access to transplantation.

  8. PROUD: Effects of preoperative long-term immunonutrition in patients listed for liver transplantation

    Directory of Open Access Journals (Sweden)

    Büchler Markus W

    2007-08-01

    Full Text Available Abstract Background Patients with end stage liver disease are characteristically malnourished which is associated with poor outcome. Formulas enriched with arginine, ω-3 fatty acids, and nucleotides, "immunonutrients", potentially improve their nutritional status. This study is designed to evaluate the clinical outcome of long-term "immunonutrition" of patients with end-stage liver disease while on the waiting list for liver transplantation. Methods/design A randomized controlled double blind multi-center clinical trial with two parallel groups comprising a total of 142 newly registered patients for primary liver transplantation has been designed to assess the safety and efficacy of the long-term administration of ORAL IMPACT®, an "immunonutrient" formula, while waiting for a graft. Patients will be enrolled the day of registration on the waiting list for liver transplantation. Study ends on the day of transplantation. Primary endpoints include improved patients' nutritional and physiological status, as measured by mid-arm muscle area, triceps skin fold thickness, grip strength, and fatigue score, as well as patients' health related quality of life. Furthermore, patients will be followed for 12 postoperative weeks to evaluate anabolic recovery after transplantation as shown by reduced post-transplant mechanical ventilation, hospital stay, wound healing, infectious morbidities (pneumonia, intraabdominal abscess, sepsis, line sepsis, wound infection, and urinary tract infection, acute and chronic rejection, and mortality. Discussion Formulas enriched with arginine, ω-3 fatty acids, and nucleotides have been proven to be beneficial in reducing postoperative infectious complications and length of hospital stay among the patients undergoing elective gastrointestinal surgery. Possible mechanisms include downregulation of the inflammatory responses to surgery and immune modulation rather than a sole nutritional effect. Trial registration Clinical

  9. Epstein-Barr virus load in transplant patients: Early detection of post-transplant lymphoproliferative disorders.

    Science.gov (United States)

    Fellner, María Dolores; Durand, Karina A; Solernou, Veronica; Bosaleh, Andrea; Balbarrey, Ziomara; García de Dávila, María T; Rodríguez, Marcelo; Irazu, Lucía; Alonio, Lidia V; Picconi, María A

    2016-01-01

    High levels of circulating EBV load are used as a marker of post-transplant lymphoproliferative disorders (PTLD). There is no consensus regarding the threshold level indicative of an increase in peripheral EBV DNA. The aim of the study was to clinically validate a developed EBV quantification assay for early PTLD detection. Transversal study: paired peripheral blood mononuclear cells (PBMC), plasma and oropharyngeal lymphoid tissue (OLT) from children undergoing a solid organ transplant with (n=58) and without (n=47) PTLD. Retrospective follow-up: 71 paired PBMC and plasma from recipients with (n=6) and without (n=6) PTLD history. EBV load was determined by real-time PCR. The diagnostic ability to detect all PTLD (categories 1-4), advanced PTLD (categories 2-4) or neoplastic PTLD (categories 3 and 4) was estimated by analyzing the test performance at different cut-off values or with a load variation greater than 0.5log units. The higher diagnostic performance for identifying all, advanced or neoplastic PTLD, was achieved with cut-off values of 1.08; 1.60 and 2.47log EBVgEq/10(5) PBMC or 2.30; 2.60; 4.47loggEq/10(5) OLT cells, respectively. EBV DNA detection in plasma showed high specificity but low (all categories) or high (advanced/neoplastic categories) sensitivity for PTLD identification. Diagnostic performance was greater when: (1) a load variation in PBMC or plasma was identified; (2) combining the measure of EBV load in PBMC and plasma. The best diagnostic ability to identify early PTLD stages was achieved by monitoring EBV load in PBMC and plasma simultaneously; an algorithm was proposed. Copyright © 2016 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Persistence of Virologic Response after Liver Transplant in Hepatitis C Patients Treated with Ledipasvir / Sofosbuvir Plus Ribavirin Pretransplant.

    Science.gov (United States)

    Yoshida, Eric M; Kwo, Paul; Agarwal, Kosh; Duvoux, Christophe; Durand, François; Peck-Radosavljevic, Markus; Lilly, Leslie; Willems, Bernard; Vargas, Hugo; Kumar, Princy; Brown, Robert S; Horsmans, Yves; De-Oertel, Shampa; Arterburn, Sarah; Dvory-Sobol, Hadas; Brainard, Diana M; McHutchison, John G; Terrault, Norah; Rizzetto, Mario; Müllhaupt, Beat

    Recurrence of HCV infection in patients with chronic hepatitis C virus (HCV) at the time of liver transplantation is nearly universal and reduces the likelihood of graft and patient survival. We evaluated outcomes of 17 patients (16 with HCV genotype 1 and 1 with genotype 4) who received up to 12 or 24 weeks of ledipasvir/sofosbuvir plus ribavirin prior to or up to the time of liver transplant in the SOLAR-1 and SOLAR-2 trials. In all patients, HCV RNA was ledipasvir / sofosbuvir plus ribavirin prior to liver transplantation was maintained after transplantation, even if treatment was stopped early. Administration of ledipasvir / sofosbuvir plus ribavirin before liver transplant can prevent post-transplant HCV recurrence.

  11. Improving preemptive transplant education to increase living donation rates: reaching patients earlier in their disease adjustment process.

    Science.gov (United States)

    Hays, Rebecca; Waterman, Amy D

    2008-12-01

    Patients who receive a preemptive kidney transplant before starting dialysis avoid the medical complications related to dialysis and have the highest graft success and lowest mortality rates. Because only 2.5% of incident patients receive kidney transplants preemptively, improved psychosocial education may assist more patients in accessing preemptive transplant. This article outlines (1) unique psychosocial issues affecting patients with chronic kidney disease stage 4 (glomerular filtration rates > 20 mL/min per 1.73 m2) and (2) how an educational program about preemptive living donor transplant should be designed and administered to increase access to this treatment option. Early referral patients may be overwhelmed in coping with and learning about their disease and, therefore, not ready to make a treatment decision, or they may be highly motivated to obtain a transplant to avoid dialysis and return to a normal life. An education program that defines the quality-of-life and health benefits possible with early transplant is outlined. The program is focused on minimizing the disruption of starting 2 treatment techniques and maximizing early transplant health, graft survival, employability, and retention of insurance coverage. Once the benefits of preemptive living donor transplant are outlined, educators can focus on demystifying the living donor evaluation process and assisting interested patients in planning how to find a living donor. To reach all patients, especially racial minorities, education about preemptive transplant should be available in primary-care physicians' and community nephrologists' offices, at dialysis centers, and through other kidney organizations.

  12. Knowledge and Demand for Information about Islet Transplantation in Patients with Type 1 Diabetes

    Directory of Open Access Journals (Sweden)

    Yuko Yamamoto

    2011-01-01

    Full Text Available This cross-sectional study based on self-administrated questionnaire was conducted to investigate knowledge, related factors, and sources of information regarding islet transplantation in patients with type 1 diabetes in Japan. Among 137 patients who provided valid responses, 67 (48.9% knew about islet transplantation. Their main source of information was newspapers or magazines (56.7% and television or radio (46.3%. However, 85.8% of patients preferred the attending physician as their source of information. Although more than half of the patients were correctly aware of issues related to islet transplantation, the following specific issues for islet transplantation were not understood or considered, and there was little knowledge of them: need for immunosuppressants, lifestyle and dietary adaptations, fewer bodily burdens, and complications. The experience of hypoglycaemia, a high level of academic background, frequent self-monitoring of blood glucose, and the use of continuous subcutaneous insulin infusion were related to higher knowledge about islet transplantation.

  13. Clinical experience with Certican (everolimus) in de novo heart transplant patients at the Deutsches Herzzentrum Berlin.

    Science.gov (United States)

    Lehmkuhl, Hans; Hetzer, Roland

    2005-04-01

    Immunosuppressant agents have greatly increased graft and overall survival in heart transplant patients, but some of these agents (e.g., calcineurin inhibitors [CNI] and corticosteroids) can also induce adverse events that may contribute to cardiac allograft vasculopathy (CAV) (e.g., nephrotoxicity and cytomegalovirus infection). The current trend is therefore toward CNI- and steroid-sparing regimes. This study reports on the initial clinical experience with Certican (everolimus), a novel proliferation signal inhibitor with immunosuppressant properties that has been shown to prevent or delay CAV. Seven de novo heart transplant patients were treated at our center. Patients received cyclosporine for microemulsion (CsA; Neoral), corticosteroids and fluvastatin in addition to everolimus. Mean everolimus blood trough levels were maintained within the target range of 3 to 8 ng/ml throughout the first 14 weeks post-transplant. CsA was initiated at a reduced dose, and by Weeks 8 to 14 the mean trough blood level was 187.7 ng/ml. The combination of everolimus and reduced-dose CsA was not associated with increased incidence of biopsy-proven acute rejection (BPAR). Two patients did experience BPAR, but only very mildly (ISHLT Grade 1A). The mean creatinine level pre-transplant was 1.5 mg/dl; this increased to 2.0 mg/dl at 2 weeks post-transplant, but returned to near baseline levels during Weeks 8 to 14 (1.66 mg/dl). Some patients had elevated blood lipids. Patients receiving everolimus should have lipid levels monitored on a regular basis. Everolimus may allow optimization of immunosuppressant regimens in de novo heart transplant patients so that adequate efficacy can be achieved with reduced CNI exposure, thereby protecting kidney function.

  14. Transplante de córnea e o conhecimento do procedimento pelos pacientes Corneal transplant and what the patients know about it

    Directory of Open Access Journals (Sweden)

    Gerson López Moreno

    2003-12-01

    Full Text Available OBJETIVO: Avaliar o grau de entendimento dos pacientes que foram submetidos a transplante de córnea no setor de Patologia Externa e Córnea da Universidade Federal de São Paulo (UNIFESP, quanto ao tipo de doença corneana, tratamento realizado, prognóstico e satisfação com o resultado final. MÉTODOS: Quarenta e dois pacientes submetidos a transplante de córnea foram entrevistados por meio de um formulário com diversas variáveis que avaliou: o conhecimento geral sobre o procedimento ao qual foi submetido, o tratamento pós-operatório, os sinais de rejeição e a satisfação final com o tratamento. Também foram revisados os prontuários e colhidos dados em relação ao diagnóstico e ao transplante. Posteriormente os resultados foram tabulados e analisados. RESULTADOS: Dos 42 pacientes entrevistados 64% não sabiam o que é um transplante de córnea, 67% não sabiam o que é rejeição, 30% não sabiam para que servem os colírios receitados e 71% dos pacientes estavam satisfeitos com o resultado final do transplante. CONCLUSÕES: A grande maioria dos pacientes desconhece o que é um transplante de córnea, qual é a importância do uso correto das medicações no pós-operatório e os sinais de rejeição, embora tenham sido submetidos ao procedimento.PURPOSE: To evaluate the understanding of the patient submitted to corneal transplant regarding the type of surgery, used treatment, rejection signs and final outcome satisfaction, at Cornea and External Disease Sector of the Federal University of São Paulo (UNIFESP. METHODS: 42 patients submitted to corneal transplant were interviewed using a questionnaire that includes multiple variables regarding knowledge on the general procedure, postoperative treatment, rejection signs and satisfaction with the final outcome. We also collected data about the diagnosis and the transplant. The data were tabulated and analyzed. RESULTS: 67% of 42 interviewed patients did not know what a corneal

  15. Effect of captopril on blood pressure and renal function in patients with transplant renal artery stenosis

    NARCIS (Netherlands)

    van der Woude, F. J.; van Son, W. J.; Tegzess, Adam M.; Donker, A. J. M.; Slooff, M. J. H.; van der Slikke, L. B.; Hoorntje, S. J.

    1985-01-01

    We evaluated 9 patients with transplant renal artery stenosis. Captopril treatment always resulted in a dramatic decrease in renal function. Moreover, only in patients (n = 2) with a stenosis in one out of more renal arteries a satisfying fall in blood pressure was achieved. Surgical reconstruction

  16. Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.

    LENUS (Irish Health Repository)

    O'Brien, Frank J

    2012-06-01

    It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival.

  17. Findings From a Randomized Controlled Trial of Fecal Transplantation for Patients With Ulcerative Colitis

    NARCIS (Netherlands)

    Rossen, Noortje G.; Fuentes, Susana; van der Spek, Mirjam J.; Tijssen, Jan G.; Hartman, Jorn H. A.; Duflou, Ann; Löwenberg, Mark; van den Brink, Gijs R.; Mathus-Vliegen, Elisabeth M. H.; de Vos, Willem M.; Zoetendal, Erwin G.; D'Haens, Geert R.; Ponsioen, Cyriel Y.

    2015-01-01

    Several case series have reported the effects of fecal microbiota transplantation (FMT) for ulcerative colitis (UC). We assessed the efficacy and safety of FMT for patients with UC in a double-blind randomized trial. Patients with mild to moderately active UC (n = 50) were assigned to groups that

  18. Findings from a Randomized Controlled Trial of Fecal Transplantation for Patients with Ulcerative Colitis

    NARCIS (Netherlands)

    Rossen, N.G.; Fuentes Enriquez de Salamanca, S.; Spek, van der M.J.; Tijssen, J.; Hartman, J.H.A.; Duflou, A.; Löwenberg, M.; Brink, van den G.R.; Mathus-Vliegen, E.M.; Vos, de W.M.; Zoetendal, E.G.; Haens, D' G.R.; Ponsioen, C.Y.

    2015-01-01

    BACKGROUND: & Aims: Several case series have reported the effects of fecal microbiota transplantation (FMT) for ulcerative colitis (UC). We assessed the efficacy and safety of FMT for patients with UC in a double-blind randomized trial. METHODS: Patients with mild to moderately active UC (n=50)

  19. High Survival and Mortality Characteristics in Heart Transplant Patients at a National Institute.

    Science.gov (United States)

    Rojas, Christian; De la Cruz-Ku, Gabriel; Yassen, Amr; Valcarcel-Valdivia, Bryan

    2017-07-11

    The identification of variables related to the survival of heart transplant patients is vital for a good medical practice. Few studies have examined this issue in a Latin American population. Therefore, the aim of this study was to analyze, retrospectively, the survival and mortality characteristics of patients after heart transplant. Information on patients was obtained through review of medical records; we collected information on all patients who underwent this procedure from 2010 to 2015. Sociodemographic, clinical, and surgical characteristics associated with posttransplant mortality were analyzed. Survival over 5 years was determined with the Kaplan-Meier method. The overall survival rate of the 35 patients who underwent heart transplant was 85%. Those with low total cholesterol values (survival at 5 years than patients with higher values (74% vs 100%; P = .044). The overall mortality was 14.3%, and the main cause of death was acutegraft rejection (40%). Lower total cholesterol level ( 600 mL; P = .013), and number of sepsis incidents (P = .03) were more frequent in patients who died. The survival in our institute at 5 years is higher than shown in the reported literature, and the mortality is lower. In addition, a low total cholesterol value negatively affects survival of heart transplant patients at 5 years.

  20. Xerostomia and chronic oral complications among patients treated with haematopoietic stem cell transplantation

    NARCIS (Netherlands)

    Brand, H. S.; Bots, C. P.; Raber-Durlacher, J. E.

    2009-01-01

    To assess the severity of xerostomia (subjective dry mouth) in haematopoietic stem cell transplantation (HSCT) patients and to investigate the association of xerostomia with other chronic oral complications. Cross-sectional study.Study participants and methods Participants were 48 patients with a

  1. Longitudinal profile of bronchoalveolar lavage cell characteristics in patients with a good outcome after lung transplantation

    NARCIS (Netherlands)

    Slebos, DJ; Scholma, J; Boezen, HM; Koeter, GH; van der Bij, W; Postma, DS; Kauffman, HF

    2002-01-01

    Bronchoalveolar lavage fluid (BALF) analysis is used in patients after lung transplantation (LTX) to obtain more insight into pathological conditions such as acute and chronic allograft rejection. Information on the normal course of BALF cell characteristics in patients with "good outcome" after LTX

  2. Body Hair Transplant by Follicular Unit Extraction: My Experience With 122 Patients.

    Science.gov (United States)

    Umar, Sanusi

    2016-11-01

    Body hair shafts from the beard, trunk, and extremities can be used to treat baldness when patients have inadequate amounts of scalp donor hair, but reports in the literature concerning use of body hair to treat baldness are confined to case reports. This study aimed to assess the outcome of body hair transplanted to bald areas of the scalp in selected patients. From 2005 through 2011, 122 patients preselected for adequate body hair had donor hair transplanted from the beard, trunk, and the extremities to the scalp by follicular unit extraction (FUE) by the author at a single center. All patients were emailed surveys to assess surgical outcomes and overall satisfaction. Seventy-nine patients (64.8%) responded with a mean time of 2.9 years between date of last surgery and time of survey. Patients were generally very satisfied with results of their procedure, giving mean scores of at least a 7.8 on a Likert-like scale of 0 to 10 for their healing status, hair growth in recipient areas, and overall satisfaction with their surgeries. These scores were comparable to mean scores provided by patients whose transplants included scalp donor sources. FUE using body hair can be an effective hair transplantation method for a select patient population of hirsute individuals who suffer from severe baldness or have inadequate scalp donor reserve. 4 Therapeutic. © 2016 The American Society for Aesthetic Plastic Surgery, Inc.

  3. Risk factors for treatment failure after allogeneic transplantation of patients with CLL

    DEFF Research Database (Denmark)

    Schetelig, J; de Wreede, L C; van Gelder, M

    2017-01-01

    For young patients with high-risk CLL, BTK-/PI3K-inhibitors or allogeneic stem cell transplantation (alloHCT) are considered. Patients with a low risk of non-relapse mortality (NRM) but a high risk of failure of targeted therapy may benefit most from alloHCT. We performed Cox regression analyses ...

  4. Autologous peripheral blood stem cell transplantation in patients with relapsed lymphoma results in accelerated haematopoietic reconstitution, improved quality of life and cost reduction compared with bone marrow transplantation: the Hovon 22 study

    NARCIS (Netherlands)

    Vellenga, E.; van Agthoven, M.; Croockewit, A. J.; Verdonck, L. F.; Wijermans, P. J.; van Oers, M. H.; Volkers, C. P.; van Imhoff, G. W.; Kingma, T.; Uyl-de Groot, C. A.; Fibbe, W. E.

    2001-01-01

    The present study analysed whether autologous peripheral blood stem cell transplantation (PSCT) improves engraftment, quality of life and cost-effectiveness when compared with autologous bone marrow transplantation (ABMT). Relapsing progressive lymphoma patients (n = 204; non-Hodgkin's lymphoma n =

  5. Autologous peripheral blood stem cell transplantation in patients with relapsed lymphoma results in accelerated haematopoietic reconstitution, improved quality of life and cost reduction compared with bone marrow transplantation : the Hovon 22 study

    NARCIS (Netherlands)

    Vellenga, E; van Agthoven, M; Croockewit, AJ; Verdonck, LF; Wijermans, PJ; van Oers, MHJ; Volkers, CP; van Imhoff, GW; Kingma, T; Uyl-de Groot, CA; Fibbe, WE

    The present study analysed whether autologous peripheral blood stem cell transplantation (PSCT) improves engraftment, quality of life and cost-effectiveness when compared with autologous bone marrow transplantation (ABMT). Relapsing progressive lymphoma patients (n = 204; non-Hodgkin's lymphoma n =

  6. Autologous peripheral blood stem cell transplantation in patients with relapsed lymphoma results in accelerated haematopoietic reconstitution, improved quality of life and cost reduction compared with bone marrow transplantation: the Hovon 22 study.

    NARCIS (Netherlands)

    Vellenga, E.; Agthoven, M. van; Croockewit, A.J.; Verdonck, L.F.; Wijermans, P.W.; Oers, M.H. van; Volkers, C.P.; Imhoff, G.W. van; Kingma, T.; Groot, C.A. de; Fibbe, W.

    2001-01-01

    The present study analysed whether autologous peripheral blood stem cell transplantation (PSCT) improves engraftment, quality of life and cost-effectiveness when compared with autologous bone marrow transplantation (ABMT). Relapsing progressive lymphoma patients (n = 204; non-Hodgkin's lymphoma n =

  7. Does Cytomegalovirus Develop Resistance following Antiviral Prophylaxis and Treatment in Renal Transplant Patients in Kuwait?

    Directory of Open Access Journals (Sweden)

    Nada Madi

    2011-01-01

    Full Text Available The resistance of cytomegalovirus (CMV to ganciclovir or valganciclovir is a factor in therapeutic failure and disease progression. CMV strains resistant to ganciclovir or valganciclovir have been associated with specific mutations in the UL97 and UL54 genes. Sequencing of both CMV UL97 and UL54 genes was performed to detect the presence of CMV antiviral resistance in six patients who received ganciclovir (and/or valganciclovir and had prolonged detectable CMV DNA in their blood during antiviral treatment. Sequencing results showed no specific mutations in either UL97 or UL54 gene of CMV and therefore the CMV strains in kidney transplant patients who received ganciclovir either prophylactically or therapeutically were from the wild type. Our results suggest that CMV management and immunosuppression protocols for kidney transplant patients followed in the Organ Transplant Centre, Kuwait, is very effective in reducing the opportunity of developing CMV antiviral resistance.

  8. Lung transplantation for high-risk patients with idiopathic pulmonary fibrosis.

    Science.gov (United States)

    De Oliveira, Nilto C; Julliard, Walker; Osaki, Satoru; Maloney, James D; Cornwell, Richard D; Sonetti, David A; Meyer, Keith C

    2016-10-07

    Survival for patients with idiopathic pulmonary fibrosis (IPF) and high lung allocation score (LAS) values may be significantly reduced in comparison to those with lower LAS values. To evaluate outcomes for high-risk IPF patients as defined by LAS values ≥46 (N=42) versus recipients with LAS values pulmonary complications was increased for the higher LAS group versus recipients with LAS <46, 30-day mortality and actuarial survival did not differ between the two cohorts. Although lung transplantation in patients with IPF and high LAS values is associated with increased risk of early post-transplant complications, long-term post-transplant survival for our high-LAS cohort was equivalent to that for the lower LAS recipients.

  9. The calcineurin activity profiles of cyclosporin and tacrolimus are different in stable renal transplant patients

    DEFF Research Database (Denmark)

    Koefoed-Nielsen, PB; Karamperis, N; Hojskov, C

    2006-01-01

    Cyclosporin and tacrolimus remain the cornerstone immunosuppressive drugs in organ transplantation. Dosing and monitoring these drugs is based on pharmacokinetic protocols, but measuring a pharmacodynamic parameter, calcineurin phosphatase (CaN) activity, could be a valuable supplement...... in determining optimal doses. Forty stable renal transplant patients were investigated three times in a 6-month period. Blood samples were drawn at 0, 1, 2, 3 and 4 h after oral intake of tacrolimus (FK) or cyclosporin at days 1 and 180. At day 90, one blood sample at trough level (FK) or C2 level (cyclosporin A...... significantly different effects on calcineurin activity in renal transplant patients with stable, well-functioning grafts and that tacrolimus-treated patients can maintain good, stable graft function with minimal CaN inhibition....

  10. Significant benefits after renal transplantation in patients with chronic heart failure and chronic kidney disease.

    Science.gov (United States)

    Kute, Vivek B; Vanikar, Aruna V; Patel, Himanshu V; Gumber, Manoj R; Shah, Pankaj R; Engineer, Divyesh P; Balwani, Manish R; Gautam, Rajesh Singh; Modi, Pranjal R; Shah, Veena R; Trivedi, Hargovind L

    2014-07-01

    Chronic heart failure (CHF) and chronic kidney disease (CKD) are serious medical conditions with significant morbidity and mortality and often coexist. Because of perioperative risks in these patients, they may not be considered a candidate for renal transplantation (RTx). We compare retrospectively RTx outcomes [graft/patient survival, rejection rates and adverse cardiac events] in study group [low left ventricular ejection fraction (LVEF) ≤ 45% by echocardiogram, n = 63] and control group [normal LVEF ≥ 50%, n = 537] from a developing country. The mean EF was 35 ± 5.6 and 57 ± 3% for the study and control groups, respectively (p renal transplantation, this appears not to be the case. The outcomes between the 2 groups are comparable and transplant is an option for even low EF patients.

  11. Pet Rodents and Fatal Lymphocytic Choriomeningitis in Transplant Patients

    Centers for Disease Control (CDC) Podcasts

    2007-05-16

    Three organ transplant recipients died from infection with lymphocytic choriomeningitis virus (LCMV), which was traced back to a hamster owned by the daughter of the organ donor. Dr. Brian Amman, a mammalogist with the Special Pathogens Branch at CDC, discusses the dangers LCMV may pose to people with immune disorders, as well as to pregnant women.  Created: 5/16/2007 by CDC, Office of the Director.   Date Released: 5/16/2007.

  12. The importance of nutrition for pediatric liver transplant patients

    OpenAIRE

    Paw?owska, Joanna

    2016-01-01

    Pediatric liver transplantation has changed the poor prognosis for children with liver failure, some metabolic diseases and liver tumors. With the increase of survival, long-term maintenance has become a priority. Therefore, obtaining appropriate nutrition, physical growth, bone metabolism, endocrine function and psychosocial development has become one of the most important long-term objectives. This article presents an up-to-date review and recommendation of nutrition assessment, both before...

  13. Patient-reported outcome 2 years after lung transplantation: does the underlying diagnosis matter?

    Directory of Open Access Journals (Sweden)

    Ghosh S

    2012-11-01

    Full Text Available Maria Jose Santana,1 David Feeny,2 Sunita Ghosh,3 Dale C Lien41Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; 2Kaiser Permanente Center for Health Research, Portland, OR, USA; 3Cross Cancer Center, University of Alberta, Edmonton, Alberta, Canada; 4University of Alberta Hospital, Edmonton, Alberta, CanadaPurpose: Transplantation has the potential to produce profound effects on survival and health-related quality of life (HRQL. The inclusion of the patient’s perspective may play an important role in the assessment of the effectiveness of lung transplantation. Patient perspectives are assessed by patient-reported outcome measures, including HRQL measures. We describe how patients’ HRQL among different diagnosis groups can be used by clinicians to monitor and evaluate the outcomes associated with transplantation.Methods: Consecutive lung transplant recipients attending the lung transplant outpatient clinic in a tertiary institution completed the 15-item Health Utilities Index (HUI questionnaire on a touchscreen computer. The results were available to clinicians at every patient visit. The HUI3 covers a range of severity and comorbidities in eight dimensions of health status. Overall HUI3 scores are on a scale in which dead = 0.00 and perfect health = 1.00; disability categories range from no disability = 1 to severe disability <0.70. Single-attribute and overall HUI3 scores were used to compare patients’ HRQL among different diagnosis groups. Random-effect models with time since transplant as a random variable and age, gender, underlying diagnoses, infections, and broncholitis obliterans syndrome as fixed variables were built to identify determinants of health status at 2-years posttransplantation.Results: Two hundred and fourteen lung transplant recipients of whom 61% were male with a mean age of 52 (19–75 years were included in the study. Chronic obstructive pulmonary disease and cystic fibrosis patients displayed

  14. Experience of percutaneous access under ultrasound guidance in renal transplant patients with allograft lithiasis

    Directory of Open Access Journals (Sweden)

    Silvano Palazzo

    2016-12-01

    Full Text Available Objective: Urolithiasis of the transplanted kidney has an incidence of 0.2 to 1.7%, it increases the risk of infection in immunosuppressed patients and it can lead to ureteral obstruction that is often associated with deterioration of renal function. Urolithiasis of the transplanted kidney has different characteristics compared to the native kidney, due to the absence of innervation, which does not lead to colic pain. Percutaneous approach is an optimal choice in transplant patients. Material and methods: Here we report our experience in two cadaveric transplant patients with urolithiasis. The first case was a patient of 68 years with a 20 mm stone located in the transplanted kidney pelvis and another smaller in a lower calyx. The second case was a patient of 65 years with a 15 mm stone in the distal part of the transplanted ureter. In both cases the patients were asymptomatic, but they had a reduction in urine output associated with worsening of the transplanted kidney function. The diagnosis was performed in both cases with ultrasound study, showing a severe hydronephrosis and it was confirmed by computed tomography scan. In both cases, we performed a Percutaneous Nephrolithotomy (PCNL. Access was made after targeting the stone, through a lower pole puncture under ultrasound guidance. The first case was treated with pneumatic and laser energy, breaking stones through a nephroscope. In the second case we performed a laser lithotripsy of the ureteral stone, using a flexible videoureteroscope. At the end of both procedures a Double-J stent and a 14 Fr Malecot nephrostomy were positioned, that were removed at 6 weeks and 10 days, respectively. Results: Both patients achieved a resolution of the worsening of renal function, recovering the spontaneous diuresis. The surgical procedure using ultrasound guidance was safe and allowed quick access to the renal pelvis. Both patients experienced no bleeding or infection during hospitalization. Conclusions

  15. Experience of percutaneous access under ultrasound guidance in renal transplant patients with allograft lithiasis.

    Science.gov (United States)

    Palazzo, Silvano; Colamonico, Ottavio; Forte, Saverio; Matera, Matteo; Lucarelli, Giuseppe; Ditonno, Pasquale; Battaglia, Michele; Martino, Pasquale

    2016-12-30

    Urolithiasis of the transplanted kidney has an incidence of 0.2 to 1.7%, it increases the risk of infection in immunosuppressed patients and it can lead to ureteral obstruction that is often associated with deterioration of renal function. Urolithiasis of the transplanted kidney has different characteristics compared to the native kidney, due to the absence of innervation, which does not lead to colic pain. Percutaneous approach is an optimal choice in transplant patients. Here we report our experience in two cadaveric transplant patients with urolithiasis. The first case was a patient of 68 years with a 20 mm stone located in the transplanted kidney pelvis and another smaller in a lower calyx. The second case was a patient of 65 years with a 15 mm stone in the distal part of the transplanted ureter. In both cases the patients were asymptomatic, but they had a reduction in urine output associated with worsening of the transplanted kidney function. The diagnosis was performed in both cases with ultrasound study, showing a severe hydronephrosis and it was confirmed by computed tomography scan. In both cases, we performed a Percutaneous Nephrolithotomy (PCNL). Access was made after targeting the stone, through a lower pole puncture under ultrasound guidance. The first case was treated with pneumatic and laser energy, breaking stones through a nephroscope. In the second case we performed a laser lithotripsy of the ureteral stone, using a flexible videoureteroscope. At the end of both procedures a Double-J stent and a 14 Fr Malecot nephrostomy were positioned, that were removed at 6 weeks and 10 days, respectively. Both patients achieved a resolution of the worsening of renal function, recovering the spontaneous diuresis. The surgical procedure using ultrasound guidance was safe and allowed quick access to the renal pelvis. Both patients experienced no bleeding or infection during hospitalization. Percutaneous Nephrolithotomy (PCNL) is an established safe and effective

  16. Clostridium difficile infection in Chilean patients submitted to hematopoietic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Javier Pilcante

    2015-12-01

    Full Text Available ABSTRACT Introduction: Patients submitted to hematopoietic stem cell transplantation have an increased risk of Clostridium difficile infection and multiple risk factors have been identi- fied. Published reports have indicated an incidence from 9% to 30% of transplant patients however to date there is no information about infection in these patients in Chile. Methods: A retrospective analysis was performed of patients who developed C. difficile infection after hematopoietic stem cell transplantations from 2000 to 2013. Statistical analysis used the Statistical Package for the Social Sciences software. Results: Two hundred and fifty patients were studied (mean age: 39 years; range: 17-69, with 147 (59% receiving allogeneic transplants and 103 (41% receiving autologous trans- plants. One hundred and ninety-two (77% patients had diarrhea, with 25 (10% cases of C. difficile infection being confirmed. Twenty infected patients had undergone allogeneic trans- plants, of which ten had acute lymphoblastic leukemia, three had acute myeloid leukemia and seven had other diseases (myelodysplastic syndrome, chronic myeloid leukemia, severe aplastic anemia. In the autologous transplant group, five patients had C. difficile infection; two had multiple myeloma, one had amyloidosis, one had acute myeloid leukemia and one had germinal carcinoma. The overall incidence of C. difficile infection was 4% within the first week, 6.4% in the first month and 10% in one year, with no difference in overall survival between infected and non-infected groups (72.0% vs. 67.6%, respectively; p-value = 0.56. Patients infected after allogeneic transplants had a slower time to neutrophil engraftment compared to non-infected patients (17.5 vs. 14.9 days, respectively; p-value = 0.008. In the autologous transplant group there was no significant difference in the neutrophil engraftment time between infected and non-infected patients (12.5 days vs. 11.8 days, respectively; p

  17. Long-term efficacy of glycerine-processed amniotic membrane transplantation in patients with corneal ulcer.

    Science.gov (United States)

    Uhlig, Constantin E; Frings, Charlotte; Rohloff, Nadine; Harmsen-Aasman, Christel; Schmitz, Ralf; Kiesel, Ludwig; Eter, Nicole; Busse, Holger; Alex, Anne F

    2015-09-01

    The aim of this study was to determine the long-term treatment efficacy of glycerine-preserved human amniotic membrane transplantation in patients suffering from corneal ulcers. This was a retrospective, non-controlled, monocentric analysis. Included were patients with corneal ulcers that were non-responsive to ointment or contact lenses and had been treated by amniotic membrane transplantation with either the overlay or sandwich procedure. Analysis parameters were visual acuity before and following treatment, recurrence rate and subjective comfort at the last follow-up. Of the 371 amniotic membrane transplantations that were conducted, 135 surgical treatments in 108 patients (51.9% male, 48.1% female; mean age 63.7 years) met the inclusion criteria. In total, 99 overlay and 36 multilayer amniotic membrane transplantations were performed. The follow-up period was 47.5 ± 66.7 weeks (mean ± SD). The recurrence rate at the last follow-up was 47.8% with overlay membranes and 51.8% with the sandwich technique. There was no significant change in best-corrected visual acuity following treatment with overlays (p = 0.219) or sandwich procedure (p = 0.703). At the last follow-up, 72.1% (overlay) and 78.3% (sandwich) of the patients reported either no pain or increased comfort. The recurrence rates and changes in visual acuity following overlay or sandwich amniotic membrane transplantation in patients suffering from corneal ulcer were lower than reported elsewhere in the literature. More than half of the patients profited from each of the amniotic membrane transplantation techniques with respect to recurrence and postoperative comfort. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  18. Benefits of a Transfer Clinic in Adolescent and Young Adult Kidney Transplant Patients

    Directory of Open Access Journals (Sweden)

    Rory F. McQuillan

    2015-12-01

    Full Text Available Background: Adolescent and young adult kidney transplant recipients have worse graft outcomes than older and younger age groups. Difficulties in the process of transition, defined as the purposeful, planned movement of adolescents with chronic health conditions from child to adult-centered health care systems, may contribute to this. Improving the process of transition may improve adherence post-transfer to adult care services. Objective: The purpose of this study is to investigate whether a kidney transplant transfer clinic for adolescent and young adult kidney transplant recipients transitioning from pediatric to adult care improves adherence post-transfer. Methods: We developed a joint kidney transplant transfer clinic between a pediatric kidney transplant program, adult kidney transplant program, and adolescent medicine at two academic health centers. The transfer clinic facilitated communication between the adult and pediatric transplant teams, a face-to-face meeting of the patient with the adult team, and a meeting with the adolescent medicine physician. We compared the outcomes of 16 kidney transplant recipients transferred before the clinic was established with 16 patients who attended the clinic. The primary outcome was a composite measure of non-adherence. Non-adherence was defined as either self-reported medication non-adherence or displaying two of the following three characteristics: non-attendance at clinic, non-attendance for blood work appointments, or undetectable calcineurin inhibitor levels within 1 year post-transfer. Results: The two groups were similar at baseline, with non-adherence identified in 43.75 % of patients. Non-adherent behavior in the year post-transfer, which included missing clinic visits, missing regular blood tests, and undetectable calcineurin inhibitor levels, was significantly lower in the cohort which attended the transfer clinic (18.8 versus 62.5 %, p = 0.03. The median change in estimated glomerular

  19. Changing cyclosporin A formulation: an analysis in paediatric cardiac transplant recipients.

    Science.gov (United States)

    Gennery, A R; O'Sullivan, J J; Hasan, A; Hamilton, J R; Dark, J H

    1999-08-01

    Cyclosporin A is the primary immunosuppressive agent used in cardiac transplantation to maintain chronic immunosuppression. Absorption may be erratic and major side-effects include nephrotoxicity. A recently introduced formulation (Neoral) improves absorption in cystic fibrosis heart-lung transplant recipients, but episodes of rejection have been reported on conversion from the oil-based formulation. A retrospective analysis of 21 paediatric cardiac transplant recipients who had been converted from the oil-based formulation to the micro-emulsified formulation was performed. No clinical rejection episodes occurred following conversion. There was a significant reduction in dose following conversion (p cardiac transplant recipients despite conversion to the new formulation.

  20. Lung transplantation for patients older than 65 years: is it a feasible option?

    Science.gov (United States)

    Machuca, T N; Camargo, S M; Schio, S M; Lobato, V; Sanchez, L B; Perin, F; Felicetti, J C; Camargo, J J

    2011-01-01

    Advanced age has been a relative contraindication to lung transplantation. However, the exact age limit for this procedure has not yet been established. The aim of this work is to present our experience with this particular group. This retrospective review included medical charts of patients who underwent lung transplantation at our institution from January 2004 to February 2009: namely, 112 cadaveric lung transplants with 12 patients (10.7%) >65 years old. There were 9 male patients and the overall mean age was 68 years (range 66-72). The indications were pulmonary fibrosis in 8 and emphysema in 4 cases. Four patients had mild coronary artery disease and 4 systemic hypertension. All of the procedures were unilateral and only 2 required extracorporeal circulation. Only 5 patients received blood product transfusions intraoperatively; the mean ischemic time was 222 minutes. Four patients developed primary graft dysfunction, the mean requirement for mechanical ventilation was 30 hours, and the mean intensive care unit stay, 11 days. Postoperative complications were respiratory infections (n = 8), catheter-related infection (n = 1), atrial fibrillation (n = 2). The mean hospital stay was 28 days and the 1-year survival was 75%. Lung transplantation is a feasible option for well-selected patients with end-stage pulmonary disease who are >65 years old. Our study reinforces the modern trend for unilateral procedures in this situation. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Rescue Arterial Revascularization Using Cryopreserved Iliac Artery Allograft in Liver Transplant Patients.

    Science.gov (United States)

    Mohkam, Kayvan; Darnis, Benjamin; Rode, Agnès; Hetsch, Nathalie; Balbo, Gregorio; Bourgeot, Jean-Paul; Mezoughi, Salim; Demian, Hassan; Ducerf, Christian; Mabrut, Jean-Yves

    2017-08-01

    Management of hepatic arterial complications after liver transplant remains challenging. The aim of our study was to assess the efficacy of rescue arterial revascularization using cryopreserved iliac artery allografts in this setting. Medical records of patients with liver transplants who underwent rescue arterial revascularization using cryopreserved iliac artery allografts at a single institution were reviewed. From 1992 to 2015, 7 patients underwent rescue arterial revascularization using cryopreserved iliac artery allografts for hepatic artery pseudoaneurysm (3 patients), thrombosis (2 patients), aneurysm (1 patient), or stenosis (1 patient). Two patients developed severe complications, comprising one biliary leakage treated percutaneously, and one acute necrotizing pancreatitis causing death on postoperative day 29. After a median follow-up of 75 months (range, 1-269 mo), 2 patients had an uneventful long-term course, whereas 4 patients developed graft thrombosis after a median period of 120 days (range, 2-488 d). Among the 4 patients who developed graft thrombosis, 1 patient developed ischemic cholangitis, 1 developed acute ischemic hepatic necrosis and was retransplanted, and 2 patients did not develop any further complications. Despite a high rate of allograft thrombosis, rescue arterial revascularization using cryopreserved iliac artery allografts after liver transplant is an effective and readily available approach, with a limited risk of infection and satisfactory long-term graft and patient survival.

  2. Comparative Assessment of Quality of Life in Hemodialysis and Kidney Transplant Patients

    Directory of Open Access Journals (Sweden)

    A Abbaszadeh

    2010-12-01

    Full Text Available Introduction: Quality of life(QOL is a state of complete physical, mental, social and spiritual well-being and may be affected by sociodemographic variables, chronic illnesses, psychiatric and physical conditions. End stage renal diseases and treatments lead to many problems in patients including physical, mental and socioeconomic problems thus affecting their overall QOL. This study evaluated and compared QOL in hemodialysis and kidney transplant patients. Methods: In a descriptive analytic study, SF36 questionnaire was used to examine QOL in 120 patients (60 hemodialysis and 60 kidney transplant patients in Kerman. Results: The mean QOL score in hemodialysis patients was 49.83±17.56, while in kidney transplant patients, it was 60.95±16.60. Although difference between the two groups was significant (p≤o.o5, the difference in three dimensions pain, physical and social function was not significant (p≥0.05. In hemodialysis patients, minimum score was in vitality dimension and maximum score in physical function. In kidney transplant patients, minimum score was in general health and maximum score was in role limitation due to physical problem dimension. Conclusion: Although QOL in both groups is lower than public communities, kidney transplantation can improve QOL, especially in role restriction due to physical problems. Based on results, it seems that age, blood creatinine levels and personal perception are the most important factors affecting QOL of hemodialysis patients and only creatinine levels and personal perception can be modified. So, in this group of patients, by maintaining creatinine levels and assuring dialysis quality, QOL can be improved. On the other hand, recognition of patient’s defiance mechanisms can improve adaptation and life satisfaction.

  3. Taste and smell function in pediatric blood and marrow transplant patients.

    Science.gov (United States)

    Cohen, J; Laing, D G; Wilkes, F J

    2012-11-01

    The intensive conditioning regimens of a pediatric blood and marrow transplant (BMT) can limit voluntary intake leading to a risk of malnutrition. Poor dietary intake is likely multi-factorial with a change in taste and smell function potentially being one contributing factor limiting intake, though this is not well studied. This research aimed to assess the taste and smell function of a cohort of pediatric BMT patients. A total of ten pediatric BMT patients (8-15 years) were recruited to this study. Smell function was assessed using a three-choice 16-item odour identification test. Taste function was assessed using five concentrations of sweet, sour, salty and bitter tastants. All tests were completed at admission to transplant and monthly until taste and smell function had normalised. At the 1-month post-transplant assessment, one third of participants displayed some evidence of taste dysfunction and one third smell dysfunction, but there was no evidence of dysfunction in any patient at the 2-month assessment. Contrary to reports of long-term loss of taste and smell function in adults, dysfunction early in transplant was found to be transient and be resolved within 2 months post-transplant in children. Further research is required to determine the causes of poor dietary intake in this population.

  4. A Clinical Prediction Score to Guide Referral of Elderly Dialysis Patients for Kidney Transplant Evaluation.

    Science.gov (United States)

    Chen, Ling-Xin; Josephson, Michelle A; Hedeker, Donald; Campbell, Kellie Hunter; Stankus, Nicole; Saunders, Milda R

    2017-07-01

    Dialysis patients aged ≥70 years derive improved life expectancy through kidney transplantation compared to their waitlisted counterparts, but guidelines are not clear about how to identify appropriate transplantation candidates. We developed a clinical prediction score to identify elderly dialysis patients with expected 5-year survival appropriate for kidney transplantation (>5 years). Incident dialysis patients in 2006-2009 aged ≥70 were identified from the United States Renal Data System database and divided into derivation and validation cohorts. Using the derivation cohort, candidate variables with a significant crude association with 5-year all-cause mortality were included in a multivariable logistic regression model to generate a scoring system. The scoring system was tested in the validation cohort and a cohort of elderly transplant recipients. Characteristics most predictive of 5-year mortality included age >80, body mass index (BMI) white race, a primary cause of end stage renal disease (ESRD) other than diabetes, employment within 6 months of dialysis initiation, and dialysis start via arteriovenous fistula (AVF). 5-year mortality was 47% for the lowest risk score group (3.6% of the validation cohort) and >90% for the highest risk cohort (42% of the validation cohort). This clinical prediction score could be useful for physicians to identify potentially suitable candidates for kidney transplantation.

  5. Percutaneous laser ablation of hepatocellular carcinoma in patients with liver cirrhosis awaiting liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Pompili, Maurizio, E-mail: mpompili@rm.unicatt.i [Department of Internal Medicine, Universita Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma (Italy); Pacella, Claudio Maurizio, E-mail: claudiomauriziopacella@gmail.co [Department of Diagnostic Imaging and Interventional Radiology, Ospedale Regina Apostolorum, Via S. Francesco D' Assisi, 50, 00041 Albano Laziale (RM) (Italy); Francica, Giampiero, E-mail: giampierofrancica@tin.i [Department of Interventional Ultrasound, Presidio Ospedaliero Camilliani, S. Maria della Pieta, Via S. Rocco, 9, 80026 Casoria (Namibia) (Italy); Angelico, Mario, E-mail: angelico@med.uniroma2.i [Hepatology Unit, Universita di Tor Vergata, Viale Oxford, 81, 00133 Rome (Italy); Tisone, Giuseppe, E-mail: tisone@med.uniroma2.i [Transplant and General Surgery Unit, Universita di Tor Vergata, Ospedale S. Eugenio, Piazzale dell' Umanesimo 10-00144 Rome (Italy); Craboledda, Paolo, E-mail: paolo.craboledda@virgilio.i [Department of Pathology, Ospedale S. Eugenio, Piazzale dell' Umanesimo, 10-00144 Rome (Italy); Nicolardi, Erica; Rapaccini, Gian Ludovico; Gasbarrini, Giovanni [Department of Internal Medicine, Universita Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma (Italy)

    2010-06-15

    Objective: The aim of this study was to determine the effectiveness and safety of percutaneous laser ablation for the treatment of cirrhotic patients with hepatocellular carcinoma awaiting liver transplantation. Materials and methods: The data of 9 male cirrhotic patients (mean age 50 years, range 45-60 years) with 12 biopsy proven nodules of hepatocellular carcinoma (mean diameter 2.0 cm, range 1.0-3.0 cm) treated by laser ablation before liver transplantation between June 2000 and January 2006 were retrospectively reviewed. Laser ablation was carried out by inserting 300 nm optical fibers through 21-Gauge needles (from two to four) positioned under ultrasound guidance into the target lesions. A continuous wave Neodymium:Yttrium Aluminium Garnet laser was used. Transarterial chemoembolization prior to liver transplantation was performed in two incompletely ablated tumors. Results: No procedure-related major complications were recorded. During the waiting time to liver transplantation local tumor progression after ablation occurred in 3 nodules (25%). At histological examination of the explanted livers complete necrosis was found in 8 nodules (66.7%, all treated exclusively with laser ablation), partial necrosis >50% in 3 nodules (25%), and partial necrosis <50% in 1 nodule. Conclusion: In patients with cirrhotic livers awaiting liver transplantation, percutaneous laser ablation is safe and effective for the management of small hepatocellular carcinoma.

  6. Transjugular intrahepatic portosystemic shunt for chylous ascites in a patient with recurrent cirrhosis following liver transplantation

    Directory of Open Access Journals (Sweden)

    Jason T. Salsamendi, MD

    2017-03-01

    Full Text Available Chylous ascites (CA is the extravasation of lipid-rich lymphatic fluid into the peritoneal space following trauma or obstruction of the lymphatic system. Refractory cases of cirrhosis-related CA may be amendable to transjugular intrahepatic portosystemic shunting (TIPS. We present a case of TIPS in the setting of refractory CA secondary to cirrhosis of a transplanted liver graft. Following TIPS, the patient reported immediate improvement in abdominal pain and no longer requires paracentesis. Our case suggests TIPS to be a safe and effective treatment option for CA in liver transplant patients with cirrhosis.

  7. Refractory Clostridium difficile Infection Cured With Fecal Microbiota Transplantation in Vancomycin-Resistant Enterococcus Colonized Patient

    Science.gov (United States)

    Jang, Mi-Ok; An, Jun Hwan; Jung, Sook-In

    2015-01-01

    The rates and severity of Clostridium difficile infections, including pseudomembranous colitis, have increased markedly. However, there are few effective treatments for refractory or recurrent C. difficile infections and the outcomes are poor. Fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. Cure rates of >90% are being consistently reported from multiple centers. We cured a case of severe refractory C. difficile infection with fecal microbiota transplantation in a patient colonized by vancomycin-resistant enterococcus. PMID:25691847

  8. Allogeneic stem cell transplantation for patients harboring T315I BCR-ABL mutated leukemias

    DEFF Research Database (Denmark)

    Nicolini, Franck Emmanuel; Basak, Grzegorz W; Soverini, Simona

    2011-01-01

    T315I(+) Philadelphia chromosome-positive leukemias are inherently resistant to all licensed tyrosine kinase inhibitors, and therapeutic options remain limited. We report the outcome of allogeneic stem cell transplantation in 64 patients with documented BCR-ABL(T315I) mutations. Median follow......) as unfavorable factors. We conclude that allogeneic stem cell transplantation represents a valuable therapeutic tool for eligible patients with BCR-ABL(T315I) mutation, a tool that may or may not be replaced by third-generation tyrosine kinase inhibitors....

  9. Diffuse hemorrhagic colitis in a patient with dyskeratosis congenita after nonmyeloablative allogeneic hematopoietic stem cell transplantation.

    Science.gov (United States)

    Ehlert, Karoline; Rossig, Claudia; Groll, Andreas H; Beyna, Torsten; Froehlich, Birgit; Juergens, Heribert

    2015-01-01

    Dyskeratosis congenita (DC) is a rare inherited disorder characterized by reticular skin pigmentation, oral cavity leukoplakia, and nail dystrophy. Bone marrow failure in DC can only be cured by allogeneic hematopoietic stem cell transplantation (HSCT). After a nonmyeloablative, matched unrelated donor transplant, the 21-year-old patient experienced severe lower gastrointestinal tract hemorrhage caused by diffuse colitis. The etiology remained unclear. Diffuse colitis with life-threatening hemorrhage has now been reported in 3 DC patients after unrelated allogeneic HSCT. To identify the underlying causes and the disease-specific risks, and to allow for prevention and/or optimal management, data should be prospectively collected.

  10. Differences in Phenotypes and Liver Transplantation Outcomes by Age Group in Patients with Primary Sclerosing Cholangitis.

    Science.gov (United States)

    Henson, Jacqueline B; Patel, Yuval A; Wilder, Julius M; Zheng, Jiayin; Chow, Shein-Chung; King, Lindsay Y; Muir, Andrew J

    2017-11-01

    There is increasing evidence for a heterogeneity of phenotypes in primary sclerosing cholangitis (PSC), but differences across the age spectrum in adults with PSC have not been well characterized. To characterize phenotypic variations and liver transplantation outcomes by age group in adults with PSC. The United Network for Organ Sharing database was used to identify waitlist registrations for primary liver transplantation in adults with PSC. Patients were split into three age groups: 18-39 (young), 40-59 (middle-aged), and ≥60 (older). Their clinical characteristics and outcomes on the waitlist and post-transplant were compared. Overall, 8272 adults with PSC were listed for liver transplantation during the study period, of which 28.9% were young, 52.0% were middle-aged, and 19.1% were older. The young age group had the greatest male predominance (70.0 vs. 66.2 vs. 65.1%, p = 0.001), the highest proportion of black individuals (20.0 vs. 11.0 vs. 5.5%, p < 0.001), and the most patients listed with concomitant autoimmune hepatitis (2.2 vs. 1.0 vs. 0.8%, p < 0.001). Older patients experienced the greatest waitlist and post-transplant mortality. Graft survival was greatest in the middle-aged group. Young patients were most likely to experience acute rejection (31 vs. 22.8 vs. 18.0%, p < 0.001) and have graft failure due to chronic rejection or PSC recurrence (47.8 vs. 42.3 vs. 17.9%, p < 0.001). Age-related differences exist among adults with PSC and are associated with outcomes pre- and post-transplant. Young patients may have a more robust immune-related phenotype that is associated with poorer graft survival. Future studies are needed to further investigate these findings.

  11. Outcomes of renal transplantation in patients with immunoglobulin A nephropathy in India

    Directory of Open Access Journals (Sweden)

    Chacko B

    2007-01-01

    Full Text Available Background: There is a paucity of data on the course of renal transplant in patients with immunoglobulin A (IgA nephropathy (IgAN from India. While the natural history of IgAN in the Indian context is rapidly progressive, the post-transplant course remains speculative. Aim: To study the graft survival in renal transplant recipients whose native kidney disease was IgAN and the incidence and correlates of recurrent disease. Settings and Designs: Retrospective case control study from a Nephrology unit of a large tertiary care center. Materials and Methods: The outcomes of 56 transplant patients (58 grafts with biopsy-proven IgAN and of 116 patients without IgAN or diabetic nephropathy, transplanted during the same period were analyzed. Correlates of biopsy-confirmed recurrent disease were determined. Statistical Analysis: Means were analyzed by Student′s t test and Mann-Whitney test; proportions were determined by Chi-square analysis and graft survival curves were generated using the Kaplan-Meier. Results: Five-year graft survival for IgA patients was not significantly different from that in the reference group (90% and 79%, P = 0.6. During a mean follow-up of 42 months (range, 1-144, 28 event graft biopsies were required in 20 grafts of IgAN. Histological recurrence was diagnosed in five of the 20 available biopsies (25% after a mean duration of 28 months. Recurrence did not correlate with donor status, HLA B35 and A2, recipient age, gender or immunosuppression. Conclusions: Renal transplantation is an appropriate treatment modality for IgA nephropathy patients with end-stage renal disease in India, despite the potential for recurrent disease. The posttransplant course is an indolent one when compared to the malignant pretransplant phase.

  12. Report of the National Heart, Lung, and Blood Institute Working Group: An Integrated Network for Congenital Heart Disease Research.

    Science.gov (United States)

    Pasquali, Sara K; Jacobs, Jeffrey P; Farber, Gregory K; Bertoch, David; Blume, Elizabeth D; Burns, Kristin M; Campbell, Robert; Chang, Anthony C; Chung, Wendy K; Riehle-Colarusso, Tiffany; Curtis, Lesley H; Forrest, Christopher B; Gaynor, William J; Gaies, Michael G; Go, Alan S; Henchey, Paul; Martin, Gerard R; Pearson, Gail; Pemberton, Victoria L; Schwartz, Steven M; Vincent, Robert; Kaltman, Jonathan R

    2016-04-05

    The National Heart, Lung, and Blood Institute convened a working group in January 2015 to explore issues related to an integrated data network for congenital heart disease research. The overall goal was to develop a common vision for how the rapidly increasing volumes of data captured across numerous sources can be managed, integrated, and analyzed to improve care and outcomes. This report summarizes the current landscape of congenital heart disease data, data integration methodologies used across other fields, key considerations for data integration models in congenital heart disease, and the short- and long-term vision and recommendations made by the working group. © 2016 American Heart Association, Inc.

  13. Report of the National Heart, Lung, and Blood Institute Working Group: An Integrated Network for Congenital Heart Disease Research

    Science.gov (United States)

    Pasquali, Sara K.; Jacobs, Jeffrey P.; Farber, Gregory K.; Bertoch, David; Blume, Elizabeth D.; Burns, Kristin M.; Campbell, Robert; Chang, Anthony C.; Chung, Wendy K.; Riehle-Colarusso, Tiffany; Curtis, Lesley H.; Forrest, Christopher B.; Gaynor, William J.; Gaies, Michael G.; Go, Alan S.; Henchey, Paul; Martin, Gerard R.; Pearson, Gail; Pemberton, Victoria L.; Schwartz, Steven M.; Vincent, Robert; Kaltman, Jonathan R.

    2016-01-01

    The National Heart, Lung, and Blood Institute convened a Working Group in January 2015 to explore issues related to an integrated data network for congenital heart disease (CHD) research. The overall goal was to develop a common vision for how the rapidly increasing volumes of data captured across numerous sources can be managed, integrated, and analyzed to improve care and outcomes. This report summarizes the current landscape of CHD data, data integration methodologies used across other fields, key considerations for data integration models in CHD, and the short- and long-term vision and recommendations made by the Working Group. PMID:27045129

  14. Fluoride excess and periostitis in transplant patients receiving long-term voriconazole therapy.

    Science.gov (United States)

    Wermers, Robert A; Cooper, Kay; Razonable, Raymund R; Deziel, Paul J; Whitford, Gary M; Kremers, Walter K; Moyer, Thomas P

    2011-03-01

    We describe a heart transplant patient with painful periostitis and exostoses who was receiving long-term therapy with voriconazole, which is a fluoride-containing medication. Elevated plasma and bone fluoride levels were identified. Discontinuation of voriconazole therapy led to improvement in pain and reduced fluoride and alkaline phosphatase levels. To determine whether voriconazole is a cause of fluoride excess, we measured plasma fluoride levels in 10 adult post-transplant patients who had received voriconazole for at least 6 months and 10 post-transplant patients who did not receive voriconazole. To assess the effect of renal insufficiency on fluoride levels in subjects receiving voriconazole, half were recruited on the basis of a serum creatinine level of ≥1.4 mg/dL on their most recent measurement, whereas the other 5 subjects receiving voriconazole had serum creatinine levels periostitis, including exostoses in 2 patients. Discontinuation of voriconazole therapy in patients with periostitis resulted in improvement of pain and a reduction in alkaline phosphatase and fluoride levels. Voriconazole is associated with painful periostitis, exostoses, and fluoride excess in post-transplant patients with long-term voriconazole use.

  15. [Effects of intracoronary autologous bone marrow mononuclear cells transplantation in patients with anterior myocardial infarction].

    Science.gov (United States)

    Wang, Wei-min; Sun, Ning-ling; Liu, Jian; Zhang, Ping; Liu, Kai-yan; Wang, Qian; Yang, Song-na; Wang, Su-qin; Zang, Yue; Guo, Ji-hong

    2006-02-01

    To investigate the efficacy of intracoronary transfer of autologous bone marrow mononuclear cells (ABMMNCs) to patients with myocardial infarction (MI) on left ventricular function and myocardial perfusion. Thirty-five patients with MI (> 4 weeks) were enrolled in this prospective, open-labeled study (20 patients in cell transplantation group; 15 patients in control group). All patients were treated by standard drug therapy and percutaneous coronary intervention (PCI). Baseline and 3 months follow-up evaluations included complete clinical and laboratory examinations, six minutes walk test, echocardiography, Dual-isotope simultaneous acquisition single photon emission computed tomography (DISA-SPECT) and cardiac magnetic resonance imaging (MRI). Baseline parameters were similar between the two groups. NYHA classification and six minutes walk test at 3 months follow-up were also similar between the two groups. However, left ventricular ejection fraction (LVEF) determined by echocardiography and DISA-SPECT was significantly higher; regional wall motion measured by echocardiography and cardiac MRI, myocardial viability and myocardial perfusion in the infarct zone assessed by DISA-SPECT were all significantly improved than before transplantation and than that in control group at 3 months follow-up. Our results indicate that intracoronary transplantation of ABMMNCs could improve the left ventricular systolic function and beneficially affect myocardial perfusion up to 3 months post transplantation in patients with myocardial infarction.

  16. Parathyroidectomy is Underutilized in Patients with Tertiary Hyperparathyroidism after Renal Transplantation

    Science.gov (United States)

    Lou, Irene; Schneider, David F; Leverson, Glen; Foley, David; Sippel, Rebecca; Chen, Herbert

    2015-01-01

    Background Parathyroidectomy is the only curative treatment for tertiary hyperparathyroidism (3HPT). With the introduction of calcimimetics (cinacalcet), parathyroidectomy can sometimes be delayed or avoided. The purpose of this study was to determine the current incidence of utilization of parathyroidectomy in patients with post-transplant 3HPT with the advent of cinacalcet. Method We evaluated renal transplant patients between 1/1/2004-6/30/2012 with a minimum of 24 months follow-up who had persistent allograft function. Patients with an increased serum level of parathyroid hormone (PTH) one year after successful renal transplantation with normocalcemia or hypercalcemia were defined as having 3HPT. A multivariate logistic regression model was constructed to determine factors associated with undergoing parathyroidectomy. Results We identified 618 patients with 3HPT, only 41 (6.6%) of whom underwent parathyroidectomy. Patients with higher levels of serum calcium (p<0.001) and PTH (p=0.002) post-transplant were more likely to be referred for parathyroidectomy. Importantly, those who underwent parathyroidectomy had serum calcium and PTH values distributed more closely to the normal range on most recent follow-up. Parathyroidectomy was not associated with rejection (p=0.400) or with worsened allograft function (p=0.163). Conclusion Parathyroidectomy appears to be underutilized in patients with 3HPT at our institution. Parathyroidectomy is associated with high cure rates, improved serum calcium and PTH levels, and is not associated with rejection. PMID:26603850

  17. Infection by Cryptosporidium parvum in renal patients submitted to renal transplant or hemodialysis

    Directory of Open Access Journals (Sweden)

    Chieffi Pedro Paulo

    1998-01-01

    Full Text Available The frequency of infection by Cryptosporidium parvum was determined in two groups of renal patients submitted to immunosuppression. One group consisted of 23 renal transplanted individuals, and the other consisted of 32 patients with chronic renal insufficiency, periodically submitted to hemodialysis. A third group of 27 patients with systemic arterial hypertension, not immunosuppressed, was used as control. During a period of 18 months all the patients were submitted to faecal examination to detect C. parvum oocysts, for a total of 1 to 6 tests per patient. The results showed frequencies of C. parvum infection of 34.8%, 25% and 17.4%, respectively, for the renal transplanted group, the patients submitted to hemodialysis and the control group. Statistical analysis showed no significant differences among the three groups even though the frequency of C. parvum infection was higher in the transplanted group. However, when the number of fecal samples containing C. parvum oocysts was taken in account, a significantly higher frequency was found in the renal transplanted group.

  18. Leptin Level in Patients with Type 2 Diabetes Mellitus after Fetal Pancreatic Stem Cell Transplant.

    Science.gov (United States)

    Ulyanova, Olga; Taubaldieva, Zhannat; Tuganbekova, Saltanat; Saparbayev, Samat; Kim, Natalya; Trimova, Rakhat; Kozina, Larissa; Shaimardanova, Galiya

    2016-11-01

    We aimed to determine leptin level in patients with type 2 diabetes mellitus after fetal pancreatic stem cell transplant. We examined 14 patients (aged 43-63 years old) with type 2 diabetes mellitus, which we subsequently divided into 2 groups and examined. Group 1 comprised 8 patients who received fetal pancreatic stem cell transplant (cells were 16-18 wk gestation) performed by intravenous infusion; group 2 comprised 6 patients in the control group who were on hypoglycemic tablet therapy or insulin therapy. The quantity of fetal stem cells infused was 5 to 6 × 106. We analyzed leptin and C-peptide levels in patients both before and 3 months after the fetal pancreatic stem cell transplant procedure. In patients with type 2 diabetes mellitus, fetal pancreatic stem cell transplant led to a significant increase in leptin levels, from 11.01 ng/mL to 16.29 ng/mL, after 3 months (P type 2 diabetes mellitus.

  19. Chronic renal disease in renal transplant patients: management of cardiovascular risk factors.

    Science.gov (United States)

    Fernández-Fresnedo, G; Gómez-Alamillo, C; Ruiz, J C; de Francisco, A L M; Arias, M

    2009-06-01

    Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Despite improvements in short-term patient and graft outcomes, there has been no major improvement in long-term outcomes. The aim of this study was to determine the prevalence of cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes, chronic kidney disease, and obesity, and the impact of their control among 526 stable renal transplant recipients according to the guidelines in the general population. Mean blood pressure was 133 +/- 16/81 +/- 9 mm Hg. The proportion of patients on antihypertensive therapy was 75%, and on ACE inhibitors or angiotensin II receptor blockers, 26%. The mean cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides were 195 +/- 41, 115 +/- 32, 51 +/- 17, and 137 +/- 75 mg/dL, respectively. The proportion of patients on statin treatment was 49.7%, and those with body mass indices between 25 and 30, 30 and 35, and >35 kg/m(2) were 35%, 15%, and 4%. We observed a high prevalence of chronic kidney disease, hypertension, dyslipidemia, and obesity among renal transplant patients. Suboptimal control was frequent and control of some of these complications was far below targets established for nontransplant patients despite progressive intensification of therapy with functional graft decline. The findings of this study may have an impact on the management of renal transplant recipients.

  20. Dengue fever in a liver-transplanted patient: a case report.

    Science.gov (United States)

    Weerakkody, Ranga Migara; Palangasinghe, Dhammika Randula; Dalpatadu, Kaluthanthri Patabandi Chamila; Rankothkumbura, Jeewan Pradeep; Cassim, Mohammed Rezni Nizam; Karunanayake, Panduka

    2014-11-21

    Dengue fever is one of the commonest mosquito-borne diseases in the tropics, and Sri Lanka is no exception. Despite its commonness, dengue fever has rarely been described among patients who have undergone transplantation. We report the case of a patient with dengue fever after liver transplantation, which, to the best of our knowledge, is the first such reported case outside Brazil. Our patient was a 46-year-old Sri Lakan man who presented to our institution two years after undergoing an ABO-compatible cadaveric liver transplant. At presentation, he had typical symptoms of dengue fever. He was taking prednisolone 5mg daily and tacrolimus 3mg twice daily as immunosuppression. Initial investigations showed thrombocytopenia and neutropenia that reached a nadir by day 7 of his illness. He had elevated liver enzymes as well. The diagnosis was confirmed on the basis of NS1 antigen detection by enzyme-linked immunosorbent assay. His blood cultures and polymerase chain reaction tests for cytomegalovirus were negative. He made an uneventful recovery and was discharged by day 9 of his illness. However, normalization of liver function took nearly two weeks. In three previously reported Brazilian cases of dengue after liver transplantation, the patients presented with dengue shock syndrome, in contrast to the relatively milder presentation of our patient. Because of the lack of case reports in the literature, it is difficult to ascertain the risk factors for severe dengue infection in transplants, but dengue fever reported in renal transplants sheds some light on them. High-dose steroids increase the risk of thrombocytopenia, whereas tacrolimus has been reported to prolong the duration of symptoms. Otherwise, dengue fever is a relatively mild illness in patients who have undergone renal transplantation, and renal allograft survival has been reported to be 86% following dengue fever. Dengue is a rarely reported infection in patients who have undergone transplantation. A high

  1. Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Mathilde Lassalle

    Full Text Available Obesity has been linked to poor access to medical care. Although scientific evidence suggest that kidney transplantation improves survival and quality of life in obese patients with end-stage renal disease (ESRD, few data exist on the impact of obesity on access to kidney transplantation in this population.We aimed to characterize the relationships between body mass index (BMI at the start of dialysis, changes in BMI after the start of dialysis, and either access to kidney transplantation or overall mortality in dialysis or transplantation among ESRD patients.Between 2002 and 2011, 19524 dialysis patients with ESRD were included in the study via the French nationwide Renal Epidemiology and Information Network. Data on sociodemographic factors, comorbidities and laboratory test results were recorded upon entry into the registry. BMI were obtained at the start of dialysis and then yearly. Cubic spline regression analyses provided a graphic evaluation of the relationships between BMI at the start of dialysis and outcomes. Joint models were used to evaluate the association between the change over time in BMI and outcomes.During a median follow-up of 20.3 months, 6634 patients underwent kidney transplantation. A BMI >31 kg/m2 at the start of the dialysis was associated with a lower likelihood of receiving a kidney transplant, and the likelihood decreased even further with higher BMI values. For patients with BMI ≥30kg/m2 at the start of the dialysis, a 1 kg/m2 decrease in BMI during follow-up was associated with a 9% to 11% increase in the likelihood of receiving a transplant. There was an L-shaped relationship between BMI at the start of dialysis and overall mortality. We showed that obese patients with ESRD face barriers to the receipt of a kidney transplant without valid reasons.Greater attention to this issue would improve the fairness of the organ allocation process and might improve outcomes for obese patients with ESRD.

  2. Fulminant hepatitis B virus : recurrence after liver transplantation in two patients also infected with hepatitis delta virus

    NARCIS (Netherlands)

    Marsman, W A; Wiesner, R H; Batts, K P; Poterucha, J J; Porayko, M K; Niesters, H G; Zondervan, P E; Krom, R A

    Liver transplantation for hepatitis B virus (HBV)-related liver disease is complicated by HBV recurrence and, consequently, poor patient and graft survival. Patients transplanted for hepatitis delta virus (HDV)-related cirrhosis are reported to have a diminished incidence of HBV recurrence and

  3. Heart and combined heart-kidney transplantation in patients with concomitant renal insufficiency and end-stage heart failure.

    Science.gov (United States)

    Schaffer, J M; Chiu, P; Singh, S K; Oyer, P E; Reitz, B A; Mallidi, H R

    2014-02-01

    In patients with end-stage heart failure (ESHF) who are candidates for isolated heart transplant (HRT), dialysis dependence (DD) is considered an indication for combined heart-kidney transplantation (HKT). HKT remains controversial in ESHF transplant candidates with nondialysis-dependent renal insufficiency (NDDRI). Using United Network for Organ Sharing data, we examined the cumulative incidences of transplant and mortality in patients with DD and NDDRI waitlisted for HKT or HRT. In all groups, 3-month waitlist mortality was dismal: 31% and 21% for HRT- and HKT-listed patients with DD and 12% and 7% for HRT- and HKT-listed patients with NDDRI. Five-year posttransplant survival was improved in HKT recipients compared with HRT recipients for both patients with DD (73% vs. 51%, pkidney transplant in patients who do not recover renal function after HRT), as opposed to HKT, maximizes organ benefit for patients with NDDRI and ESHF requires assessment. Nevertheless, given their dismal waitlist outcomes and excellent posttransplant results, we suggest that patients with DD and NDDRI with ESHF be considered for early listing and transplant. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

  4. Genogrouping and incidence of virulence factors of Enterococcus faecalis in liver transplant patients differ from blood culture and fecal isolates

    NARCIS (Netherlands)

    Waar, K; Muscholl-Silberhorn, AB; Slooff, MJH; Harmsen, HJM; Degener, JE; Willems, Rob J. L.

    2002-01-01

    Enterococcus faecalis is a leading cause of infections in liver transplant patients. This study reviewed the incidence of virulence factors such as hemolysin, gelatinase, aggregation substances (asa1 and asa373), or the enterococcal surface protein (Esp) in isolates from liver transplant patients.

  5. Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies

    DEFF Research Database (Denmark)

    Sorror, Mohamed L; Sandmaier, Brenda M; Storer, Barry E

    2011-01-01

    A minimally toxic nonmyeloablative regimen was developed for allogeneic hematopoietic cell transplantation (HCT) to treat patients with advanced hematologic malignancies who are older or have comorbid conditions.......A minimally toxic nonmyeloablative regimen was developed for allogeneic hematopoietic cell transplantation (HCT) to treat patients with advanced hematologic malignancies who are older or have comorbid conditions....

  6. Atypical Presentation of Herpes Zoster Duplex Bilateralis in a Renal Transplanted Patient

    Directory of Open Access Journals (Sweden)

    Ana Isabel Gouveia

    2013-12-01

    Full Text Available Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have uncommon presentations, and require a high index of suspicion and additional diagnostic testing for proper management. We report a rare presentation of herpes zoster duplex bilateralis involving symmetrical dermatomes over the lower limbs occurring in a woman with a recent history of renal transplantation. The skin lesions were also atypical representing a diagnostic challenge. This infection should be part of differential diagnosis of cutaneous manifestations in organ transplant recipients.

  7. Restricting kidney transplant wait-listing for obese patients: let's stop defending the indefensible.

    Science.gov (United States)

    Kovesdy, Csaba P; Molnar, Miklos Z

    2014-01-01

    The allocation of limited medical resources represents an ethical dilemma that continues to generate lively debates. While the allocation of allografts to wait-listed patients is done in a transparent manner, with its rules open to public debate and prone to continuous improvement, the practice of wait-listing is not centrally regulated, and its rules are often less scrutinized. Denial of kidney transplant wait-listing to obese individuals has been a common practice by most transplant centers. On the face of it, this practice is justified by commonly accepted ethical standards, yet there is now mounting evidence that these justifications do not withstand closer scrutiny. A candid and open debate in the Nephrology and Transplant community is needed to examine the true motivations that underlie the practice of denying wait-listing to obese individuals, and to find a solution that is truly in the best interest of our patients. © 2014 Wiley Periodicals, Inc.

  8. Bloodstream infection after umbilical cord blood transplantation using reduced-intensity stem cell transplantation for adult patients.

    Science.gov (United States)

    Narimatsu, Hiroto; Matsumura, Tomoko; Kami, Masahiro; Miyakoshi, Shigesaburo; Kusumi, Eiji; Takagi, Shinsuke; Miura, Yuji; Kato, Daisuke; Inokuchi, Chiho; Myojo, Tomohiro; Kishi, Yukiko; Murashige, Naoko; Yuji, Koichiro; Masuoka, Kazuhiro; Yoneyama, Akiko; Wake, Atsushi; Morinaga, Shinichi; Kanda, Yoshinobu; Taniguchi, Shuichi

    2005-06-01

    Bloodstream infection (BSI) is a significant problem after cord blood transplantation (CBT). However, little information has been reported on BSI after reduced-intensity CBT (RI-CBT). We retrospectively reviewed the medical records of 102 patients. The median age of the patients was 55 years (range, 17-79 years). Preparative regimens comprised fludarabine 125 to 150 mg/m 2 , melphalan 80 to 140 mg/m 2 , or busulfan 8 mg/kg and total body irradiation 2 to 8 Gy. Prophylaxis against graft-versus-host disease comprised cyclosporin or tacrolimus. BSI developed within 100 days of RI-CBT in 32 patients. The cumulative incidence of BSI was 25% at day 30 and 32% at day 100. The median onset was day 15 (range, 1-98 days). Causative organisms included Pseudomonas aeruginosa (n = 12), Staphylococcus epidermidis (n = 11), Staphylococcus aureus (n = 6), Enterococcus faecium (n = 4), Enterococcus faecalis (n = 4), Stenotrophomonas maltophilia (n = 4), and others (n = 7). Of the 32 patients with BSI, 25 (84%) died within 100 days after RI-CBT. BSI was the direct cause of death in 8 patients (25%). Univariate analysis failed to identify any significant risk factors. BSI clearly represents a significant and fatal complication after RI-CBT. Further studies are warranted to determine clinical characteristics, identify patients at high risk of BSI, and establish therapeutic strategies.

  9. Accuracy and Trending of Continuous Noninvasive Hemoglobin Monitoring in Patients Undergoing Liver Transplantation.

    Science.gov (United States)

    Huang, P H; Shih, B F; Tsai, Y-F; Chung, P C H; Liu, F C; Yu, H P; Lee, W C; Chang, C J; Lin, C C

    2016-05-01

    Shift in large fluid volumes and massive blood loss during liver transplantation frequently leads to rapid changes in hemoglobin (Hb) concentration; thus, to ensure adequate tissue oxygenation, accurate and rapid determination of Hb concentration is essential in transplant recipients. The Radical-7 Pulse CO-Oximeter provides a noninvasive and continuous way to monitor Hb concentration (SpHb) in real time and is an ideal candidate for use during liver transplantation. In this study, we assessed the relationship between SpHb and total Hb (tHb) obtained from arterial blood samples during surgery. Forty patients undergoing liver transplantation were enrolled in this study. tHb and time-matched SpHb were measured at 5 different phases throughout surgery. Paired SpHb and tHb levels were assessed using linear regression, Bland-Altman analysis, and the Critchley polar plot method. A total of 161 paired measurements with sufficient signal quality were analyzed. The correlation between SpHb and tHb was 0.59 (P liver transplantation surgery in our cohort. In particular, in critical patients and in those with low Hb levels, invasive Hb measurement should be used for assessment. Copyright © 2016. Published by Elsevier Inc.

  10. Ischemic heart disease after renal transplantation in patients on cyclosporine in Spain.

    Science.gov (United States)

    Marcén, Roberto; Morales, José María; Arias, Manuel; Fernández-Juárez, Gema; Fernández-Fresnedo, Gema; Andrés, Amado; Rodrigo, Emilio; Pascual, Julio; Domínguez, Beatriz; Ortuño, Joaquín

    2006-12-01

    Ischemic heart disease (IHD), more common among transplant recipients than in the general population, accounts for approximately 50% of cardiovascular deaths. Despite its importance, only a few publications have addressed the prevalence of and risk factors for this complication. This was a retrospective cohort study in 2382 cadaver renal transplant recipients who were treated with cyclosporine as initial immunosuppression. Two groups were formed. The first group consisted of 163 patients with IHD, and the second group consisted of 326 patients without IHD. The prevalence of IHD was 6.8%, and the incidence was 15.7/1000 patient-years. Cardiac events presented during the first year in 62 (38%) patients. Multivariate analysis showed that the risk factors for IHD were age at transplant in years (relative risk [RR] 1.054; 95% confidence interval [CI] 1.033 to 1.075; P = 0.000), male gender (RR 1.940; 95% CI 1.221 to 3.081; P = 0.005), body weight at transplant in kg (RR 1.020; 95% CI 1.007 to 1.033; P = 0.002), pretransplantation cardiovascular disease (RR 2.150; 95% CI 1.733 to 3.359; P = 0.001), and a history of pretransplantation hypercholesterolemia (RR 2.032; 95% CI 1.378 to 2.998; P = 0.000). When only ischemic events that occurred 12 mo after transplantation were taken into consideration, the risk factors were age, male gender, body weight, smoking, and pretransplantation and posttransplantation hypercholesterolemia, whereas pretransplantation cardiovascular disease disappeared from the model. IHD affected nearly 7% of transplant recipients. Smoking, hypertension, and hypercholesterolemia constituted the treatable risk factors for IHD in this population. Emphasis should be placed on the need to stop smoking and to control hypertension and pre- and posttransplantation levels of serum cholesterol.

  11. CMV infections in bone marrow transplanted patients--evaluation of prophylaxis with Cytotect (CMV hyperimmuneglobulin).

    Science.gov (United States)

    Zintl, F; Färber, I; Hermann, J; Fuchs, D; Prager, J; Wutzler, P

    1989-01-01

    Cytomegalovirus (CMV) infection is a frequent and clinically important infection following bone marrow transplantation. Candidates for this study were patients admitted for transplantation: 22 patients received bone marrow from a HLA-identical, MCR-nonreactive sibling, in 9 patients an autologous BMT was performed. The anti-CMV IgG (Cytotect) was administered at a dosage of 1 ml/kg on days -7, 13, 33, 53, 73 and 93 after BMT. 5 patients in the very beginning of our BMT program did not receive Cytotect. Patients were given random blood products from the bloodbank not tested for CMV positivity. Active CMV infection or seroconversion in our patients was defined as a rise in IgG titer against the late antigen of fourfold or more or an IgM increase. In the allogeneic BMT group the pretransplant serological status was in 6 cases negative in recipients and donor, in 7 patients positive in recipients and negative in donors, and in 4 patients positive in recipients and donors. Of the 6 patients seronegative in recipients and donors, 3 developed active infection and of the 7 patients pretransplant positive with seronegative donors 3 developed active infection and 4 latent infections during the period from 2 to 100 days following grafting. 1 patient out of the group transplanted in third partial remission of AML developed interstitial pneumonia and died on day +30.4 of the 4 cases with seropositivity of recipients and donors developed active CMV infection. Of 9 patients with autologous transplantation 6 patients were pretransplant seropositive. 3 of these 6 developed active infection and 2 latent infection 30 to 180 days after grafting.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. High-resolution CT findings of pulmonary tuberculosis in liver transplant patients.

    Science.gov (United States)

    Schuhmacher Neto, R; Giacomelli, I L; Schuller Nin, C; da Silva Moreira, J; Comaru Pasqualotto, A; Marchiori, E; Loureiro Irion, K; Hochhegger, B

    2017-10-01

    To assess the high-resolution computed tomography (HRCT) findings in liver transplant patients diagnosed with pulmonary Mycobacterium tuberculosis infection. The HRCT findings from 19 patients diagnosed with pulmonary tuberculosis infection after liver transplantation were reviewed. The patients included were 12 men and seven women, age range 23-65 years; mean age 57 years. The diagnosis was established with Mycobacterium tuberculosis detection in bronchoalveolar lavage, sputum, or biopsy. HRCT images were reviewed independently by two observers who reached a consensus decision. The HRCT findings were classified as (1) miliary nodules; (2) cavitation and centrilobular tree-in-bud nodules; (3) ground-glass attenuation and consolidation; and (4) mediastinal lymph node enlargement. The time between the transplantation and the diagnosis of pulmonary tuberculosis ranged from 7 to 153 days with an average of 79 days. The main HRCT pattern was cavitation and centrilobular tree-in-bud nodules (79%) followed by mediastinal lymph node enlargement (10.4%), ground-glass attenuation or consolidation (5.2%) and miliary nodules (5.2%). None of the patients presented pleural effusion. The cavitation and centrilobular tree-in-bud nodules pattern had upper lobe predominance, and ground-glass attenuation and consolidation pattern had middle lobe/lingular segment predominance. The main HRCT pattern of pulmonary tuberculosis in liver transplant patients was cavitation and centrilobular tree-in-bud nodules. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  13. Jejunal varices diagnosed by capsule endoscopy in patients with post-liver transplant portal hypertension.

    Science.gov (United States)

    Bass, Lee M; Kim, Stanley; Superina, Riccardo; Mohammad, Saeed

    2017-02-01

    Portal hypertension secondary to portal vein obstruction following liver transplant occurs in 5%-10% of children. Jejunal varices are uncommon in this group. We present a case series of children with significant GI blood loss, negative upper endoscopy, and jejunal varices detected by CE. Case series of patients who had CE for chronic GI blood loss following liver transplantation. Three patients who had their initial transplants at a median age of 7 months were identified at our institution presenting at a median age of 8 years (range 7-16 years) with a median Hgb of 2.8 g/dL (range 1.8-6.8 g/dL). Upper endoscopy was negative for significant esophageal varices, gastric varices, and bleeding portal gastropathy in all three children. All three patients had significant jejunal varices noted on CE in mid-jejunum. Jejunal varices were described as large prominent bluish vessels underneath visualized mucosa, one with evidence of recent bleeding. The results led to venoplasty of the portal vein in two patients and a decompressive shunt in one patient with resolution of GI bleed and anemia. CE is useful to diagnose intestinal varices in children with portal hypertension and GI bleeding following liver transplant. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Integrity of the Oral Tissues in Patients with Solid-Organ Transplants

    Directory of Open Access Journals (Sweden)

    Gonzalo Rojas

    2012-01-01

    Full Text Available The relationship between the use of immunosuppressants in solid-organ transplant patients and oral tissue abnormalities has been recognized. The