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Objective : to determine the diagnostic value of galectin-3 in transplant recipients with myocardial fibrosis and acute heart transplant rejection, verified by endomyocardial biopsy. Materials and methods . The study included 124 patients with end-stage heart failure. Their ages ranged from 16 to 71 (average 48 ± 12) years, of which 106 (85%) were men and 18 (15%) were women. From 2013 to 2016, these patients underwent a heart transplant procedure at the Shumakov National Medical Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation. Analysis of endomyocardial biopsy specimens was used to verify acute cellular, humoral rejection and myocardial fibrosis of the heart transplant. Severity and nature of fibrosis was evaluated using a qualitative imaging technique. Galectin-3 concentration was measured by enzyme immunoassay using Human Galectin-3 Platinum ELISA reagent kits (Bender MedSystems GmbH, Vienna, Austria). Results . In the long-term post-transplantation period, in comparison with the early post-transplantation period, the number of verified graft myocardial fibrosis increased by 88% in recipients who had acute rejection crises and by 37% in recipients who had no rejection crises. Graft myocardial fibrosis was detected more often in recipients who had acute humoral rejection than in those who had acute cell rejection (92% vs 75% of cases, respectively). Plasma galectin-3 levels in recipients with graft myocardial fibrosis was higher than in recipients without it (p = 0.05 1 year and p = 0.01 1–5 years after heart transplantation). In recipients who had acute rejection crises, the risk of developing graft myocardial fibrosis was 1.64 (RR = 1.64 ± 0.1 [95% CI 1.1–2.2]). Conclusion . Galectin-3 is a biomarker for myocardial fibrosis in acute heart transplant rejection.

Objetivo: Este trabalho tem o objetivo de descrever cinco casos de coledocoduodenostomia para reconstrução biliar no transplante hepático, suas indicações e seus desfechos. Métodos: Trata-se de estudo retrospectivo dos prontuários de pacientes submetidos a transplante de fígado, entre 1999 e 2019, na Unidade de Transplante de Fígado de Pernambuco (UTF-HUOC), tendo sido selecionados cinco pacientes submetidos a coledocoduodenostomia para reconstrução das vias biliares. Resultados: Os motivos que indicaram a coledocoduodenostomia foram: via biliar do enxerto dilatada e anomalia de via biliar principal; varizes de mesentério; peritonite encapsulante acompanhada de varizes de mesentério e intensas aderências abdominais em dois pacientes. Dentre os cinco pacientes incluídos, dois foram a óbito por disfunção primária do enxerto. Nenhum dos cinco pacientes apresentou fístula biliar e, apenas, um paciente apresentou estenose biliar. Conclusão: Os dados levantados neste trabalho e na literatura apontam para uma semelhança entre Hepaticojejunostomia em Y de Roux e Coledocoduodenostomia em termos de morbidade e mortalidade, com a Coledocoduodenostomia apresentando como vantagem a possibilidade de acesso através de endoscopia.

A heart transplant is the gold standard treatment for end stage heart failure. Preservation of the donor heart during its transfer from the hospital of the donor to that of the recipient has a significant impact on the outcome of the transplant procedure. Icebox storage is a conventional method utilized for this purpose that may not provide uniform cooling of the donor heart and does not allow monitoring of the temperature of the donor heart during preservation. The Paragonix SherpaPak Cardiac Transport System offers uniform cooling by suspending the donor heart in a preservation solution and provides continuous temperature monitoring.

Purpose Corneal transplantation is the most frequently performed transplant procedure. In much of the world, the demand for donor tissue heavily outstrips supply. With developments within lamellar corneal graft surgery, the use of split corneal donor tissue to increase donor tissue supply seems a pragmatic solution to reduce the supply and demand mismatch. This is especially important with tissue supply expected to be affected by the COVID-19 pandemic. Methods A literature review of techniques was performed, enabling multiple transplants to be derived from a single donor and simulation of a model to quantify the number of corneas potentially saved. Results Studies on splitting corneal donor tissue have demonstrated that up to 5 recipients may benefit from 1 donor scleral button. The impact of splitting donor tissue may provide a saving of up to 25.3% of donor graft tissue. Conclusions Splitting and preparing the donor tissue within an eye bank will improve tissue validation and donor tissue availability and may increase surgeon efficiency.

Aim: We determined the frequency of graft-versus-host disease (GvHD) and overall survival (OS) in sex matched vs mismatched transplant. Methods: Medical records were analyzed of patients undergoing transplant from 2004 to 2016. Variables included age, sex of patient and donor, indication, conditioning regimen, stem cell source, frequency of GvHD and OS. Results: We performed n = 162 allogeneic stem cell transplants. The most common conditioning regimen was busulfan/cyclophosphamide (n = 64). There was no difference in the frequency of GvHD in both groups. The transplant related mortality was higher (8.7%) in sex-mismatched transplants. The OS in both groups was similar. Conclusion: Our study showed higher transplant-related mortality in sex-mismatched transplant. There was no difference in GvHD and OS in both groups.

Kidney transplantation in small animals has been crucial in the development of anti-rejection therapies. While there is no substitute for a skilled microsurgeon, there are many aspects of the transplant procedure that can be modified to optimize the reproducibility and utility of the technique. This article provides a detailed description, including video recording, of orthotopic kidney transplantation in the rat. The key variables in the technique are also discussed.

Knowledge of the hepatic arterial anatomy and celiac trunk is gaining importance, since the use of minimally invasive surgeries is more frequent nowadays. This kind of procedure meant that surgeons had less room for visualization of anatomical variants and work. In addition, failure to recognize the correct anatomy of the hepatic vascularization in a transplant procedure can lead to organ failure and death. The present case aims to demonstrate an arterial hepatic celiac trunk pattern that was never described by any of the acknowledged classification systems. This pattern is challenging for the surgical management of possible upper abdominal interventions, since non-recognition may lead to iatrogenesis. Keywords: Hepatic artery; mesenteric artery; superior; celiac artery; anatomy

Liver transplant (LT) recipients require life-long immunosuppression (IS) therapy to preserve allograft function. The risks of chronic IS include an increased frequency of malignancy, infection, renal impairment, and other systemic toxicities. Despite advances in IS, long-term LT outcomes have not been improved over the past three decades. Standard-of-care (SoC) therapy can, in rare cases, lead to development of operational tolerance that permits safe withdrawal of maintenance IS. However, successful IS withdrawal cannot be reliably predicted and, in current prospective studies, is attempted several years after the transplant procedure, after considerable exposure to the cumulative burden of maintenance therapy. A recent pilot clinical trial in liver tolerance induction demonstrated that peri-transplant immunomodulation, using a regulatory T-cell (Treg) approach, can reduce donor-specific alloreactivity and allow early IS withdrawal. Herein we review protocols for active tolerance induction in liver transplantation, with a focus on identifying tolerogenic cell populations, as well as barriers to tolerance. In addition, we propose the use of novel IS agents to promote immunomodulatory mechanisms favoring tolerance. With numerous IS withdrawal trials underway, improved monitoring and use of novel immunomodulatory strategies will help provide the necessary knowledge to establish an active liver tolerance induction protocol for widespread use.

In standard bilateral living-donor lobar lung transplantation (LDLLT), the right and left lower lobes from 2 healthy donors are implanted in the recipient in place of whole right and left lungs. In other words, total 10 lobes (5 lobes in each donor) are shared by the 2 donors (4 lobes in each donor) and the recipient (2 lobes) in this transplant procedure. This study aimed to compare pulmonary function between donors and recipients before and after LDLLT.We performed 76 LDLLT procedures between June 2008 and March 2017. After excluding 12 single LDLLT and 11 native-lung-sparing LDLLT procedures, we identified 38 recipients of bilateral LDLLT who survived1 year and underwent routine pulmonary function testing. Acquired recipient pulmonary function was compared with lost donor pulmonary function at 1 year post-LDLLT.The median age of the 38 recipients was 44 years (range, 8-62 years); 14 were men. The median age of the 76 donors was 41.5 years (range, 20-60 years); 50 were men. One year post-LDLLT, acquired recipient forced vital capacity was significantly greater than lost donor forced vital capacity (1889.5 ± 581.3 mL vs 1073.9 ± 661.6 mL; P .001). Similarly, acquired recipient forced expiratory volume in 1 second at 1 year post-LDLLT was significantly greater than lost donor forced expiratory volume in 1 second (1646.8 ± 483.0 mL vs 1064.2 ± 534.5 mL; P .001).These results indicated that acquired recipient pulmonary function was better than lost donor pulmonary function in bilateral LDLLT.

With accumulating evidence and improved outcomes along with recognition that modern biological therapies are not universally effective, require chronic administration and have high acquisition costs, hematopoietic stem cell transplantation (HSCT) has become an emerging direction for cell therapy in autoimmune diseases (ADs). The goal of this therapy is to induce medication-free remissions by resetting the immune system into a naive and self-tolerant state through eradication of the autoreactive immunologic memory and profound re-configuration of the immune system induced by the transplant procedure. Safety of HSCT has generally improved by implementing internal quality management and external accreditation. Inter-disciplinary guidelines for patient selection, transplant technique and supportive care along with greater center experience should optimize safe and appropriate delivery of HSCT in specific ADs. In this review, we discuss the current role and future perspectives of HSCT in AD, focusing on recent published clinical and scientific studies and recommendations in the field.

Allogeneic hematopoietic stem cell transplantation (HSCT) represents a curative treatment for many patients with hematological malignant or non-malignant disorders. Evaluation of potential donors for HSCT includes a rigorous assessment of the human leukocyte antigens (HLA) match status of family members, and the identification of suitable unrelated donors. Genes encoding transplantation antigens are placed both within and outside the major histocompatibility complex (MHC). The human MHC is located on the short arm of chromosome 6 and contains a series of genes encoding two distinct types of highly polymorphic cell surface glycoproteins. Donors for HSCT are routinely selected based on the level of matching for HLA-A, -B, -C, -DRB1, and -DQB1 loci. However, disease relapse, graft-versus-host-disease, and infection remain significant risk factors of morbidity and mortality. In the same breath, in high-risk patients, graft-versus-leukemia effects inherent in HLA mismatching play a substantial immunological role to limit the recurrence of post-transplant disease. The definition of a suitable donor is ever changing, shaped not only by current typing technology, but also by the specific transplant procedure. Indeed, a more complete understanding of permissible HLA mismatches and the role of Killer Immunoglobulin-like receptors’ genes increases the availability of HLA-haploidentical and unrelated donors.

Introduction: This article deals with two patients who underwent bilateral hand transplantation following amputation of both upper limbs at the distal third of the foream. Materials and Methods: The first patient had a history of loss of hands in a train accident, with possiblity of a run over element during the injury. The second patient lost his both hands in a mine blast. The preoperative work up included detailed clinical and psychological evaluation. The donor retrieval was similar in both the cases and the donors were housed in our own instittution. The donor preparation, recipient preparation and the transplant procedure was similar except for the need of primary tendon transfers in the left hand of the first patient. Results: The first patient needed a free flap transfer to cover compromised skin flap on the left hand on the second day. The second hand transplant was uneventful. Both the recipients are now back to their normal daily routines. Conclusions: Hand transplantation is a potentially life altering procedure, but to optimise the results, it is imperative that there is a meticulous planning and diligent execution with utmost importance to the detail coupled with a synchronised team effort.

Engraftment following HSCT is an essential goal for sustained long-term and effective hematopoiesis. It is the most important criteria for a better overall survival. However, stem cell engraftment may be accompanied with a clinical condition known as engraftment syndrome (ES) that could have a devastating outcome. Nurses caring for HSCT recipients must be aware of ES symptoms in order to intervene quickly and appropriately. Conversely, graft failure (GF) is a major complication and is associated with a dismal prognosis. It is classically divided into primary or secondary graft failure. The risk factors associated with GF may be related to characteristics of the graft, the patient, the donor, or the transplant procedure. The conditions that are associated with an increased occurrence of GF and the available treatment options will be thoroughly discussed in the chapter along with the nursing considerations.

The human microbiota comprises all the microorganisms of our body, which can also be categorised as commensals, mutualists and pathogens according to their behaviour. Our knowledge of the human microbiota has considerably increased since the introduction of 16S rRNA next generation sequencing (16S rDNA gene). This technological breakthrough has seen a revolution in the knowledge of the micro biota composition and its implications in human health. This article details the different human bacterial ecosystems and the scientific evidence of their involvement in different diseases. The faecal microbiota transplant procedure, particularly used to treat recurrent diarrhoea caused by Clostridium difficile, and the methodological bases of the new molecular techniques used to characterise microbiota are also described. (C) 2017 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.

Patellar osteochondral lesions are common and particularly disabling injuries that can affect young and highly active patients. If enough functional impairment, ranging from difficulty climbing stairs to pain with squatting, is present, surgical treatment may be warranted. For the treatment of these lesions, various techniques have been described, including autologous osteochondral transplantation, as well as microfracture surgery. However, these are not without disadvantages. Although morbidity is noted in cases of autologous osteochondral transplantation, uncertain and possibly unsustainable results are associated with the microfracture procedure. Therefore, we present an alternative surgical treatment option for this pathology. The objective of this Technical Note is to describe our preferred approach for an osteochondral allograft transplant procedure to treat a focal patellar osteochondral lesion.

BACKGROUND Equoral(®) is a generic formulation of Cyclosporine A (CsA), which is significantly cheaper than the original medicine. Our center participated in the clinical trial designed to evaluate the efficacy and safety of Equoral(®) in kidney transplant recipients in the first 9 months after a transplant procedure. The aim of our paper is to present the 5-year follow-up of patients who participated in the study and were monitored in our center. MATERIAL/METHODS We performed intention-to-treat retrospective analysis of 20 de novo kidney transplant recipients who received Equoral®-based immunosuppressive regimen and were monitored in our department for 5 years after transplantation. RESULTS The 5-year patient and graft survival was 90%, and the frequency of acute rejection was 15%. In 80% of patients, the initial immunosuppressive regimen had to be changed. CONCLUSIONS In our group of kidney transplant recipients, immunosuppression based on generic formulation of CsA had excellent 5-year patient and graft survival and effectively prevented acute rejection episodes. However, most patients needed modification of the initially administered immunosuppressive regimen.

With the aid of a professional developer, the South West Transplant Centre designed and launched a website in September 2006 to provide patient friendly information in all aspects of renal transplantation and health professionals with transplant related e-book protocols alongside research materials, printable referral forms and statistical data including survival figures. The aim of this paper is to report on our experience of the first year of operating such a website. The website consists of approximately 500 pages covering subjects ranging from transplant related procedures to the transplant procedure itself. During the first year the total number of hits on SWTC website were 70,971 with April 2007 having a peak of 10,357 hits. There was sustained interest in the website throughout the year and the amount of information (kilo- bytes) downloaded was highest during the first three months. Regular visitors to the website come from several countries across the globe including the United Kingdom, New Zealand, Seychelles, Canada, France and the US. A well-designed website is a useful tool for increasing awareness of Unit activities, increasing organ donation, providing information and in some instances training people in geographically remote areas. To maintain relevance transplant websites require to be upgraded on a regular basis by transplant clinicians and relevant sections expanded to meet the needs of the public.

Purpose: The purpose of this study was to compare spirometric data between patients submitted to single-lung and double-lung transplantation along the first year after the transplant procedure. Introduction: Lung transplant was first described as an experimental method in 1963; it became a therapeutic option for patients with advanced pulmonary diseases due to improvements in the organ conservation, surgical techniques, immunosuppressive therapy, and treatment of post-operative infections. Methods: We retrospectively reviewed records of 39 patients, who received lung transplantation in our institution between August, 2003 and August, 2006. The Post-transplant survival after 1 year occurred in 29 patients, and all of them were followed-up. Results: Increase of the lung function in double-lung transplant group occurred earlier, presenting statistical difference after the 1st month both in the FEV1 and FVC compared to pre-transplant values (p

Objectives Beginning to do liver transplants in a developing country is challenging. We report on the first few liver transplants performed in Qatar and discuss future exceptions and challenges facing our program. Materials and methods The first liver transplant was performed in Qatar on December 6, 2011. Since starting the program, 4 deceased-donor liver transplants have been performed in Qatar. All recipients underwent a standard deceased-donor liver transplant procedure, which included a duct-to-duct biliary anastomosis without a veno-venous bypass. All liver transplants were performed at the Hamad Medical Corporation by a local team of surgeons without external assistance. Results The 4 patients were all men, with a median age of 56 years (age range, 46-63 y). Indications for liver transplant included hepatitis C cirrhosis in 2 patients, and 1 patient with hepatitis B cirrhosis with hepatocellular carcinoma, and the other patient with cryptogenic liver cirrhosis. Median amount of blood transfused was 6 units (range, 0-10 U); median time spent in the intensive care unit was 2 days (range, 2-5 d); median amount of time spent in the hospital was 10 days (range, 9-16 d). All 4 recipients have survived after a median follow-up of 438 days (range, 33-602 d) and are enjoying a healthy life, with no significant posttransplant complications. Conclusions A deceased-donor liver transplant can be performed in Qatar with no external assistance. However, a severe organ shortage remains the biggest obstacle facing us. Efforts should be directed toward improving the number and quality of available deceased donors in Qatar. Meanwhile, live-donor liver transplant may be the only way for us, going forward, to prevent deaths on the waiting list.

Key points 1. The Model for End-Stage Liver Disease (MELD) system can be used to assess recipient pre-transplant risks and help select appropriate candidates for the adult to adult living donation liver transplant procedure. 2. Selection of candidates for the adult to adult living donation liver transplant procedure requires assessment of candidate risk of death without a transplant, risk of death with a transplant, and donor risk of death. 3. Understanding of the risks involved allows for development of clinical decision models to inform the risk benefit analyses. 4. MELD provides a useful, objective, and universal tool for clinicians around the world to estimate risks for clinical decision making in all forms of liver transplantation.

Purpose To perform increased intraocular pressure (IOP) screening in non-glaucomatous patients after deep anterior lamellar keratoplasty (DALK) due to keratoconus with normal IOP measured during control visits. Methods Ten non-glaucomatous patients, who underwent DALK procedure due to keratoconus were included into study. Patients were measuring IOP using self-tonometer Icare One (Icare, Finland) continuously for 30 days, 3 times per each day. Additionally patients were checked by ophthalmologist 3-times during follow-up time in Outpatient Clinic, where applanation tonometry and central corneal thickness measurements were performed. After 30-days, self-measured IOP was evaluated for rises above 21 mmHg as well as rises above mean GAT values measured during control visits. Results Mean IOP measured with GAT and adjusted according to CCT was 15 mmHg and ranged between 11 and 19 mmHg. There were no values above 21 mmHg reported during follow-up time. In Icare One measurements, all patients showed incidents of IOP values higher than measured with GAT, however mean values ranged between 10-18 mmHg. Six out of 10 patients revealed to have IOP elevations higher than 21 mmHg between control visits (with maximum values up to 46 mmHg), and this elevated values constituted from 3.3 up to 20.0 % of all self-measurements. Conclusion Self-tonometry with Icare One might be useful tool to identify patients who develop undetectable IOP increases between control visits. This can help in prevention of vision loss and transplant procedure failure in DALK patients.

Myocardial power output is an important determinant of ventricular function but few measurements of this parameter have been made using human tissue samples. Our group has been measuring force-velocity curves, and thus power output, in left ventricular samples obtained from patients undergoing cardiac surgery at the University of Kentucky. Multicellular preparations are prepared from previously-frozen tissue samples by mechanical homogenization and chemical permeabilization. They are then connected between a force transducer and a motor and maximally activated in a saturating [Ca2+] solution. Once force has reached steady-state, the samples are allowed to shorten against pre-set loads imposed using SLControl software. Panel A in the figure shows superposed force and muscle-length traces for an isolated myocardial preparation obtained from the heart removed from a 32 year old male during a transplant procedure. Panel B shows force-velocity and power curves calculated from these records. One of the goals of our ongoing study is to determine whether maximal power output in isolated left ventricular samples improves after patients are fitted with left ventricular assist devices. Our study will, to our knowledge, be the first to measure force-velocity and power output in preparations isolated from these patients.View Large Image | View Hi-Res Image | Download PowerPoint Slide

The Karolinska Institute is carrying out two inquiries into an experimental transplant procedure.

Made available in DSpace on 2021-07-14T10:29:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05. Added 1 bitstream(s) on 2021-07-14T11:31:23Z : No. of bitstreams: 1 S1516-84842010000700020.pdf: 1511058 bytes, checksum: 25cb298b447bc0bc199b7b1c1b71907e (MD5) A infecção em receptores de transplante de células-tronco hematopoéticas (TCTH) está relacionada a altas taxas de morbidade e mortalidade. O tipo de transplante, a fonte de célula-tronco hematopoética, a utilização de doadores alternativos e outras medidas relacionadas ao procedimento influenciam diretamente no tipo e na intensidade da imunossupressão, modificando o risco de desenvolver uma infecção. Nesta seção são discutidas as estratégias para monitorização, diagnóstico e tratamento das infecções em receptores de TCTH em três fases: na fase pré-transplante, durante a fase de neutropenia, e na fase pós-pega do enxerto. Infectious complications following stem cell transplantation are frequent and associated with high morbidity and mortality. Several factors related to the transplant procedure, such as type of transplant, the source of stem cells, the utilization of alternative donors are important determinants of the immune status of the host, and impact on the risk of infection. In this section we will discuss the different approaches for monitoring patients at risk and diagnosing and treating infectious complications in three time periods: before transplant, during neutropenia, and after engraftment. Universidade Federal do Paraná Universidade Federal de Juiz de Fora Universidade Federal do Rio de Janeiro Universidade Estadual Paulista Universidade de São Paulo, Hospital Amaral Caravalho Universidade Estadual Paulista

The endomyocardial biopsy is invasive, reduces quality of life and cannot be repeated daily. Initial studies on noninvasive cardiac graft monitoring have been presented recently. During the heart transplant procedure, we implanted wideband telemetric pacemakers and fractally coated, epimyocardial electrodes. On biopsy days and during each follow-up, intramyocardial electrogram sequences were obtained. The maximum T-slew rate from the ventricular evoked response (VER) was automatically calculated and compared to the biopsy results (n = 331, ISHLT grading). The VER T-slew rate was significantly lower during rejection grade 2 or higher. The negative predictive value to exclude rejection was 98 %. Using a single threshold diagnosis model, 74 % of the biopsies could have been avoided. Non-invasive cardiac graft monitoring can reduce the need for surveillance biopsies and may offer a tool to optimize immunosuppressive therapy after heart transplantation

Corneal transplantation, first reported a century ago, is the oldest and most frequent form of solid tissue transplantation. Although keratoplasty is also considered as the most successful transplant procedure, several studies indicate that the long term survival of corneal grafts is even lower than that of transplanted parenchymatous organs. Despite the immune privilege enjoyed by the cornea and anterior segment of the eye, immunologic graft rejection is a major limitation to corneal transplantation. This review gives an update on corneal immunobiology and the mechanisms of corneal graft rejection, focusing on antigen presentation, as well as on the molecular and cellular mediators of this particular immune response.

n December 1984, Dr. Michael A. E. Ramsay was summonedto the boardroom of Baylor University Medical Center(BUMC) to meet with Mr. Boone Powell, Jr., president ofthe medical center; Dr. John S. Fordtran, chief of the Depart-ment of Internal Medicine; Dr. Goran B. Klintmalm, recentlyappointed director of transplantation services; and other medi-cal staff leaders. Those already assembled were on a conferencecall with Dr. Thomas E. Starzl, professor of surgery and directorof transplantation at the University of Pittsburgh School ofMedicine. First Lady Nancy Reagan had asked Dr. Starzl if a 4-year-old child, who had been part of the White House Christ-mas tree–lighting ceremony, could have a liver transplant. Anorgan was available, but there were no open hospital beds at Pitts-burgh. Dr. Starzl had called to inquire whether the transplantcould be done as the first liver transplant procedure at BUMC.The decision was made to proceed. Dr. Starzl flew to Dallas andtogether with his previous fellow, Dr. Klintmalm, performed thefirst successful orthotopic liver transplant in Texas, with Dr.Ramsay, Dr. Peter T. Walling, and Dr. Thomas W. Swygert as-sisting with anesthesia.Organ transplantation could not have been contemplatedsave for centuries of effort to develop effective anesthetic agentsand techniques for managing high-acuity patients for extendedperiods of time. Making the momentous decision to perform thetransplant at BUMC was feasible only because of the near-century–long effort to develop BUMC’s medical staff, technicalsupport, equipment, facilities, and financing, together with de-tailed planning, guided by Dr. Starzl, to develop a major organtransplantation program at BUMC.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:58:41Z No. of bitstreams: 1 S0034-72992003000200003.pdf: 866055 bytes, checksum: 57e763e89dedadaffad24373a4576cb7 (MD5) Made available in DSpace on 2013-08-22T18:58:41Z (GMT). No. of bitstreams: 1 S0034-72992003000200003.pdf: 866055 bytes, checksum: 57e763e89dedadaffad24373a4576cb7 (MD5) Previous issue date: 2003-03-01 Made available in DSpace on 2013-09-30T18:22:06Z (GMT). No. of bitstreams: 2 S0034-72992003000200003.pdf: 866055 bytes, checksum: 57e763e89dedadaffad24373a4576cb7 (MD5) S0034-72992003000200003.pdf.txt: 22539 bytes, checksum: a9797dcf839474e82a1b1b494a93cd46 (MD5) Previous issue date: 2003-03-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:36:48Z No. of bitstreams: 2 S0034-72992003000200003.pdf: 866055 bytes, checksum: 57e763e89dedadaffad24373a4576cb7 (MD5) S0034-72992003000200003.pdf.txt: 22539 bytes, checksum: a9797dcf839474e82a1b1b494a93cd46 (MD5) Made available in DSpace on 2014-05-20T13:36:48Z (GMT). No. of bitstreams: 2 S0034-72992003000200003.pdf: 866055 bytes, checksum: 57e763e89dedadaffad24373a4576cb7 (MD5) S0034-72992003000200003.pdf.txt: 22539 bytes, checksum: a9797dcf839474e82a1b1b494a93cd46 (MD5) Previous issue date: 2003-03-01 FORMA DE ESTUDO: Experimental. MATERIAL E MÉTODO: Transplante homógeno de traquéia foi realizado em 51 cobaias (Cavia Porcellus). RESULTADO: Observamos reepitelização do enxerto a partir da traquéia receptora da cobaia, evoluindo de epitélio escamoso de 1 a 3 células nos animais com 3, 7 e 14 dias de observação para epitélio ciliado após 60 a 120 dias do transplante. A viabilidade do enxerto traqueal era boa, com reabsorção parcial da cartilagem e formação de estenose traqueal parcial, mas sem sinais clínicos evidentes de obstrução respiratória durante o tempo de observação dos animais. STUDY DESIGN: Experimental. MATERIAL and METHOD: Tracheal homograft was performed in 51 guinea pigs (cavia porcellus) in order to study the graft epithelization. RESULTS: After the transplant procedure we observed reepithelization of the graft which initiated from the recipient trachea. The new formed epithelium was of squamous type and had 1 to 3 cell layers and was observed in animals with 3, 7 and 14 days after the surgical procedure. Respiratory epithelium with cilia was present with 60 and 120 days after the transplant. Cartilage absorption close to the tracheal anastomosis was the cause of partial tracheal stenosis in some animals. No clinical repercussion was noted due to this partial stenosis. Our conclusion was that tracheal homograft is an efficient surgical procedure for tracheal reconstruction. UNESP Faculdade de Medicina de Botucatu Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço UNESP Faculdade de Medicina de Botucatu Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço

Within a 17-month period, 130 orthotopic liver transplantations were performed in our hospital. Nine of these were retransplantations and were not included in our analysis. In the remaining 121 patients, splenectomy was performed in 34 patients, either synchronously with the transplant procedure (27 patients) or in the postoperative period (7 patients). Indications for splenectomy were lienalis-steal syndrome in 15 patients and hypersplenism in 15 cases. The number of rejection episodes was fairly equal in both groups (splenectomized vs. non-splenectomized, 61.7% vs. 63.9%, respectively). There was a marked difference in the frequency of infectious episodes (61.7% vs. 25.3%) that resulted in a decreased survival rate (77.5% vs. 95.4%) for splenectomized patients. Therefore, we recommend splenectomy only for very selected patients and investigate the banding of the splenic artery as an alternative.

The transplant community, including patients and carers, physicians, scientists and health-care workers, has long benefited from the altruistic donations provided by sibling or unrelated volunteer individuals. It is, therefore, to our shame that it has taken over 40 years for a careful consideration of the rights of the donor to be fully informed of the nature of the research being undertaken in the transplant centre, to appear in the transplant literature. King and colleagues have given great thought to this matter and have concluded that when the donor is required to do more than simply provide cells for a straightforward transplant procedure or to provide data and/or material that will be used in an identifiable manner, the research protocol should be approved in the country of origin of both donor and patient, the donor should be fully informed and should have the right to refuse to participate. This seems entirely reasonable and, as the authors argue, in keeping with the spirit of the Helsinki agreement.

Long-term survival of relapsed/refractory acute myeloid leukemia (AML) remains a major problem, particularly in patients not eligible for transplantation.We hereby evaluated the feasibility and efficacy of adding Gemtuzumab Ozogamicin to salvage chemotherapy (Ara-C, Idarubicine, Peg-Filgrastim) in relapsed/refractory AML. The main endpoints were: the rate of complete remissions (CR) and the proportion of patients capable of undergoing a stem cell transplant.Fourty-two patients were enrolled. The overall CR rate was 76% and no induction deaths were reported. In 56% of patients, a transplant procedure could be performed. The treatment schedule proved feasible and well tolerated, providing a high CR rate and a useful bridge to transplant.

A review of the medical literature suggests that type 1 diabetes in a bone marrow allograft donor may be transmitted to the recipient after a successful transplant (1,2). We report a 21-year follow-up after a successful allograft for aplastic anemia. The donor had type 1 diabetes at the time of transplant. The recipient has developed a number of antibodies against pancreatic islet cells, and although these have persisted for a number of years, she has not developed diabetes. A 6-year-old Caucasian girl presented in 1976 with aplastic anemia. She showed a partial response to androgens, but this was not sustained, and in 1979 she received a bone marrow transplant (BMT) from her HLA-matched male sibling, who was 3 years older and had been diagnosed with type 1 diabetes 7 years earlier. Both patients were group O Rh (D) positive and HLA-A1, -2, -B8, and MLC nonreactive. The transplant procedure and the progress post-BMT have already been published (3). Full donor engraftment of the hemopoietic system has been documented on a number of occasions over the past 21 years. …

SUMMARY This paper reviews the development of the techniques used for liver preservation and describes their clinical use. Recent advances with the introduction of lactobionate based solutions for simple cold storage are described and illustrated by their effect on the Cambridge/King's College Hospital transplant programmes. Better preservation of the liver has simplified the logistics of the transplant procedure, improving organ usage and allowing increased sharing of livers for urgent or paediatric cases.

The high rate of persistent hyperglycemia, termed primary nonfunction, after islet allotransplantation in C57BL/6 mice recipients of B10.BR strain islets, as compared with B10.BR recipients of C57BL/6 islets, led to a series of experiments to determine whether islet allograft primary nonfunction was attributable to technical aspects of the transplant procedure or whether it was a consequence of alloimmunity. Primary nonfunction was prevented by systemic pharmacologic immunosuppression of the host with cyclosporine. Selective immunodepletion of host CD4+ and CD8+ T lymphocytes significantly extended the time of classic rejection but did not significantly affect the rate of primary nonfunction. However, modulation of macrophages by administration to the host of silica completely abolished primary nonfunction. These observations, in conjunction with the immunohistological findings of intense macrophage infiltration in islet allografts from recipients exhibiting persistent post-transplant hyperglycemia, support the hypothesis that primary nonfunction results from a cell-mediated host-immune response of rapid onset that is dependent on macrophages or macrophage byproducts as the main effectors.

In this report, Morris et al describe three patients with refractory malignant disease, who died of an ARDS-like syndrome within the first few weeks after autologous stem cell transplantation (autoSCT). These patients were found to have increased pretransplant serum levels of C-reactive protein (CRP), as compared with a group of 21 patients who survived the transplant procedure. Post transplant levels of CRP did not differ significantly between groups. The authors found no additional value in measuring cytokine levels, including IL-6 and TNF-alpha, either pre- or post transplant.

Seven patients with heterotopic heart transplants have undergone further heart transplant procedures. In 5, the first heterotopically placed donor heart was excised and replaced with the second donor heart. In 2, the first heterotopic donor heart was left in situ and the patient's own heart (then nonfunctioning) was excised and replaced by the second donor heart; thus, these patients underwent orthotopic transplantation and were left with two donor hearts. The decision to perform retransplantation in a patient undergoing irreversible acute rejection is usually straightforward, but the timing of a further transplant procedure in a patient with advanced graft arteriosclerosis may present a difficult problem. Two of the 7 patients in this series died of infectious complications within the first 3 months after retransplantation. A third patient acutely rejected the second donor heart within 5 days, but survived an additional 17 months with the support of his own cardiomyopathic heart. Four patients remain alive and well between 5 and 36 months following the second transplant and between 17 and 54 months following the first transplant procedure.