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The longer waiting time for a liver graft in patients with blood group O makes it necessary to expand the donor pool for these patients. This applies in both urgent situations and for elective patients. We report on our experience with ABO-incompatible liver transplantation using A2 and B non-secretor donors here. Patients and methods: Between 1996 and 2005, 12 adult blood group O recipients (seven male/five female) received ABO-incompatible cadaveric liver grafts (10 A2 donors, two B non-secretor donors). The indications were either rapid deterioration of liver function or hepatocellular cancer, in blood group O recipients, where an ABO-identical/compatible graft was not available. Mean recipient age was 54±8 (mean±SD) yr. All pre-operative CDC crossmatches were negative. The initial immunosuppression was induction therapy with antithymocyte globulin ( n=3), interleukin 2 receptor antagonists ( n=3) or anti-CD20 antibody (rituximab) ( n=1), followed by a tacrolimus-based protocol. Three patients underwent plasmapheresis post-transplantation. Baseline biopsies were taken before or immediately after reperfusion of the graft and after grafting when clinically indicated. No pre-operative plasmapheresis, immunoadsorption or splenectomies were performed. Results: Patient and graft survival was 10/12 (83%) and 8/12 (67%), respectively, with a 6.5-month median follow-up (range 10 days to 109 months). Two patients (B non-secretor grafts) died of multiorgan failure probably because of a poor condition before transplantation. Three patients were retransplanted. Causes of graft loss were bacterial arteritis ( n=1), death with a functioning graft ( n=1) and portal vein thrombosis ( n=2). In one of the patients with portal vein thrombosis, an anti-A titer increase occurred concomitantly, and ABO incompatibility as the cause of the thrombosis cannot be excluded. Seven acute rejections occurred in five patients and all were reversed by steroids or increased tacrolimus dosage. The pre-transplant anti-A titers tested against A1 red blood cells were 1 to 128 (NaCl technique) and 4 to 1024 (indirect antiglobulin technique, IAT); the maximum postoperative titers were 16 to 2048 (NaCl) and 256 to 32 000 (IAT). Conclusion: The favorable outcome of A2 to O grafting, with a patient survival of 10/10 and a graft survival of 8/10, makes it possible to also consider this blood group combination in non-urgent situations. The use of non-secretor donor grafts is interesting but has to be further documented. There was no hyperacute rejection or increased rate of rejection. Anti-A/B titer changes seem not to play a significant role in the monitoring of ABO-incompatible liver transplantation. [ABSTRACT FROM AUTHOR]

The effect in vivo of the angiotensin converting enzyme (ACE) inhibitors captopril and enalapril and the calcium antagonist verapamil was studied in an experimental model using rat heart allografts. Daily post-transplant treatment of recipient rats (DA strain) with verapamil (75 mg kg[sup -1] day[sup -1]) or captopril (40 mg kg[sup -1] day[sup -1]) significantly prolonged survival of allografts from donors (PVG/c strain) when compared with an untreated control group (p < 0.05). No synergistic effect was observed when the two drugs were used for combined treatment. An equipotent does of enalapril (12.5 mg kg[sup -1] day[sup -1]) caused no change in allograft survival of statistical significance. The results support the hypothesis that verapamil and captopril have effects on the immune reactivity in vivo, and that this is not a characteristic shared by all ACE inhibitors. [ABSTRACT FROM AUTHOR]

FK 506 (FK) has a strong immunosuppressive effect, but a low-grade, dose-dependent nephrotoxicity and diabetogenicity, which means that reducing the dose of FK is of considerable interest. Lipo-prostaglandin E1 (LPGE1) is a preparation of PGE1 that has potent immunosuppressive properties, and its duration of action is longer than that of ordinary PGE1. The purpose of this study was to investigate whether LPGE1 can enhance the immunosuppressive effect of FK. Heterotopic cardiac transplantations to the neck vessels were performed, and recipient rats were treated with intramuscular injections of FK and LPGE1 once daily for 10 days. All grafts without any treatment were rejected within 14 days. In comparison, the FK doses of 0.07, 0.2 and 1.0 mg/kg/day for 10 days significantly increased the long-term graft survival (>100 days) to 8%, 44% and 100%, respectively. The addition of LPGE1 to the first two dosages caused a further significant increase in the graft survival, to 18% and 80%, respectively, when compared with the control. LPGE1 appears to enhance the immunosuppressive effect of FK. [ABSTRACT FROM AUTHOR]

Presents two cases of acute hepatic artery thrombosis, after whole liver transplantation in children. Viability of bile ducts and the liver parenchyma; Use of streptokinase to resolve a hepatic arterial thrombosis after liver transplantation; Cause of morbidity after liver transplantation; Use of Doppler ultrasound in treating hepatic arterial thrombosis.

Rationale & Objective: In kidney transplant recipients (KTRs), a belatacept-based immunosuppressive regimen is associated with beneficial effects on cardiovascular (CV) risk factors compared with calcineurin inhibitor (CNI)-based regimens. Our objective was to compare the calculated CV risk between belatacept and CNI (predominantly tacrolimus) treatments using a validated model developed for KTRs., Study Design: Prospective, randomized, open-label, parallel-group, investigator-initiated, international multicenter trial., Setting & Participants: KTRs aged 18-80 years with a stable graft function (estimated glomerular filtration rate > 20 mL/min/1.73 m 2 ), 3-60 months after transplantation, treated with tacrolimus or cyclosporine A, were eligible for inclusion., Intervention: Continuation with a CNI-based regimen or switch to belatacept for 12 months., Outcomes: Comparison of the change in the estimated 7-year risk of major adverse CV events and all-cause mortality, changes in traditional markers of CV health, as well as measures of arterial stiffness., Results: Among the 105 KTRs randomized, we found no differences between the treatment groups in the predicted risk for major adverse CV events or mortality. Diastolic blood pressure, measured both centrally by using a SphygmoCor device and peripherally, was lower after the belatacept treatment than after the CNI treatment. The mean changes in traditional cardiovascular (CV) risk factors, including kidney transplant function, were otherwise similar in both the treatment groups. The belatacept group had 4 acute rejection episodes; 2 were severe rejections, of which 1 led to graft loss., Limitations: The heterogeneous baseline estimated glomerular filtration rate and time from transplantation to trial enrollment in the participants. A limited study duration of 1 year., Conclusions: We found no effects on the calculated CV risk by switching to the belatacept treatment. Participants in the belatacept group had not only lower central and peripheral diastolic blood pressure but also a higher rejection rate., Funding: The trial has received a financial grant from Bristol-Myers Squibb., Trial Registration: EudraCT no. 2013-001178-20., (© 2022 The Authors.)