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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.

Lung transplantation remains a therapeutic option in end-stage lung disease. However, despite advances in the field, early allograft function can be compromised by the development of primary graft dysfunction (PGD); this being the leading cause of morbidity and mortality immediately following the lung transplant procedure. Several recipient factors have been associated with increased risk of PGD, but less is known about donor factors. Aging, tobacco, and chronic alcohol use are donor factors implicated, but how these factors promote PGD remains unclear. Herein, we discuss the available clinical data that link these donor factors with outcomes after lung transplantation, and how they might render the recipient susceptible to PGD through a two-hit process. This article is protected by copyright. All rights reserved.

Coronary artery fistulas have been described in patients after heart transplantation more often than in the normal population. We reviewed our centre’s database between 2008 and 2020. Thirty patients had coronary angiography and 13 showed non-cameral coronary artery fistulas in their first coronary angiography. Distribution, degree and evolution of the fistulas and characteristics of transplant procedure, patient and immunosuppressive treatments were analysed.

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.

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 microbiota 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.

Vitiligo is an acquired pigmentary skin of depigmentation occurring secondary to melanocyte destruction. Vitiligo and other leukodermas have a profound impact on quality of life. Current therapies include medical options, such as phototherapy, topical and systemic corticosteroids, topical calcineurin inhibitors, immunomodulators, and antioxidiants, and surgical options. Surgical options provide melanocytic cells to previously depigmented areas and use either tissue grafting or cellular grafting methods. Topical treatments are often insufficient, and many of the current surgical procedures have shown variable response rates. In this review, we discuss the process of the cellular grafting melanocyte-keratinocyte transplantation procedure (MKTP) and critically analyze its efficacy and safety in the treatment of vitiligo and other leukodermas. PubMed was searched for studies (2001-2017) describing the use of MKTP in patients with vitiligo or other leukodermas. Articles or trials discussing the use of MKTP for these patients were selected for in-depth review. Clinically relevant results regarding efficacy and safety of MKTP in vitiligo and leukoderma patients were analyzed. Numerous trials and case series/reports have demonstrated tolerability and efficacy of MKTP with repigmentation for patients with refractory, stable vitiligo. However, the response rates have been variable, likely influenced by vitiligo type and affected areas. Future research and clinical reporting will provide more insight on which phenotypes may benefit from MKTP.

Hematopoietic Stem Cell Transplantation activity levels vary across European countries. No data are available on the homogeneity of access to the transplant procedure for patient with leukaemia, within any European country. We measured homogeneity of the rate of alternative donor search in patients affected by acute leukaemia resident in each Italian region and macro-region during years 2010-2013. A total of 2747 alternative donor searches were studied. Twenty-one percent of all donor searches were made through extra-regional migration. Rate of alternative donor searches varied among the country's regions and macro-regions. The rate of donor searches was 38% lower in South Italy than in North Italy, and the rate of alternative donor transplantations performed was 45% lower. A reduced rate of alternative donor search in South macro-region was observed in all age cohorts. Despite the overall allogeneic transplant rate in Italy is relatively high, there are wide regional differences in access to transplant from alternative donor. Extra-regional migration cannot completely compensate for the lower access to transplant of acute leukaemia patients living in those regions where transplant activity is low.

Pediatric lung transplantation is a highly specialized clinical endeavor. Since the late 1980's, there have only been slightly more than 2200 implants reported to the International Society for Heart and Lung transplantation registry. This review will discuss the historical aspects of pediatric lung transplantation. It will familiarize the reader with the current indications for transplant and the referral and listing process. The current state of lung assist devices as a bridge to pediatric lung transplantation is discussed in addition to the technical aspects of the transplant procedure. Finally, posttransplant outcomes, including anticipated morbidity and the role of retransplantation, are clarified.

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.

Existing epidermal transplantation procedures applied in burn surgery or wound treatment, such as mesh grafting or the Meek method, do not lead to a restoration of all the skin layers. Dermal skin layers are indispensable in ensuring the quality and function of the transplanted skin as a frictional surface and a carrier of skin appendages such as hair, sweat glands, and sebaceous glands, as well as nerve receptors for detecting pressure, vibration, and temperature. Because of the restricted skin surface area that can be provided by the donor, full-skin transplants cannot be transplanted over a large area. Cultured skin procedures, based on skin cells cultivated in a laboratory, have not yet reached a stage of development where a complex full epidermal transplantation is possible. In particular, the introduction of skin appendages with a functional cell-to-cell communication has not been observed thus far in cultivated skin. Based on the Reverdin transplantation method, in which concave skin islands with epidermal and dermal parts are transplanted, Davis in 1910 described the transplantation of multiple 2−5 mm sized full-skin islands as a new method for the treatment of skin lesions. Further modifying this 100-year-old procedure, we developed a miniaturization and automation of the Davis transplantation method that started in 2011 and called it “SkinDot”. In the following article we describe the effectiveness of the full-skin island transplant procedure in two patients. The transplantation of single 2−3 mm full-skin islands results in a full-skin equivalent without any limits on donor area and with a reduced donor morbidity.

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.

Lung transplantation has become an accepted therapy in infants, children and adolescents suffering from end-stage lung diseases, an impaired quality of life as well as a reduced life expectancy. Within Europe, pediatric lung transplantation is largely performed in predominantly adult centers due to a relatively low overall case volume. Children do represent a specific and challenging cohort facing a transplant procedure, where the selection of potential candidates becomes a crucial step to maximize net survival benefit. Therefore, interdisciplinary evaluation and early listing in view of current indications and contraindications, adequate preoperative education of the child and family members, discussion of possibly required bridging procedures in case of deterioration, appropriate technical planning of the operation, adherence to postoperative medical treatment and follow-up are all crucial steps in this demanding puzzle. In this article, the authors review recent advances in the field of pediatric lung transplantation and outline challenges in the future.

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.

Liver transplant patients presenting to the ED with abdominal pain offer unique challenges in diagnosis and management. In addition to the usual abdominal pathologies considered, the emergency medicine provider must consider unusual causes of pain that stem from anatomical complications related to the transplant procedure itself, organ rejection, and the effects of immunosuppressive medications. The timing of presentation in relation to the date of transplant is critical as this heavily influences the differential diagnoses and guides empiric antimicrobial therapy. Finally, early communication with the patient’s transplant team or surgeon is crucial to guide appropriate workup and disposition decisions.

Purpose Our objective is to compare the inflammatory response pattern of lungs transplanted from DBD and cDCD donors. Methods Eighty adult lung recipients, 40 from DBD and 40 from cDCD donors (paired by LT indication and age) were prospectively enrolled in 4 Spanish transplant centres from Jul-18 to Jul-19. Data from donors and recipients as well as transplant procedure were analyzed. Blood samples were collected from the donor before (E0) and during the retrieval process (E1), and from the recipient before implant (R-1), after graft reperfusion (R0) and 24(R24)/ 48(R48) and 72(R72) hours after LT. Inflammatory response (IL-6, IL-8, IL-10, TNF-α) was compared between groups. Results Demographics of donors and recipients as well as transplant surgical procedure characteristics were similar between groups except for a higher rate of corticoid treatment and vaso-active support in DBD donor group and higher blood transfusion requirements in cDCD donor group (Table 1). DBD donors presented higher IL6 and IL10 plasma levels (p Conclusion Controlled DCD triggers a lower inflammatory response than DBD that may also influence the inflammatory pattern in the recipient. cDCD is a safe alternative to DBD in lung transplantation.

Purpose The number of heart transplants that require a reoperative sternotomy has increased dramatically with the growing utilization of LVADs. A reoperative surgical field complicates the recipient cardiectomy. The objective of this study was to evaluate the effect of reoperative sternotomy and LVAD explantation on the duration of surgery, the physiologic impact to the patient, and transfusion requirements. Methods This study is a single institution, retrospective review of all adult heart transplants between January 2013 and August 2018. Patients were excluded if they underwent a multi-organ transplant. Eligible patients were divided into three groups: non-reoperative, non-LVAD reoperative sternotomy, and LVAD explantation. The physiologic effect on the patient was estimated by the peak postoperative lactate level. Results During the study period, 174 adult heart transplants were performed. Twenty-two patients met exclusion criteria and the final cohort included 152 patients. The average age was 54 ± 12 years. The non-LVAD reoperative sternotomy group included 32 patients (21.0%) patients and 39 (25.7%) were in the LVAD explantation group. The results are summarized in Table 1. Patient outcomes were negatively affected by reoperative sternotomy in regards to duration of operative times, intra- and post operative blood product requirements, and physiologic stress as indicated by lactate levels. When compared to other patients undergoing a reopeartive sternotomy, those with an LVAD had longer operative times and larger intraoperative blood product requirements. Conclusion This study illustrates a negative impact of reoperative sternotomy and LVAD explanation on the heart transplant procedure itself and the consequences for the patient. The growing use of LVADs as a bridge to transplant will continue to increase the number of patients undergoing reoperative sternotomies. This study supports the development of less invasive devices for use as a bridge to transplant.

WOS: 000362463000002 PubMed ID: 26370456 In the present study, the effects of tacrolimus on the activity and expression of tissue factor (TF) were investigated in the ovarian ischemia-reperfusion induced injury in rats. Twenty-eight female rats (8-12 weeks, 300-350 g) were divided into four groups: control, ischemia-reperfusion (IR), tacrolimus treated before ischemia (TBI), and tacrolimus treated before reperfusion (TBR) groups (n = 7/per group). TF activity was measured using Quick's method, whereas TF expression was examined immunohistochemically. TF activity was significantly higher in all treated groups compared with the control group. Strong ovarian TF expression was demonstrated in the IR and TBR groups. Moreover, tacrolimus decreased TF activity in the TBI group compared with the IR group. The decreased activity of TF in the ovarian IR model may prevent IR-related inflammation during transplant procedure. (C) 2015 Society for Biology of Reproduction & the Institute of Animal Reproduction and Food Research of Polish Academy of Sciences in Olsztyn. Commission of Scientific Investigations Projects of Marmara University (Turkey) [SAG-C-YLP-120613-0240] This study was financially supported by Grant Project No: SAG-C-YLP-120613-0240 from the Commission of Scientific Investigations Projects of Marmara University (Turkey).

Aim This mixed methods study describes the post-transplantation daily life of pre-adolescents and adolescents who had undergone living donor liver transplantation and their parents. Methods Nine parent–child dyads were enrolled and all children were living donor liver transplant recipients. Three participants were pre-adolescents and the six were adolescents. Five of the parents surveyed in this study had been the donors. Members of the parent–child dyads completed the questionnaires and participated in semistructured interviews. An inductive qualitative analysis of the interview data was conducted. Results The post-transplantation daily life of the parent–child dyads had four distinct patterns: (i) pre-adolescents who had undergone transplantation during infancy, who had no understanding of the transplant procedure, and whose care was managed by their parent(s) without any problems; (ii) adolescents who were aware that their physical condition had improved after the transplant and who managed and dealt with the situation on their own; (iii) adolescents who were dissatisfied with the transplantation and associated immunosuppression because transplant procedures were perceived as negative or because they could not remember the transplant procedure; and (iv) one participant could not be categorized because their liver function deteriorated post-transplantation and they were registered for re-transplantation. Patterns were identified that characterized the post-transplantation daily life of pre-adolescents/adolescents who underwent liver transplantation, and that of their parents. Further research for post-transplantation parent–child dyads is warranted.

Dramatic, overnight cost increases of important orphan and generic medications have recently come under public and government scrutiny. We highlight the case of aerosolized ribavirin, an important antiviral agent in hematopoietic stem cell transplantation which, because of substantial price increases, may now cost more than the transplant procedure itself.

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.

Worldwide, more than 70,000 hematopoietic stem cell transplants (HSCTs) are performed each year and numbers continue to rise. It has taken more than 50 years to arrive at this point, with many setbacks occurring along the way. Today, absolute transplant numbers and transplant rates (TR; number of HSCTs per number of inhabitants) vary significantly between centers, countries, and global regions. Recent investigations have shed light on some factors associated with these differences. Macroeconomic factors such as availability of resources, type of infrastructure, organization of the medical network, prevalence of specific disease types, and the genetic backgrounds of recipients and donors explain some country-specific TR differences. Microeconomic center-specific factors, such as years of experience, patient volume, accreditation status, and the expectations of patients and physicians from the HSCT procedure add to these differences. The aim of the transplant procedure itself is the same for all: HSCT should provide a better outcome for the individual patient regarding overall survival, quality of life, and costs. Information about their own macro- and microeconomic backgrounds will assist new transplant centers to achieve these goals.

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.

Examination of cardiac explants is a challenge to the surgical pathologist. This is due to the complex anatomy of the heart, the numerous pathologies unique to the heart, and the complexities of cardiovascular interventions including the transplant procedure itself. The dissection technique described permits complete evaluation of the heart with good photographic and histologic documentation while maintaining the integrity of the specimen.

Purpose of review Bridging to lung transplantation remains a controversy. Individually, it may be a life-saving therapy to use ventilation and extracorporeal means for gas exchange to keep a patient alive until lung transplantation. Collectively, this may lead to a selection of patients with the worst outcome. New technologies have become available to minimize the adverse events of extracorporeal devices. This may have an impact on the indication and use of such devices and also on the outcome. Recent findings Literature of the last 3 years were reviewed for new aspects of extracorporeal gas exchange (extracorporeal membrane oxygenation, ECMO) in order to define the status quo of these therapeutic tools in bridging to lung transplantation. It was found that new oxygenator technologies as well as pump designs miniaturized ECMO systems. In addition, a variety of possibilities for specific indications were described. Recently, many programs work on concepts to use ECMO no longer in addition to mechanical ventilation, but to avoid or wean from ventilation. This situation represents a paradigm shift in the bridging strategies for lung transplantation. Summary Bridging to lung transplantation changes to concepts avoiding the sequels mechanical ventilation and thereby offers improvement of lung recipients prior to the transplant procedure.

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.

Imaging has played a major role in monitoring the well-being of the renal graft. Ultrasound, in particular, has been extremely helpful for the detection of postoperative complications related to the transplant kidney. From an imaging perspective, the complications of renal transplantation can be categorized into vascular complications, complications related to the collecting systems (urological complications), perinephric fluid collections, and parenchymal complications. Additionally, there are some complications that may occur, secondary to a transplant renal biopsy. To be able to correctly identify the complications associated with renal transplants, one should have a comprehensive understanding of various aspects of the transplant procedure and be familiar with the normal or expected findings after a transplant. This article provides an overview of renal transplantation and discusses the use of various imaging modalities in its evaluation. The various complications associated with renal transplant as well as renal biopsy are elaborated in this article with special emphasis on the use of ultrasound.

Introduction The definition of the optimal timing of referral for lung transplantation in cases of chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis remains a difficult question. Background The decision is based on the balance between the risk of death associated with the transplant procedure on one hand and, on the other, the risk of death associated with the natural course of the disease and/or the severity of the disability. It is not surprising, therefore, that the selection criteria take into account the main prognostic factors identified in both diseases. Recommendations for the selection criteria based on these prognostic indices have been published recently by a panel of international experts. In case of chronic obstructive pulmonary disease, the main indication for lung transplantation worldwide, the decision is not simple. The course of the individual patient is not easy to determine as, on an individual basis, some patients have a prolonged survival. In the case of idiopathic pulmonary fibrosis, the survival benefit provided by lung transplantation is well documented and it is therefore recommended to refer the patient to a transplantation centre once the diagnosis is established. This evaluation for lung transplantation does not prevent the subsequent inclusion of the patients in therapeutic protocols. Conclusion International guidelines assist the pulmonologist to define the optimal moment of referral but these guidelines are not absolute and therefore, in case of doubt, physicians should not hesitate to refer the patient to a transplant centre.

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

While the genetic matching between the donor and the recipient is essential for the success of the transplant procedure, there are other genetic factors that have the potential to significantly influence the clinical outcome. In this paper, the light is shed on this notion from a relatively new point of view.

Background: Melanocyte-keratinocyte transplant procedure (MKTP) successfully repigments postburn leukodermic scars. Objective: To further investigate the efficacy and limitations of MKTP for treatment of mechanically and chemically induced leukodermic scars. Methods: Ten patients with mechanically or chemically induced, depigmented or hypopigmented scars were preoperatively evaluated with Wood’s light examination, treated with MKTP, and followed for at least 6 months, with monitoring of repigmentation and colour matching. Results: Nine patients attended at least 6 months of follow-up. Six patients showed no fluorescence of scars under Wood’s lamp. All patients whose lesions didn’t fluoresce displayed less than 50% repigmentation, with 5 of 6 attaining 0% to 24%. Of the 3 patients displaying bright or some fluorescence, more than 95% repigmentation was achieved in 2 patients (skin phototypes V and VI), while less than 24% was attained for the third (skin phototype II). Conclusions: In this small case series, lack of fluorescence in leukodermic scars may be a useful negative prognostic indicator for MKTP, but additional trials are needed to verify that this is not due to melanocompetency.

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.

Background: The patient reported in this study was diagnosed with acute nonlymphocytic leukemia and underwent an allogenic bone marrow transplantation. She was referred for persisting oral ulceration and pain associated with the transplant procedure. Aim: To present an unusual involvement of gingival tissues during a case of oral chronic graft-versus-host-disease. Conclusion: This is one of the very few reports in the dental literature of a case of oral chronic graft-versus-host disease that includes the unusual manifestation of prominent gingival lesions.

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.

A transplanted organ suffers inherently from an ischaemic insult and subsequent reperfusion injury. The severity of such early events is thought to influence the success of the transplant procedure, not only in the immediate post-transplant period, but also to predispose the graft to both acute and chronic rejection. In this paper, we review the influence of the complement system upon ischaemia/reperfusion injury. The recognition of the involvement of complement has led to novel strategies to try to modulate ischaemia/reperfusion injury, some of which we have summarized. Finally, we note our own strategy to target complement inhibition in ischaemic tissues.

Although bone marrow transplantation (BMT) has become a widely practiced therapy for many childhood disorders, little research has been conducted on the psychosocial impact of BMT on family members. Parents have expressed particular concern about the psychosocial effects of BMT on the ill child's siblings. In a cohort of donor and nondonor siblings, the authors found that donors had significantly more anxiety, lower self-esteem, and more adaptive skills in school than did nondonors, whereas nondonors exhibited significantly more school problems. The authors report detailed findings derived from interviews with 44 siblings aged 6 to 18 years and 44 parents of surviving pediatric BMT patients. Among the siblings, minimal explanation of the transplant procedure, loneliness and lack of attention, donors' lack of choice, and need for support groups emerged as major themes. The authors emphasize the importance of attending to siblings' needs throughout the transplantation process and offer suggestions ...

To clarify the usefulness of spirometry to assess the function of the lung allograft post-transplant, we retrospectively reviewed 351 sequential spirometry measurements performed by 65 healthy recipients after the 80th postoperative day when the clinical evaluation and fiberoptic bronchoscopy with transbronchial biopsies and bronchoalveolar lavage excluded significant rejection or infection in the allograft. The mean coefficients of variation (CV) and significant values for change (SC) for the FVC, FEV1, and FEF25-75% were calculated according to the type of transplant procedure (heart-lung and double-lung [HL-DL] versus single-lung [SL]), and to the time after transplant when the spirometry measurements were obtainedor = 1 yr versus1 yr). The SC for the FVC decreased with time after transplantation for both HL-DL (or = 1 yr: 17% versus1 yr: 7%) and SL recipients (or = 1 yr: 13% versus1 yr: 8%). The higher degree of variability within the first year was primarily due to increasing values especially in the HL-DL recipients. The SC for the FEV1 also decreased over time for HL-DL recipients (or = 1 yr: 18% versus1 yr: 9%) but was similar for SL recipients at both intervals (13%). Our results suggest that decreases ofor = 11% in FVC or 12% in FEV1 in HL-DL recipients andor = 12% in FVC or 13% in FEV1 for SL recipients indicate a significant decrease in allograft function that may be due to infection or rejection.

C OMPLICATIONS are common after liver transplantation. A decade ago, the University of Pittsburgh reported that 87% of patients experienced severe complications] This high rate of complications is not surprising because end-stage liver disease, independent of transplantation, is accompanied by multiple, severe secondary end-organ dysfunction. These include systemic vascular dilatation, hepatorenal and hepatopulmonary syndromes, and encephalopathy. These secondary complications are often the primary reason for liver transplantation, because a functioning liver graft leads to resolution of these multiorgan abnormalities. In this respect, the major "complications" of liver transplantation are, in fact, the resolution of end-organ dysfunction. For this reason, we review the basic physiology of end-stage liver disease and what is known of its resolution after liver transplantation. In addition, complications strictly attributable to the transplant procedure, specifically venovenous bypass complications and hepatic artery thrombosis, also are reviewed.

Summary Lung transplantation is an evolving technology. It is amazing how much has changed in just a few years as new information has become available. Information in this article will probably also become outdated quickly. Nevertheless, this report does represent the generally accepted current views regarding candidate selection and choice of transplant procedure. The trend over the years has been to broaden indications and liberalize criteria. However, the era of managed care is upon us and this is forcing us to closely examine costs. The greater emphasis placed on cost will probably negatively impact further liberalization of selection criteria. To remain competitive in the managed care era, centers will be rewarded for performing procedures as cheaply as possible. One way to accomplish this is to avoid high-risk patients and high-risk procedures. A high-risk procedure can be defined as anything that has never been performed or has been performed only a few times. Because pushing forward the frontiers of knowledge requires assumption of greater risks of complications and/or adverse outcomes with the attendant risk of higher costs and poorer outcome, the current environment is not conducive to innovation in lung transplantation. A revisit of this topic in the next 4 or 5 years should be interesting.