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Successful Transplantation (successful + transplantation)
Selected AbstractsOverview and Future Practice Patterns in Cardiac and Pulmonary PreservationJOURNAL OF CARDIAC SURGERY, Issue 2 2000John V. Conte M.D. Successful transplantation requires preservation of allografts until they can be implanted and reperfused. In the decades since the transplantation of thoracic organs became a clinical reality, many advances have been made in preoperative donor management, procurement, and preservation techniques. This article summarizes the state of the art in heart and lung preservation and review some of the areas of current research that may lead to improvements in preservation techniques in the future. [source] Successful transplantation of a cadaveric kidney with post-infectious glomerulonephritisPEDIATRIC TRANSPLANTATION, Issue 1 2000S. Mizuiri Abstract: This report describes a successful renal Tx in a patient with chronic renal failure, caused by dysplastic kidneys, who received a cadaveric kidney with post-infectious glomerulonephritis. Sequential renal biopsies were performed at 12 h before Tx, and at 1 h and on days 8 and 58 post-Tx. Post-operative hematuria disappeared on day 9 and proteinuria on day 13. Normal graft function was observed within 1 month, with histologic resolution. Our study suggests that while the donor kidney facilitates deposition of certain immune reactants, this is a host (environmental) problem and when transplanted into a new host (new environment), the problem is no longer sustained. [source] Successful transplantation of organs from a donor who died from acute cocaine intoxicationCLINICAL TRANSPLANTATION, Issue 2 2003Francisco Caballero One to two percent of the general population of western countries are regular consumers of cocaine, 10% being sporadic consumers. This proportion increases considerably in the population age groups which are most frequently organ donors. Cocaine may directly cause brain death, or be present in those with brain death who died from other causes, especially head trauma. We present a 30-yr-old female donor, a regular consumer of inhaled cocaine, who died of brain anoxia after cocaine inhalation. Twenty-five hours after cocaine inhalation, the liver and kidneys were removed for transplantation. The liver was transplanted to a patient with acute hepatocellular failure caused by isoniazids, and the kidneys to two recipients with renal polycystosis. Toxicity attributable to the cocaine was not observed in any of the three recipients. All three grafts presented immediate function, and the clinical evolution of all three recipients and the function of all three grafts were excellent during the 5 yr of follow-up. The serum creatinines of the two kidney recipients 5 yr from transplantation were 76 and 72 ,mol/L, respectively. [source] Efficient generation of human hepatocytes by the intrahepatic delivery of clonal human mesenchymal stem cells in fetal sheep,HEPATOLOGY, Issue 6 2007Jason Chamberlain Alternative methods to whole liver transplantation require a suitable cell that can be expanded to obtain sufficient numbers required for successful transplantation while maintaining the ability to differentiate into hepatocytes. Mesenchymal stem cells (MSCs) possess several advantageous characteristics for cell-based therapy and have been shown to be able to differentiate into hepatocytes. Thus, we investigated whether the intrahepatic delivery of human MSCs is a safe and effective method for generating human hepatocytes and whether the route of administration influences the levels of donor-derived hepatocytes and their pattern of distribution throughout the parenchyma of the recipient's liver. Human clonally derived MSCs were transplanted by an intraperitoneal (n = 6) or intrahepatic (n = 6) route into preimmune fetal sheep. The animals were analyzed 56,70 days after transplantation by immunohistochemistry, enzyme-linked immunosorbent assay, and flow cytometry. The intrahepatic injection of human MSCs was safe and resulted in more efficient generation of hepatocytes (12.5% ± 3.5% versus 2.6% ± 0.4%). The animals that received an intrahepatic injection exhibited a widespread distribution of hepatocytes throughout the liver parenchyma, whereas an intraperitoneal injection resulted in a preferential periportal distribution of human hepatocytes that produced higher amounts of albumin. Furthermore, hepatocytes were generated from MSCs without the need to first migrate/lodge to the bone marrow and give rise to hematopoietic cells. Conclusion: Our studies provide evidence that MSCs are a valuable source of cells for liver repair and regeneration and that, by the alteration of the site of injection, the generation of hepatocytes occurs in different hepatic zones, suggesting that a combined transplantation approach may be necessary to successfully repopulate the liver with these cells. (HEPATOLOGY 2007.) [source] Pre-emptive renal transplantation in childrenINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2001Hiroshi Harada Abstract Background: Renal transplantation is a definitive therapeutic modality in end-stage renal disease (ESRD). Most ESRD patients in Japan experience dialysis prior to renal transplantation. The present study was undertaken to examine the usefulness of pre-emptive renal transplantation (PET). Methods: Between 1987 and 1998, 255 renal transplantations were carried out by the authors. Among those consecutive cases, 10 were cases of PET. In nine pediatric cases, demographics, graft and patient survival, height growth and benefits from successful transplantation were studied and compared with age-matched dialyzed transplantation controls. Results: All transplantation was living-related. There was a disparity of causes of ESRD between the two groups. In PET, acquired renal deterioration due to a congenital lower urinary tract disorder was the major cause. Graft and patient prognosis was favorable in both groups. Growth retardation in PET patients under 15 years of age was significantly less apparent at the time of transplantation and after 3 years compared to the control. The benefits from transplantation were different in the two groups. Most PET patients felt an improvement of their physical condition; however, all of the control patients felt that the major boon was the freedom from the restriction of the daily diet and time for dialysis. Conclusion: In pediatric renal transplantation, short-term preceding dialysis does not have a detrimental effect, but PET could benefit ESRD patients by maintaining their quality of life. Moreover, PET minimizes the production of renal dwarfism in prepubertal children. Thus, PET should be taken into consideration in the choice of renal replacement therapy. [source] A national conference to determine research priorities in pediatric solid organ transplantationPEDIATRIC TRANSPLANTATION, Issue 2 2008Sharon M. Bartosh Abstract:, The need for evidence-based practice guidelines requires high quality, carefully controlled clinical research trials. This multidisciplinary conference attempted to: identify urgent clinical and research issues, identify obstacles to performing clinical trials, develop concepts for organ-specific and all-organ research and generate a report that would serve as a blueprint for future research initiatives. A few themes became evident. First, young children present a unique immunologic environment which may lead to tolerance, therefore, including young children in immunosuppression withdrawal and tolerance trials may increase the potential benefits of these studies. Second, adolescence poses significant barriers to successful transplantation. Non-adherence may be insufficient to explain poorer outcomes. More studies focused on identification and prevention of non-adherence, and the potential effects of puberty are required. Third, the relatively naive immune system of the child presents a unique opportunity to study primary infections and alloimmune responses. Finally, relatively small numbers of transplants performed in pediatric centers mandate multicenter collaboration. Investment in registries, tissue and DNA repositories will enhance productivity. The past decade has proven that outcomes after pediatric transplantation can be comparable to adults. The pediatric community now has the opportunity to design and complete studies that enhance outcomes for all transplant recipients. [source] Hepatoblastoma in a child with progressive familial intrahepatic cholestasisPEDIATRIC TRANSPLANTATION, Issue 6 2005A. Richter Abstract:, End-stage liver cirrhosis because of metabolic or infectious diseases predisposes to hepatic malignancies like hepatocellular carcinoma. We report the first case of hepatoblastoma incidentally detected in the explanted liver of a 2-yr-old child undergoing liver transplantation for cirrhosis because of progressive familial intrahepatic cholestasis (PFIC). The diagnosis was difficult to obtain. The hepatoblastoma was not seen on ultrasound examination of the cirrhotic liver. As we could confirm retrospectively, alpha fetoprotein (AFP) was found elevated prior to transplantation. Two years after successful transplantation, there are no signs of malignancy detectable by clinical and radiological methods. We conclude from this case that PFIC may induce hepatoblastoma and that children with liver cirrhosis should undergo routine screening of serum AFP concentration. [source] Hypothermic Machine Preservation in Human Liver Transplantation: The First Clinical SeriesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2010J. V. Guarrera Hypothermic machine perfusion (HMP) is widely used to preserve kidneys for transplantation with improved results over cold storage (CS). To date, successful transplantation of livers preserved with HMP has been reported only in animal models. In this, the first prospective liver HMP study, 20 adults received HMP-preserved livers and were compared to a matched group transplanted with CS livers. HMP was performed for 3,7 h using centrifugal perfusion with Vasosol® solution at 4,6°C. There were no cases of primary nonfunction in either group. Early allograft dysfunction rates were 5% in the HMP group versus 25% in controls (p = 0.08). At 12 months, there were two deaths in each group, all unrelated to preservation or graft function. There were no vascular complications in HMP livers. Two biliary complications were observed in HMP livers compared with four in the CS group. Serum injury markers were significantly lower in the HMP group. Mean hospital stay was shorter in the HMP group (10.9 ± 4.7 days vs. 15.3 ± 4.9 days in the CS group, p = 0.006). HMP of donor livers provided safe and reliable preservation in this pilot case-controlled series. Further multicenter HMP trials are now warranted. [source] Successful Urgent Transplantation of an Adult Kidney into a Child with Inferior Vena Cava ThrombosisAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009R. B. Stevens Poor venous drainage options following inferior vena cava (IVC) thrombosis have been considered to complicate or preclude renal transplantation of adult kidneys into pediatric patients. We describe urgent renal transplantation in a 5-year-old (15.3 kg) male with IVC thrombosis using an adult living donor. Preoperative magnetic resonance venography revealed a patent infrahepatic/suprarenal vena cava and portal system. In surgery, the right liver lobe was mobilized sufficiently to anastomose the graft renal vein to the native IVC at the confluence of the native left renal vein and proximal vena cava. Graft function has remained excellent with serum creatinine of 0.5 mg/dL at 36 months. IVC thrombosis need not preclude successful transplantation of adult-sized kidneys into children. [source] Proteasome Inhibition Causes Apoptosis of Normal Human Plasma Cells Preventing Alloantibody ProductionAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2009D. K. Perry Antibody production by normal plasma cells (PCs) against human leukocyte antigens (HLA) can be a major barrier to successful transplantation. We tested four reagents with possible activity against PCs (rituximab, polyclonal rabbit antithymocyte globulin (rATG), intravenous immunoglobulin (IVIG) and the proteasome inhibitor, bortezomib) to determine their ability to cause apoptosis of human bone marrow-derived PCs and subsequently block IgG secretion in vitro. IVIG, rituximab and rATG all failed to cause apoptosis of PCs and neither rituximab nor rATG blocked antibody production. In contrast, bortezomib treatment led to PC apoptosis and thereby blocked anti-HLA and antitetanus IgG secretion in vitro. Two patients treated with bortezomib for humoral rejection after allogeneic kidney transplantation demonstrated a transient decrease in bone marrow PCs in vivo and persistent alterations in alloantibody specificities. Total IgG levels were unchanged. We conclude that proteasome activity is important for PC longevity and its inhibition may lead to new techniques of controlling antibody production in vivo. [source] Domino Heart Transplantation Involving InfantsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2007T. L. Astor Domino heart transplantation has been well described in adults, but has not previously been reported in infant patients. We report the successful transplantation of a ,domino' heart from a 3-month-old infant with primary pulmonary hypertension undergoing heart,lung transplantation, into a 3-month-old infant with complex congenital heart disease. Both infants have survived past 1 year post-transplant, and neither infant has experienced any clinically significant allograft-related complications. Echocardiography and cardiac catheterization of the domino heart have consistently demonstrated stable hypertrophy of the right ventricle (RV) and interventricular septum, but good right and left ventricular function. Domino heart transplant surgery may be an effective way to provide ,pre-conditioned' donor hearts to infants urgently in need of heart transplantation. [source] The taming of the shrew or corneal transplantation: past, present and futureACTA OPHTHALMOLOGICA, Issue 2008U PLEYER Keratoplasty has definitely its paradoxes. It has been the first successful transplantation in man and is with approx. 100. 000 grafts/year easily the most frequent allograft in human medicine. At the same time it is still the least understood form of transplantation in respect to its biology. It is both, the most successfull as well as probably the most underestimated procedure regarding its risks in clinical transplantation. Indeed, the common assumtion, that corneal transplantation is a safe procedure with good prognosis may have hindered more intensive effort of research in this field. This lecture aims to highlight significant milestones in the rich history of corneal transplantation, and to pay tribute to the many inspired and dedicated individuals involved in the development of keratoplasty. There are still limitations to corneal transplantation, and corneal allograft rejection still poses the greatest challenge to the modern corneal surgeon. Therefore, particular emphasis will be paid to recent efforts and developments to overcome this challenge. [source] Predictors of employment after successful kidney transplantation , a population-based studyCLINICAL TRANSPLANTATION, Issue 4 2008Maristela Bohlke Abstract:, Introduction:, Kidney transplantation is currently the treatment of choice for end-stage renal disease. As the successful transplantation improves the physical and mental quality of life, it is expected that the transplant recipient should play a productive role in the society. The present study evaluates the occurrence and predictors of employment after kidney transplantation. Methods:, Population-based cross-sectional study in which 272 adult kidney recipients assisted in a Brazilian Southern state were evaluated. Results:, At the moment of the interview, 29% of the patients were employed. After analysis with logistic regression, the predictors of employment were male sex (OR 4.04; 95% CI 1.99,8.23), pre-transplant employment for non-diabetic (OR 4.35; 95% CI 3.79,4.99), diabetes for individuals who worked while on dialysis (OR 0.06; 95% CI 0.008,0.5), high educational level for individuals with mental quality of life scores above the 25th percentile (OR 3.06; 95% CI 2.98,3.14 for 50th percentile of mental quality of life). The Hosmer,Lemeshow test was of 3.33 (p = 0.91). Conclusion:, The participation of the kidney transplant recipients with functioning graft into the work force in the Brazilian state of Rio Grande do Sul is low, being predicted mainly by sociodemographic factors. It was not detected any influence of patient perception of his/her physical conditions or other clinical variables, except for the presence of diabetes. [source] | ||||||||||