Journal of Transplantation最新文献

{"title":"Waitlist Mortality and Posttransplant Outcomes in African Americans with Autoimmune Liver Diseases.","authors":"John Paul Nsubuga,&nbsp;Daniela Goyes,&nbsp;Hirsh D Trivedi,&nbsp;Esli Medina-Morales,&nbsp;Vilas Patwardhan,&nbsp;Alan Bonder","doi":"10.1155/2021/6692049","DOIUrl":"https://doi.org/10.1155/2021/6692049","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation is indicated in end-stage liver disease due to autoimmune diseases. The liver allocation system can be affected by disparities such as decreased liver transplant referrals for racial minorities, especially African Americans that negatively impact the pre- and posttransplant outcomes.</p><p><strong>Aim: </strong>To determine differences in waitlist survival and posttransplant graft survival rates between African American and Caucasian patients with autoimmune liver diseases. <i>Study</i>. The United Network for Organ Sharing database was used to identify all patients with autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis who underwent liver transplant from 1988 to 2019. We compared waitlist survival and posttransplant graft survival between Caucasians and African Americans using Kaplan-Meier curves and Cox regression models. We also evaluated the cumulative incidence of death or delisting for deterioration and posttransplant incidence of death and retransplantation using competing risk analysis.</p><p><strong>Results: </strong>African Americans were more likely to be removed from the waitlist for death or clinical deterioration (subdistribution hazard ratio (SHR) 1.26, 95% CI 1-1.58, <i>P</i>=0.046) using competing risk analysis. On multivariate Cox regression analysis, there was no difference in posttransplant graft survival among the two groups (hazard ratio (HR) 1.10, 95% CI 0.98-1.23, <i>P</i>=0.081).</p><p><strong>Conclusions: </strong>Despite the current efforts to reduce racial disparities, we found that African Americans are more likely to die on the waitlist for liver transplant and are less likely to be transplanted, with no differences in graft survival rates. The persistence of healthcare disparities continues to negatively impact African Americans.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"6692049"},"PeriodicalIF":2.5,"publicationDate":"2021-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8357471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39313458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Bigger Better? Living Donor Kidney Volume as Measured by the Donor CT Angiogram in Predicting Donor and Recipient eGFR after Living Donor Kidney Transplantation.","authors":"Chaudhry Adeel Ebad, David Brennan, Julio Chevarria, Mohammad Bin Hussein, Donal Sexton, Douglas Mulholland, Ciaran Doyle, Patrick O'Kelly, Yvonne Williams, Ruth Dunne, Conall O'Seaghdha, Dilly Little, Martina Morrin, Peter J Conlon","doi":"10.1155/2021/8885354","DOIUrl":"10.1155/2021/8885354","url":null,"abstract":"<p><strong>Background: </strong>The role of kidney volume measurement in predicting the donor and recipient kidney function is not clear.</p><p><strong>Methods: </strong>We measured kidney volume bilaterally in living kidney donors using CT angiography and assessed the association with the donor remaining kidney and recipient kidney (donated kidney) function at 1 year after kidney transplantation. Donor volume was categorized into tertiles based on lowest, middle, and highest volume.</p><p><strong>Results: </strong>There were 166 living donor and recipient pairs. The mean donor age was 44.8 years (SD ± 10.8), and donor mean BMI was 25.5 (SD ± 2.9). The recipients of living donor kidneys were 64% male and had a mean age of 43.5 years (SD ± 13.3). Six percent of patients experienced an episode of cellular rejection and were maintained on dialysis for a mean of 18 months (13-32) prior to transplant. Kidney volume was divided into tertiles based on lowest, middle, and highest volume. Kidney volume median (range) in tertiles 1, 2, and 3 was 124 (89-135 ml), 155 (136-164 ml), and 184 (165-240 ml) with donor eGFR ml/min (adjusted for body surface area expressed as ml/min/1.73 m²) at the time of donation in each tertile, 109 (93-129), 110 (92-132), and 101 ml/min (84-117). The median (IQR) eGFR in tertiles 1 to 3 in kidney recipients at 1 year after donation was 54 (44-67), 62 (50-75), and 63 ml/min (58-79), respectively. The median (IQR) eGFR in tertiles 1 to 3 in the remaining kidney of donors at 1 year after donation was 59 (53-66), 65 (57-72), and 65 ml/min (56-73), respectively.</p><p><strong>Conclusion: </strong>Bigger kidney volume was associated with better eGFR at 1 year after transplant in the recipient and marginally in the donor remaining kidney.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"8885354"},"PeriodicalIF":2.5,"publicationDate":"2021-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39265841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Timing of Stent Removal on the Incidence of UTI, Recurrence, Symptomatology, Resistance, and Hospitalization in Renal Transplant Recipients.","authors":"Ziad Arabi,&nbsp;Khalefa Al Thiab,&nbsp;Abdulrahman Altheaby,&nbsp;Mohammed Tawhari,&nbsp;Ghaleb Aboalsamh,&nbsp;Mohamad Almarastani,&nbsp;Samy Kashkoush,&nbsp;Mohammed F Shaheen,&nbsp;Abdulrahman Altamimi,&nbsp;Lina Alnajjar,&nbsp;Rawan Alhussein,&nbsp;Raghad Almuhiteb,&nbsp;Bashayr Alqahtani,&nbsp;Rayana Alotaibi,&nbsp;Marah Alqahtani,&nbsp;Yahya Ghazwani,&nbsp;Wael O'Hali,&nbsp;Khalid Bin Saad","doi":"10.1155/2021/3428260","DOIUrl":"https://doi.org/10.1155/2021/3428260","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of early (<3 weeks) versus late (>3 weeks) urinary stent removal on urinary tract infections (UTIs) post renal transplantation.</p><p><strong>Methods: </strong>A retrospective study was performed including all adult renal transplants who were transplanted between January 2017 and May 2020 with a minimum of 6-month follow-up at King Abdulaziz Medical City, Riyadh, Saudi Arabia.</p><p><strong>Results: </strong>A total of 279 kidney recipients included in the study were stratified into 114 in the early stent removal group (ESR) and 165 in the late stent removal group (LSR). Mean age was 43.4 ± 15.8; women: <i>n</i>: 114, 40.90%; and deceased donor transplant: <i>n</i>: 55, 19.70%. Mean stent removal time was 35.3 ± 28.0 days posttransplant (14.1 ± 4.6 days in the ESR versus 49.9 ± 28.1 days in LSR, <i>p</i> < 0.001). Seventy-four UTIs were diagnosed while the stents were in vivo or up to two weeks after the stent removal \"UTIs related to the stent\" (<i>n</i> = 20, 17.5% in ESR versus <i>n</i> = 54, 32.7% in LSR; <i>p</i>=0.006). By six months after transplantation, there were 97 UTIs (<i>n</i> = 36, 31.6% UTIs in ESR versus <i>n</i> = 61, 37% in LSR; <i>p</i>=0.373). Compared with UTIs diagnosed after stent removal, UTIs diagnosed while the stent was still in vivo tended to be complicated (17.9% versus 4.9%, <i>p</i>: 0.019), recurrent (66.1% versus 46.3%; <i>p</i>: 0.063), associated with bacteremia (10.7% versus 0%; <i>p</i>: 0.019), and requiring hospitalization (61% versus 24%, <i>p</i>: 0.024). Early stent removal decreased the need for expedited stent removal due to UTI reasons (rate of UTIs before stent removal) (<i>n</i> = 11, 9% in the early group versus <i>n</i> = 45, 27% in the late group; <i>p</i>=0.001). The effect on the rate of multidrug-resistant organisms (MDRO) was less clear (33% versus 47%, <i>p</i>: 0.205). Early stent removal was associated with a statistically significant reduction in the incidence of UTIs related to the stent (HR = 0.505, 95% CI: 0.302-0.844, <i>p</i>=0.009) without increasing the incidence of urological complications. Removing the stent before 21 days posttransplantation decreased UTIs related to stent (aOR: 0.403, CI: 0.218-0.744). Removing the stent before 14 days may even further decrease the risk of UTIs (aOR: 0.311, CI: 0.035- 2.726).</p><p><strong>Conclusion: </strong>Early ureteric stent removal defined as less than 21 days post renal transplantation reduced the incidence of UTIs related to stent without increasing the incidence of urological complications. UTIs occurring while the ureteric stent still in vivo were notably associated with bacteremia and hospitalization. A randomized trial will be required to further determine the best timing for stent removal.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"3428260"},"PeriodicalIF":2.5,"publicationDate":"2021-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39219637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Living-Related Kidney Transplant Program in Brunei Darussalam: Lessons Learnt from a Nascent National Program in a Small, Muslim, and Asian Country.","authors":"Jackson Tan,&nbsp;Muhammad Abdul Mabood Khalil,&nbsp;Dalinatul Ahmed,&nbsp;Jayakrishnan Pisharam,&nbsp;Chiao Yuen Lim,&nbsp;Hock Beng Chua,&nbsp;William Chong,&nbsp;Kim Khee Tan","doi":"10.1155/2021/8828145","DOIUrl":"https://doi.org/10.1155/2021/8828145","url":null,"abstract":"<p><p>Brunei Darussalam commenced its living-related renal transplant program in 2013, with subsequent attainment of independent local capacity and proficiency in 2019. The preliminary outcome from the program has already begun to shape the national nephrology landscape with a 36% increment in transplant rate and mitigation of commercialized transplantations. The blueprint for the program was first laid out in 2010 and thereupon executed in four phases. The first phase involved the gathering of evidence to support the establishment of the national program, through researches investigating feasibility, public opinion, quality of life, graft survival, and cost-effectiveness. The second phase focused on laying the foundation of the program through grooming of local expertise, implementation of legal-ethical frameworks, religious legitimization, and propagation of awareness. The third phase worked on facilitating experiential exposure and strengthening local infrastructure through the upgrading of facilities and the introduction of subsidiary services. The fourth phase was implemented in Brunei in 2013 when foreign personnel worked together with the local team to perform the transplants. Between 2013 and 2019, ten kidney transplants were performed, with two being done in 2018 and three in 2019. We hope to inspire other similar countries to develop their own self-sustainable and independent local program.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"8828145"},"PeriodicalIF":2.5,"publicationDate":"2021-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38895930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Hepatitis C Post-Liver Transplantation Could Mitigate Discard Rates of Hepatitis C-Positive Deceased Donor Livers and Expand the Donor Pool.","authors":"Jennifer Keller,&nbsp;Gary Marklin,&nbsp;Obi Okoye,&nbsp;Roshani Desai,&nbsp;Tej Sura,&nbsp;Ajay Jain,&nbsp;Chintalapati Varma,&nbsp;Mustafa Nazzal","doi":"10.1155/2021/6612453","DOIUrl":"https://doi.org/10.1155/2021/6612453","url":null,"abstract":"<p><strong>Background: </strong>Prior to 2014, treatment for hepatitis C was limited. However, the subsequent introduction of direct acting antiviral medications (DAA) against hepatitis C led to improvements in morbidity and better medication tolerance. DAA therapy allowed for an increase in treatment rates of hepatitis C in patients on the liver transplant waiting list. With the popularization of DAA, there became a growing concern about the utility of hepatitis C-positive (HCV+) deceased liver donors, especially after treating HCV+ potential recipients on the transplant waiting list.</p><p><strong>Methods: </strong>This is a retrospective, observational study using Mid-America Transplant Services (MTS) database from 2008 to 2017. Comparison was made before the widespread use of DAAs 2008-2013 (pre-DAA) against their common practice use 2014-2017 (post-DAA). All deceased liver donors with HCV antibody or nucleic acid positive results were evaluated.</p><p><strong>Results: </strong>Between 2008 and 2017, 96 deceased liver donors were positive for HCV. In the pre-DAA era, 47 deceased liver donors were positive for HCV, of which 32 (68.1%) were transplanted and 15 (31.9%) were discarded. In the post-DAA era, a total of 49 HCV+ organs were identified, out of which 43 (87.8%) livers were transplanted and 6 (12.2%) were discarded. Discard rate was significantly higher in the pre-DAA population (31.9% vs. 12.2%, <i>p</i> = 0.026). Secondary analysis showed a distinct trend towards increased regional sharing and utilization of HCV+ donors.</p><p><strong>Conclusion: </strong>In order to reduce discard rates of HCV+ patients, our data suggest that transplant centers could potentially delay HCV treatment in patients on the transplant waitlist.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2021 ","pages":"6612453"},"PeriodicalIF":2.5,"publicationDate":"2021-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25351312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversibility of Frailty after Lung Transplantation.","authors":"Elyn Montgomery, Peter S Macdonald, Phillip J Newton, Sungwon Chang, Kay Wilhelm, Sunita R Jha, Monique Malouf","doi":"10.1155/2020/3239495","DOIUrl":"10.1155/2020/3239495","url":null,"abstract":"Background Frailty contributes to increased morbidity and mortality in patients referred for and undergoing lung transplantation (LTX). The study aim was to determine if frailty is reversible after LTX in those classified as frail at LTX evaluation. Methods Consecutive LTX recipients were included. All patients underwent modified physical frailty assessment during LTX evaluation. For patients assessed as frail, frailty was reassessed on completion of the post-LTX rehabilitation program. Frailty was defined by the presence of ≥ 3 domains of the modified Fried Frailty Phenotype (mFFP). Results We performed 166 lung transplants (frail patients, n = 27, 16%). Eighteen of the 27 frail patients have undergone frailty reassessment. Eight frail patients died, and one interstate recipient did not return for reassessment. In the 18 (66%) patients reassessed, there was an overall reduction in their frailty score post-LTX ((3.4 ± 0.6 to 1.0 ± 0.7), p < 0.001) with 17/18 (94%) no longer classified as frail. Improvements were seen in the following frailty domains: exhaustion, mobility, appetite, and activity. Handgrip strength did not improve posttransplant. Conclusions Physical frailty was largely reversible following LTX, underscoring the importance of considering frailty a dynamic, not a fixed, entity. Further work is needed to identify those patients whose frailty is modifiable and establish specific interventions to improve frailty.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2020 ","pages":"3239495"},"PeriodicalIF":2.5,"publicationDate":"2020-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/3239495","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38313166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sirtuin 1: A Dilemma in Transplantation.","authors":"Sara Assadiasl,&nbsp;Nuala Mooney,&nbsp;Bahareh Mohebbi,&nbsp;Yousef Fatahi,&nbsp;Narjes Soleimanifar","doi":"10.1155/2020/9012980","DOIUrl":"https://doi.org/10.1155/2020/9012980","url":null,"abstract":"<p><p>Sirtuin 1, a member of sirtuin family of histone deacetylase enzymes, has been implicated in a variety of physiologic and pathologic events, including energy metabolism, cell survival, and age-related alterations. In view of the anti-inflammatory properties of sirtuin 1 along with its protective role in ischemia reperfusion injury, it might be considered as contributing to the promotion of transplantation outcome. However, the potential ability of sirtuin 1 to induce malignancies raises some concerns about its overexpression in clinic. Moreover, despite the findings of sirtuin 1 implication in thymic tolerance induction and T regulatory (Treg) cells survival, there is also evidence for its involvement in Treg suppression and in T helper 17 cells differentiation. The identification of sirtuin 1 natural and synthetic activators leads to the proposal of sirtuin 1 as an eligible target for clinical interventions in transplantation. All positive and negative consequences of sirtuin 1 overactivation/overexpression in the allograft should therefore be studied thoroughly. Herein, we summarize previous findings concerning direct and indirect influences of sirtuin 1 manipulation on transplantation.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2020 ","pages":"9012980"},"PeriodicalIF":2.5,"publicationDate":"2020-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/9012980","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37905904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretransplant Donor-Specific Anti-HLA Antibodies and the Risk for Rejection-Related Graft Failure of Kidney Allografts.","authors":"Michiel G H Betjes,&nbsp;Kasia S Sablik,&nbsp;Henny G Otten,&nbsp;Dave L Roelen,&nbsp;Frans H Claas,&nbsp;Annelies de Weerd","doi":"10.1155/2020/5694670","DOIUrl":"https://doi.org/10.1155/2020/5694670","url":null,"abstract":"<p><strong>Background: </strong>The presence of donor-specific antibodies (DSAs) against HLA before kidney transplantation has been variably associated with decreased long-term graft survival. Data on the relation of pretransplant DSA with rejection and cause of graft failure in recipients of donor kidneys are scarce.</p><p><strong>Methods: </strong>Patients transplanted between 1995 and 2005 were included and followed until 2016. Donor-specific antibodies before transplantation were determined retrospectively. For cause, renal transplant biopsies were reviewed.</p><p><strong>Results: </strong>Pretransplant DSAs were found in 160 cases on a total of 734 transplantations (21.8%). In 80.5% of graft failures, a diagnostic renal biopsy was performed. The presence of pretransplant DSA (DSApos) increased the risk of graft failure within the first 3 months after transplantation (5.2% vs. 9.4%) because of rejection with intragraft thrombosis (<i>p</i> < 0.01). One year after transplantation, DSApos recipients had an increased hazard for antibody-mediated rejection at 10 years (9% DSAneg vs. 15% DSApos, <i>p</i> < 0.01). One year after transplantation, DSApos recipients had an increased hazard for antibody-mediated rejection at 10 years (9% DSAneg vs. 15% DSApos, <i>p</i> < 0.01). One year after transplantation, DSApos recipients had an increased hazard for antibody-mediated rejection at 10 years (9% DSAneg vs. 15% DSApos.</p><p><strong>Conclusions: </strong>Pretransplant DSAs are a risk factor for early graft loss and increase the incidence for humoral rejection and graft loss but do not affect the risk for T cell-mediated rejection.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2020 ","pages":"5694670"},"PeriodicalIF":2.5,"publicationDate":"2020-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5694670","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37678955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type of Preservation Solution, UW or HTK, Has an Impact on the Incidence of Biliary Stricture following Liver Transplantation: A Retrospective Study.","authors":"Rojbin Karakoyun,&nbsp;Antonio Romano,&nbsp;Johan Nordström,&nbsp;Bo-Göran Ericzon,&nbsp;Greg Nowak","doi":"10.1155/2019/8150736","DOIUrl":"https://doi.org/10.1155/2019/8150736","url":null,"abstract":"<p><p>Organ preservation plays a crucial role in the outcome following solid organ transplantation. The aim of this study was to perform a retrospective outcome analysis following liver transplantation using histidine tryptophan ketoglutarate (HTK) or the University of Wisconsin (UW) solutions for liver graft preservation. We retrospectively reviewed data on adult patients who were liver-transplanted at Karolinska University Hospital between 2007 and 2015. There was evaluation of donor and recipient characteristics, pre- and post-transplant blood chemistry tests, biliary and vascular complications, graft dysfunction and nonfunction, and patient and graft survivals. A total of 433 patients were included in the analyses, with 230 and 203 patients having received livers preserved with HTK and UW, respectively. Mean follow-up was 45 ± 29 months for the HTK group and 42.4 ± 26 for the UW group. There was no difference between the two groups either in terms of patient and graft survival, or of results of postoperative blood chemistry, or incidence of arterial complications, early allograft dysfunction, or primary graft nonfunction. However, the incidence of biliary stricture was higher in the UW group (22.7%) versus the HTK group (13.5%; <i>p</i>=0.013). Use of UW and HTK preservation solution in liver transplantation has no impact on patient and graft survival. However, use of HTK solution results in a lower incidence of posttransplant biliary stricture.</p>","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2019 ","pages":"8150736"},"PeriodicalIF":2.5,"publicationDate":"2019-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/8150736","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37540613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial Glycocalyx Shedding Occurs during Ex Vivo Lung Perfusion: A Pilot Study","authors":"T. M. Sladden, S. Yerkovich, D. Wall, M. Tan, W. Hunt, J. Hill, I. Smith, P. Hopkins, D. Chambers","doi":"10.1155/2019/6748242","DOIUrl":"https://doi.org/10.1155/2019/6748242","url":null,"abstract":"Background Damage to the endothelium has been established as a key pathological process in lung transplantation and ex vivo lung perfusion (EVLP), a new technology that provides a platform for the assessment of injured donor lungs. Damage to the lung endothelial glycocalyx, a structure that lines the endothelium and is integral to vascular barrier function, has been associated with lung dysfunction. We hypothesised that endothelial glycocalyx shedding occurs during EVLP and aimed to establish a porcine model to investigate the mechanism underlying glycocalyx breakdown during EVLP. Methods Concentrations of endothelial glycocalyx breakdown products, syndecan-1, hyaluronan, heparan sulphate, and CD44, were measured using the ELISA and matrix metalloproteinase (MMP) activity by zymography in the perfusate of both human (n = 9) and porcine (n = 4) lungs undergoing EVLP. Porcine lungs underwent prolonged EVLP (up to 12 hours) with perfusion and ventilation parameters recorded hourly. Results During human EVLP, endothelial glycocalyx breakdown products in the perfusate increased over time. Increasing MMP-2 activity over time was positively correlated with levels of syndecan-1 (r = 0.886; p=0.03) and hyaluronan (r = 0.943; p=0.02). In the porcine EVLP model, hyaluronan was the only glycocalyx product detectable during EVLP (1 hr: 19 (13–84) vs 12 hr: 143 (109–264) ng/ml; p=0.13). Porcine hyaluronan was associated with MMP-9 activity (r = 0.83; p=0.02) and also with dynamic compliance (r = 0.57; p=0.03). Conclusion Endothelial glycocalyx products accumulate during both porcine and human EVLP, and this accumulation parallels an accumulation of matrix-degrading enzyme activity. Preliminary evidence in our porcine EVLP model suggests that shedding may be related to organ function, thus warranting additional study.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2019 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/6748242","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44970511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}