Journal of Transplantation最新文献_第6页

A Single Perioperative Injection of Dexamethasone Decreases Nausea, Vomiting, and Pain after Laparoscopic Donor Nephrectomy 腹腔镜供肾切除术后单次围手术期注射地塞米松可减少恶心、呕吐和疼痛

IF 2.5

Journal of Transplantation Pub Date : 2017-01-22 DOI: 10.1155/2017/3518103

Shigeyoshi Yamanaga, A. Posselt, C. Freise, Takaaki Kobayashi, M. Tavakol, Sang-Mo Kang

{"title":"A Single Perioperative Injection of Dexamethasone Decreases Nausea, Vomiting, and Pain after Laparoscopic Donor Nephrectomy","authors":"Shigeyoshi Yamanaga, A. Posselt, C. Freise, Takaaki Kobayashi, M. Tavakol, Sang-Mo Kang","doi":"10.1155/2017/3518103","DOIUrl":"https://doi.org/10.1155/2017/3518103","url":null,"abstract":"Background. A single dose of perioperative dexamethasone (8–10 mg) reportedly decreases postoperative nausea, vomiting, and pain but has not been widely used in laparoscopic donor nephrectomy (LDN). Methods. We performed a retrospective cohort study of living donors who underwent LDN between 2013 and 2015. Donors who received a lower dose (4–6 mg) (n = 70) or a higher dose (8–14 mg) of dexamethasone (n = 100) were compared with 111 donors who did not receive dexamethasone (control). Outcomes and incidence of postoperative nausea, vomiting, and pain within 24 h after LDN were compared before and after propensity-score matching. Results. The higher dose of dexamethasone reduced postoperative nausea and vomiting incidences by 28% (P = 0.010) compared to control, but the lower dose did not. Total opioid use was 29% lower in donors who received the higher dose than in control (P = 0.004). The higher dose was identified as an independent factor for preventing postoperative nausea and vomiting. Postoperative complication rates and hospital stays did not differ between the groups. After propensity-score matching, the results were the same as for the unmatched analysis. Conclusion. A single perioperative injection of 8–14 mg dexamethasone decreases antiemetic and narcotic requirements in the first 24 h, with no increase in surgical complications.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2017 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2017-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/3518103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44377671","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}

引用次数: 15

Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss 冷缺血时间与夜班手术的风险平衡可能降低再手术率和围手术期移植物损失

IF 2.5

Journal of Transplantation Pub Date : 2017-01-19 DOI: 10.1155/2017/5362704

N. Emmanouilidis, Julius Boeckler, B. Ringe, A. Kaltenborn, F. Lehner, Hans-Friedrich Koch, J. Klempnauer, H. Schrem

{"title":"Risk Balancing of Cold Ischemic Time against Night Shift Surgery Possibly Reduces Rates of Reoperation and Perioperative Graft Loss","authors":"N. Emmanouilidis, Julius Boeckler, B. Ringe, A. Kaltenborn, F. Lehner, Hans-Friedrich Koch, J. Klempnauer, H. Schrem","doi":"10.1155/2017/5362704","DOIUrl":"https://doi.org/10.1155/2017/5362704","url":null,"abstract":"Background. This retrospective cohort study evaluates the advantages of risk balancing between prolonged cold ischemic time (CIT) and late night surgery. Methods. 1262 deceased donor kidney transplantations were analyzed. Multivariable regression was used to determine odds ratios (ORs) for reoperation, graft loss, delayed graft function (DGF), and discharge on dialysis. CIT was categorized according to a forward stepwise pattern ≤1h/>1h, ≤2h/>2h, ≤3h/>3h,…, ≤nh/>nh. ORs for DGF were plotted against CIT and a nonlinear regression function with best R2 was identified. First and second derivative were then implemented into the curvature formula k(x) = f′′(x)/(1 + f′(x)2)3/2 to determine the point of highest CIT-mediated risk acceleration. Results. Surgery between 3 AM and 6 AM is an independent risk factor for reoperation and graft loss, whereas prolonged CIT is only relevant for DGF. CIT-mediated risk for DGF follows an exponential pattern f(x) = A · (1 + k · e(I · x)) with a cut-off for the highest risk increment at 23.5 hours. Conclusions. The risk of surgery at 3 AM–6 AM outweighs prolonged CIT when confined within 23.5 hours as determined by a new mathematical approach to calculate turning points of nonlinear time related risks. CIT is only relevant for the endpoint of DGF but had no impact on discharge on dialysis, reoperation, or graft loss.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2017-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/5362704","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44677765","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}

引用次数: 9

Blood Transfusions and Tumor Biopsy May Increase HCC Recurrence Rates after Liver Transplantation 输血和肿瘤活检可能增加肝移植后HCC的复发率

IF 2.5

Journal of Transplantation Pub Date : 2017-01-05 DOI: 10.1155/2017/9731095

D. Seehofer, R. Öllinger, T. Denecke, M. Schmelzle, A. Andreou, E. Schott, J. Pratschke

{"title":"Blood Transfusions and Tumor Biopsy May Increase HCC Recurrence Rates after Liver Transplantation","authors":"D. Seehofer, R. Öllinger, T. Denecke, M. Schmelzle, A. Andreou, E. Schott, J. Pratschke","doi":"10.1155/2017/9731095","DOIUrl":"https://doi.org/10.1155/2017/9731095","url":null,"abstract":"Introduction. Beneath tumor grading and vascular invasion, nontumor related risk factors for HCC recurrence after liver transplantation (LT) have been postulated. Potential factors were analyzed in a large single center experience. Material and Methods. This retrospective analysis included 336 consecutive patients transplanted for HCC. The following factors were analyzed stratified for vascular invasion: immunosuppression, rejection therapy, underlying liver disease, age, gender, blood transfusions, tumor biopsy, caval replacement, waiting time, Child Pugh status, and postoperative complications. Variables with a potential prognostic impact were included in a multivariate analysis. Results. The 5- and 10-year patient survival rates were 70 and 54%. The overall 5-year recurrence rate was 48% with vascular invasion compared to 10% without (p < 0.001). Univariate analysis stratified for vascular invasion revealed age over 60, pretransplant tumor biopsy, and the application of blood transfusions as significant risk factors for tumor recurrence. Blood transfusions remained the only significant risk factor in the multivariate analysis. Recurrence occurred earlier and more frequently in correlation with the number of applied transfusions. Conclusion. Tumor related risk factors are most important and can be influenced by patient selection. However, it might be helpful to consider nontumor related risk factors, identified in the present study for further optimization of the perioperative management.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2017-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/9731095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45163375","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}

引用次数: 13

Retrospective Study Looking at Cinacalcet in the Management of Hyperparathyroidism after Kidney Transplantation. cinacalet治疗肾移植后甲状旁腺功能亢进的回顾性研究。

IF 2.5

Journal of Transplantation Pub Date : 2017-01-01 Epub Date: 2017-03-13 DOI: 10.1155/2017/8720283

Habib Mawad, Hugues Bouchard, Duy Tran, Denis Ouimet, Jean-Philippe Lafrance, Robert Zoël Bell, Sarah Bezzaoucha, Anne Boucher, Suzon Collette, Vincent Pichette, Lynne Senécal, Michel Vallée

{"title":"Retrospective Study Looking at Cinacalcet in the Management of Hyperparathyroidism after Kidney Transplantation.","authors":"Habib Mawad, Hugues Bouchard, Duy Tran, Denis Ouimet, Jean-Philippe Lafrance, Robert Zoël Bell, Sarah Bezzaoucha, Anne Boucher, Suzon Collette, Vincent Pichette, Lynne Senécal, Michel Vallée","doi":"10.1155/2017/8720283","DOIUrl":"https://doi.org/10.1155/2017/8720283","url":null,"abstract":"Objectives. The primary objective of this study is to evaluate the use of cinacalcet in the management of hyperparathyroidism in kidney transplant recipients. The secondary objective is to identify baseline factors that predict cinacalcet use after transplantation. Methods. In this single-center retrospective study, we conducted a chart review of all patients having been transplanted from 2003 to 2012 and having received cinacalcet up to kidney transplantation and/or thereafter. Results. Twenty-seven patients were included with a mean follow-up of 2.9 ± 2.4 years. Twenty-one were already taking cinacalcet at the time of transplantation. Cinacalcet was stopped within the first month in 12 of these patients of which 7 had to restart therapy. The main reason for restarting cinacalcet was hypercalcemia. Length of treatment was 23 ± 26 months. There were only 3 cases of mild hypocalcemia. There was no statistically significant association between baseline factors and cinacalcet status a year later. Conclusions. Discontinuing cinacalcet within the first month of kidney transplantation often leads to hypercalcemia. Cinacalcet appears to be an effective treatment of hypercalcemic hyperparathyroidism in kidney transplant recipients. Further studies are needed to evaluate safety and long-term benefits.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2017 ","pages":"8720283"},"PeriodicalIF":2.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/8720283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34893356","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}

引用次数: 8

Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with Common Induction Regimens: A Study of over Twelve-Thousand Cases in the United States. 与常见诱导方案相关的肾脏再移植结果风险因素分析：对美国超过 1.2 万例病例的研究。

IF 2.5

Journal of Transplantation Pub Date : 2017-01-01 Epub Date: 2017-09-24 DOI: 10.1155/2017/8132672

Alfonso H Santos, Michael J Casey, Karl L Womer

{"title":"Analysis of Risk Factors for Kidney Retransplant Outcomes Associated with Common Induction Regimens: A Study of over Twelve-Thousand Cases in the United States.","authors":"Alfonso H Santos, Michael J Casey, Karl L Womer","doi":"10.1155/2017/8132672","DOIUrl":"10.1155/2017/8132672","url":null,"abstract":"We studied registry data of 12,944 adult kidney retransplant recipients categorized by induction regimen received into antithymocyte globulin (ATG) (N = 9120), alemtuzumab (N = 1687), and basiliximab (N = 2137) cohorts. We analyzed risk factors for 1-year acute rejection (AR) and 5-year death-censored graft loss (DCGL) and patient death. Compared with the reference, basiliximab: (1) one-year AR risk was lower with ATG in retransplant recipients of expanded criteria deceased-donor kidneys (HR = 0.56, 95% CI = 0.35-0.91 and HR = 0.54, 95% CI = 0.27-1.08, resp.), while AR risk was lower with alemtuzumab in retransplant recipients with >3 HLA mismatches before transplant (HR = 0.63, 95% CI = 0.44-0.93 and HR = 0.81, 95% CI = 0.63-1.06, resp.); (2) five-year DCGL risk was lower with alemtuzumab, not ATG, in retransplant recipients of African American race (HR = 0.54, 95% CI = 0.34-0.86 and HR = 0.73, 95% CI = 0.51-1.04, resp.) or with pretransplant glomerulonephritis (HR = 0.65, 95% CI = 0.43-0.98 and HR = 0.82, 95% CI = 0.60-1.12, resp.). Therefore, specific risk factor-induction regimen combinations may predict outcomes and this information may help in individualizing induction in retransplant recipients.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2017 ","pages":"8132672"},"PeriodicalIF":2.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35719010","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}

引用次数: 0

The CECARI Study: Everolimus (Certican®) Initiation and Calcineurin Inhibitor Withdrawal in Maintenance Heart Transplant Recipients with Renal Insufficiency: A Multicenter, Randomized Trial. CECARI研究:依维莫司(Certican®)起始和钙调磷酸酶抑制剂停药对肾功能不全的维护性心脏移植受者:一项多中心、随机试验。

IF 2.5

Journal of Transplantation Pub Date : 2017-01-01 Epub Date: 2017-02-20 DOI: 10.1155/2017/6347138

Jan Van Keer, David Derthoo, Olivier Van Caenegem, Michel De Pauw, Eric Nellessen, Nathalie Duerinckx, Walter Droogne, Gábor Vörös, Bart Meyns, Ann Belmans, Stefan Janssens, Johan Van Cleemput, Johan Vanhaecke

{"title":"The CECARI Study: Everolimus (Certican®) Initiation and Calcineurin Inhibitor Withdrawal in Maintenance Heart Transplant Recipients with Renal Insufficiency: A Multicenter, Randomized Trial.","authors":"Jan Van Keer, David Derthoo, Olivier Van Caenegem, Michel De Pauw, Eric Nellessen, Nathalie Duerinckx, Walter Droogne, Gábor Vörös, Bart Meyns, Ann Belmans, Stefan Janssens, Johan Van Cleemput, Johan Vanhaecke","doi":"10.1155/2017/6347138","DOIUrl":"https://doi.org/10.1155/2017/6347138","url":null,"abstract":"In this 3-year, open-label, multicenter study, 57 maintenance heart transplant recipients (>1 year after transplant) with renal insufficiency (eGFR 30-60 mL/min/1.73 m2) were randomized to start everolimus with CNI withdrawal (N = 29) or continue their current CNI-based immunosuppression (N = 28). The primary endpoint, change in measured glomerular filtration rate (mGFR) from baseline to year 3, did not differ significantly between both groups (+7.0 mL/min in the everolimus group versus +1.9 mL/min in the CNI group, p = 0.18). In the on-treatment analysis, the difference did reach statistical significance (+9.4 mL/min in the everolimus group versus +1.9 mL/min in the CNI group, p = 0.047). The composite safety endpoint of all-cause mortality, major adverse cardiovascular events, or treated acute rejection was not different between groups. Nonfatal adverse events occurred in 96.6% of patients in the everolimus group and 57.1% in the CNI group (p < 0.001). Ten patients (34.5%) in the everolimus group discontinued the study drug during follow-up due to adverse events. The poor adherence to the everolimus therapy might have masked a potential benefit of CNI withdrawal on renal function.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2017 ","pages":"6347138"},"PeriodicalIF":2.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/6347138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34833100","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}

引用次数: 7

Switching Stable Kidney Transplant Recipients to a Generic Tacrolimus Is Feasible and Safe, but It Must Be Monitored. 将稳定的肾移植受者转换为通用的他克莫司是可行和安全的，但必须进行监测。

IF 2.5

Journal of Transplantation Pub Date : 2017-01-01 Epub Date: 2017-01-26 DOI: 10.1155/2017/5646858

Fernando González, René López, Elizabeth Arriagada, René Carrasco, Natalia Gallardo, Eduardo Lorca

{"title":"Switching Stable Kidney Transplant Recipients to a Generic Tacrolimus Is Feasible and Safe, but It Must Be Monitored.","authors":"Fernando González, René López, Elizabeth Arriagada, René Carrasco, Natalia Gallardo, Eduardo Lorca","doi":"10.1155/2017/5646858","DOIUrl":"https://doi.org/10.1155/2017/5646858","url":null,"abstract":"Background. Tacrolimus is the primary immunosuppressive drug used in kidney transplant patients. Replacing brand name products with generics is a controversial issue that we studied after a Chilean Ministry of Health mandate to implement such a switch. Methods. Forty-one stable Prograf (Astellas) receiving kidney transplant patients were switched to a generic tacrolimus (Sandoz) in a 1 : 1 dose ratio and were followed up for up to 8 months. All other drugs were maintained as per normal practice. Results. Neither tacrolimus doses nor their trough blood levels changed significantly after the switch, but serum creatinine did: 1.62 ± 0.90 versus 1.75 ± 0.92 mg/dL (p < 0.001). At the same time, five graft biopsies were performed, and two of them showed cellular acute rejection. There were nine infectious episodes treated satisfactorily with proper therapies. No patient or graft was lost during the follow-up time period. Conclusion. Switching from brand name tacrolimus to a generic tacrolimus (Sandoz) is feasible and appears to be safe, but it must be monitored carefully by treating physicians.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2017 ","pages":"5646858"},"PeriodicalIF":2.5,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/5646858","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34771961","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}

引用次数: 5

Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population 高MELD人群肝移植后移植前因素与术后呼吸衰竭、ICU住院时间和短期生存的关系

IF 2.5

Journal of Transplantation Pub Date : 2016-11-17 DOI: 10.1155/2016/6787854

Mark R. Pedersen, Myunghan Choi, J. Brink, A. Seetharam

{"title":"Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population","authors":"Mark R. Pedersen, Myunghan Choi, J. Brink, A. Seetharam","doi":"10.1155/2016/6787854","DOIUrl":"https://doi.org/10.1155/2016/6787854","url":null,"abstract":"Changes in distribution policies have increased median MELD at transplant with recipients requiring increasing intensive care perioperatively. We aimed to evaluate association of preoperative variables with postoperative respiratory failure (PRF)/increased intensive care unit length of stay (ICU LOS)/short-term survival in a high MELD cohort undergoing liver transplant (LT). Retrospective analysis identified cases of PRF and increased ICU LOS with recipient, donor, and surgical variables examined. Variables were entered into regression with end points of PRF and ICU LOS > 3 days. 164 recipients were examined: 41 (25.0%) experienced PRF and 74 (45.1%) prolonged ICU LOS. Significant predictors of PRF with univariate analysis: BMI > 30, pretransplant MELD, preoperative respiratory failure, LVEF < 50%, FVC < 80%, intraoperative transfusion > 6 units, warm ischemic time > 4 minutes, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted PRF (OR 1.14, p = 0.01). Significant predictors of prolonged ICU LOS with univariate analysis are as follows: pretransplant MELD, FVC < 80%, FEV1 < 80%, deceased donor, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted prolonged ICU LOS (OR 1.28, p < 0.001). One-year survival among cohorts with PRF and increased ICU LOS was similar to subjects without. Pretransplant MELD is a robust predictor of PRF and ICU LOS. Higher MELDs at LT are expected to increase need for ICU utilization and modify expectations for recovery in the immediate postoperative period.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2016 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2016-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/6787854","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64489259","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}

引用次数: 18

Immunomodulatory Role of Mesenchymal Stem Cell Therapy in Vascularized Composite Allotransplantation 间充质干细胞治疗在血管化复合异体移植中的免疫调节作用

IF 2.5

Journal of Transplantation Pub Date : 2016-10-16 DOI: 10.1155/2016/6951693

R. Heyes, Andrew Iarocci, Y. Tchoukalova, D. Lott

{"title":"Immunomodulatory Role of Mesenchymal Stem Cell Therapy in Vascularized Composite Allotransplantation","authors":"R. Heyes, Andrew Iarocci, Y. Tchoukalova, D. Lott","doi":"10.1155/2016/6951693","DOIUrl":"https://doi.org/10.1155/2016/6951693","url":null,"abstract":"This review aims to summarize contemporary evidence of the in vitro and in vivo immunomodulatory effects of mesenchymal stem cells (MSCs) in promoting vascularized composite allotransplant (VCA) tolerance. An extensive literature review was performed to identify pertinent articles of merit. Prospective preclinical trials in mammal subjects receiving VCA (or skin allograft) with administration of MSCs were reviewed. Prospective clinical trials with intravascular delivery of MSCs in human populations undergoing solid organ transplant were also identified and reviewed. Sixteen preclinical studies are included. Eleven studies compared MSC monotherapy to no therapy; of these, ten reported improved graft survival, which was statistically significantly prolonged in eight. Eight studies analyzed allograft survival with MSC therapy as an adjunct to proven immunosuppressive regimens. In these studies, daily immunosuppression was transiently delivered and then stopped. In all studies, treatment-free graft survival was statistically significantly prolonged in animals that received MSC therapy. MSCs have been safely administered clinically and their use in renal transplant clinical trials provides evidence that they improve allograft transplant tolerance in clinical practice. There is potential for MSC induction therapy to overcome many of the obstacles to widespread VCA in clinical practice. Preclinical studies are needed before MSC-induced VCA tolerance becomes a clinical reality.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2016 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2016-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/6951693","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64498032","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}

引用次数: 9

Utilization of Public Health Service Increased Risk Donors Yields Equivalent Outcomes in Liver Transplantation 利用公共卫生服务增加风险供者在肝移植中产生相同的结果

IF 2.5

Journal of Transplantation Pub Date : 2016-09-29 DOI: 10.1155/2016/9658904

V. Fleetwood, J. Lusciks, J. Poirier, M. Hertl, E. Chan

{"title":"Utilization of Public Health Service Increased Risk Donors Yields Equivalent Outcomes in Liver Transplantation","authors":"V. Fleetwood, J. Lusciks, J. Poirier, M. Hertl, E. Chan","doi":"10.1155/2016/9658904","DOIUrl":"https://doi.org/10.1155/2016/9658904","url":null,"abstract":"Background. The PHS increased risk donor (IRD) is underutilized in liver transplantation. We aimed to examine the posttransplant outcomes in recipients of increased-risk organs. Methods. We analyzed 228,040 transplants in the Organ Procurement and Transplantation Network database from 2004 to 2013. Endpoints were graft failure and death. Results were controlled for demographics and comorbidities. Statistical analysis utilized Fisher's test and logistic regression. Results. 58,816 patients were identified (5,534 IRD, 53,282 non-IRD). IRDs were more frequently male (69.2% versus 58.3%, p < 0.001), younger (34 versus 39, p < 0.001), and less likely to have comorbidities (p < 0.001). Waitlist time was longer for IRD graft recipients (254 versus 238 days, p < 0.001). All outcomes were better in the IRD group. Graft failure (23.6 versus 27.3%, p < 0.001) and mortality (20.4 versus 22.3%, p = 0.001) were decreased in IRD graft recipients. However, in multivariate analysis, IRD status was not a significant indicator of outcomes. Conclusion. This is the first study to describe IRD demographics in liver transplantation. Outcomes are improved in IRD organ recipients; however, controlling for donor and recipient comorbidities, ischemia time, and MELD score, the differences lose significance. In multivariate analysis, use of IRD organs is noninferior, with similar graft failure and mortality despite the infectious risk.","PeriodicalId":45795,"journal":{"name":"Journal of Transplantation","volume":"2016 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2016/9658904","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64630261","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}

引用次数: 18