Transplantation proceedings最新文献

{"title":"Gun-Sight Technique With Dual Hepatic Vascular Embolization for Sigmoidal Refractory Biliary Stricture After Living-Donor Liver Transplantation: A Case Report.","authors":"Yuta Yamada, Kenei Furukawa, Koichiro Haruki, Shinji Onda, Yoshihiro Shirai, Masashi Tsunematsu, Mitsuru Yanagaki, Michinori Matsumoto, Yosuke Igarashi, Toru Ikegami","doi":"10.1016/j.transproceed.2024.10.041","DOIUrl":"https://doi.org/10.1016/j.transproceed.2024.10.041","url":null,"abstract":"<p><strong>Background: </strong>Biliary stricture is a common complication after living-donor liver transplantation (LDLT), but its management is challenging. We herein report a case of successful internal drainage achieved through combination of the gun-sight technique and dual hepatic vascular embolization (DHVE).</p><p><strong>Case presentation: </strong>A 54-year-old woman with primary biliary cholangitis underwent ABO-incompatible LDLT with the right lobe. Duct-to-duct biliary anastomosis was performed, and V5 and V8 of the graft were reconstructed using a vein graft. However, 5 months after surgery, magnetic resonance cholangiopancreatography revealed stricture of the bile duct anastomosis. Endoscopic stenting could not be attempted because of the sigmoidal bending of the bile duct. Instead, percutaneous transhepatic cholangiographic drainage (PTCD) of the anterior and posterior branches was performed. We attempted to remove the PTCD tube by an endofistulization technique. We performed the gun-sight technique, originally employed for transjugular intrahepatic portosystemic shunt procedures, to create a pathway for internal drainage of the posterior segment. The anterior lobe was abandoned by applying DHVE, resulting in no external drainage tubes.</p><p><strong>Conclusion: </strong>Application of the gun-sight technique with DHVE for sigmoidal refractory biliary stricture after LDLT appears to be a feasible treatment.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775968","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}

{"title":"De Novo C3 Glomerulonephritis of Allograft Associated With Factor H Autoantibody in a Patient with Systemic Lupus Erythematosus: A Case Report.","authors":"Sumit Sureshkumar Patel, Miroslav Smogorzewski, Thin Thin Maw, Neeraj Sharma","doi":"10.1016/j.transproceed.2024.11.006","DOIUrl":"https://doi.org/10.1016/j.transproceed.2024.11.006","url":null,"abstract":"<p><p>C3 Glomerulonephritis (C3GN) is a rare disease with a challenging diagnosis and poor prognosis. It is characterized by dysregulation of alternate complement pathway and diagnosed by biopsy findings of isolated or predominant C3 deposits on immunofluorescence (IF) staining. Dysregulation of alternate complement pathway (ACP) caused by genetic mutations or autoantibodies leads to C3 glomerulopathy (C3G) and complement-mediated thrombotic microangiopathies (c-TMA), later also referred to as atypical hemolytic uremic syndrome (aHUS). Autoantibodies like C3 nephritic factor and Factor H autoantibodies (FHAA) are frequently seen as acquired abnormalities in C3GN. SLE is a multisystem complex disorder distinguished by the presence of autoantibodies to multiple nuclear antigens, including DNA and ribonucleoprotein leading to complement activation, characterized by low level of C3 and C4 and may present with c-TMA. There are not many cases of C3GN with SLE that have been described, and current literature lacks strong evidence-based treatment options of post-transplant C3GN. Here, we describe a case of de novo C3GN of allograft in a patient with SLE.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775234","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}

{"title":"Mild Permissive Alkalosis Improves Outcomes in Porcine Negative Pressure Ventilation Ex-Situ Lung Perfusion.","authors":"Keir Forgie, Abeline Watkins, Katie Du, Alynne Ribano, Nicholas Fialka, Sayed Himmat, Sanaz Hatami, Mubashir Khan, Xiuhua Wang, Ryan Edgar, Katie-Marie Buswell-Zuk, Darren H Freed, Jayan Nagendran","doi":"10.1016/j.transproceed.2024.10.031","DOIUrl":"10.1016/j.transproceed.2024.10.031","url":null,"abstract":"<p><strong>Background: </strong>Ex-Situ Lung Perfusion (ESLP) employs a membrane deoxygenator and mixed (N₂/O₂/CO₂) or pure sweep gas (CO₂) to target venous blood gas composition with physiologic pCO₂ and pH. Clinically, mild permissive alkalosis counteracts elevated pulmonary vascular resistance (PVR) to improve perfusion. Increased PVR and pulmonary artery pressure (PAP) during ESLP mirrors rising pro-inflammatory cytokines. Increased hydrostatic pressure worsens edema and lung function. We report improved ESLP outcomes using mild permissive alkalosis.</p><p><strong>Methods: </strong>Twelve juvenile pig lungs underwent 12-hour Negative Pressure Ventilation (NPV)-ESLP with a physiologic pH (Control: pH 7.35-7.45, n=6) or mild permissive alkalosis (pH+: pH 7.45-7.55, n=6) by varying sweep CO₂ delivery. Three left lungs per group were transplanted and assessed over 4-hours.</p><p><strong>Results: </strong>Five Control lungs failed on ESLP due to high PAPs, low compliance, and poor oxygenation. Repeat Controls (n=6) were performed to attain 12-hours of ESLP. There were no failures in the pH+ group. Results are pH+ vs Control. Oxygenation (PaO₂/FiO₂ 454.2 vs 438.2; P = .37) and dynamic compliance (21.38 vs 22.22 mL/cmH₂O; P = .41) were stable over 12-hour NPV-ESLP. Mean evaluation pH/pCO₂/HCO₃^- was 7.50/15.6/14.5 vs 7.41/38.7/24.7. Control lungs required repeat THAM and milrinone boluses on ESLP to prevent acidosis and treat elevated PVR; this was not necessary in the pH+ group. Weight-gain/hour was similar (1.23% vs 1.38%; P = .37). Mean left lung PF ratios 4-hours post-transplantation were 301 mmHg vs 196 mmHg (P = .11). Control TNF-⍺ and IL-6 perfusate concentrations were significantly greater.</p><p><strong>Conclusions: </strong>Mild permissive alkalosis porcine NPV-ESLP demonstrated more reliable preservation with reduced inflammation compared to a physiologic pH strategy.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":"2284-2291"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776037","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}

{"title":"The Role of Fibrinogen and Platelets in Mouse Liver Ischemia-Reperfusion Injury: Distribution and Pathophysiological Insights.","authors":"Meng-Qi Dong, Zhi-Hao Huang, Zhi-Min Liu, Yuan Lin, Feng-Yong Liu, Wei-Jie Zhou","doi":"10.1016/j.transproceed.2024.10.045","DOIUrl":"10.1016/j.transproceed.2024.10.045","url":null,"abstract":"<p><p>Liver ischemia-reperfusion (I/R) injury is a critical issue in clinical settings, particularly in liver transplantation and resection, leading to severe hepatocellular dysfunction and organ failure. This study investigates the role of fibrinogen and platelets in liver I/R injury, focusing on their distribution and pathophysiological impact within liver lobules. Using a mouse model, we examined the expression and localization of fibrinogen and platelets at various time points postreperfusion. In normal liver, fibrinogen is predominantly expressed in hepatic sinusoids near the portal vein, with sparse platelet distribution. Following I/R injury, fibrinogen expression significantly increases in hepatic sinusoids and hepatocytes, accompanied by substantial platelet aggregation and embolization, particularly in Zone 1 of the liver lobules. These findings highlight the zonal heterogeneity of fibrinogen distribution and its regulatory function in platelet adhesion and microthrombi formation. This study provides crucial insights for developing therapeutic strategies targeting fibrinogen and platelet interactions to mitigate liver I/R injury.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":"2263-2267"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752307","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}

{"title":"Targeting the PANoptosome Using Necrostatin-1 Reduces PANoptosis and Protects the Kidney Against Ischemia-Reperfusion Injury in a Rat Model of Controlled Experimental Nonheart-Beating Donor.","authors":"Mehmet Dokur, Erdal Uysal, Faruk Kucukdurmaz, Serdar Altinay, Sait Polat, Kadir Batcioglu, Yakup Yilmaztekin, Turkan Guney, Tugce Sapmaz Ercakalli, Asli Yaylali, Efe Sezgin, Zafer Cetin, Eyup Ilker Saygili, Osman Barut, Hatem Kazimoglu, Gokturk Maralcan, Suna Koc, Mehmet Sokucu, Sema Nur Dokur Yeni","doi":"10.1016/j.transproceed.2024.10.047","DOIUrl":"10.1016/j.transproceed.2024.10.047","url":null,"abstract":"<p><strong>Purpose: </strong>Reducing renal ischemia is crucial for the function and survival of grafts from nonheartbeat donors, as it leads to inflammatory responses and tubulointerstitial damage. The primary concern with organs from nonheartbeat donors is the long warm ischemia period and reperfusion injury following renal transplantation. This study had two main goals; one goal is to determine how Necrostatin-1 targeting the PANoptosome affects PANoptosis in the nonheart-beating donor rat model. The other goal is to find out if Necrostatin-1 can protect the kidney from ischemic injury for renal transplantation surgery.</p><p><strong>Methods: </strong>Twenty-four rats were grouped randomly as control and Necrostatin-1 in this experimental animal study, and we administered 1.65 mg/kg of Necrostatin-1 intraperitoneally to the experimental group for 30 minutes before cardiac arrest. We removed the rats' left kidneys and measured various oxidative stress marker measures such as malondialdehyde, superoxide dismutase, catalase, GPx, and 8-hydroxy-2-deoxyguanosine levels. We then subjected the tissues to immunohistochemical analysis, electron microscopy, and histopathological analysis.</p><p><strong>Findings: </strong>The Necrostatin-1 group had a lower total tubular injury score (P < .001) and less Caspase-3, gasdermin D, and mixed lineage kinase domain-like protein expression. Additionally, the apoptotic index of the study group was lower (P < .001). Furthermore, the study group had higher levels of superoxide dismutase and GPx (P < .05), whereas malondialdehyde levels were reduced (P = .009). Electron microscopy also revealed a significant improvement in tissue structure in the Necrostatin-1 group.</p><p><strong>Conclusion: </strong>Necrostatin-1 protects against ischemic acute kidney injury in nonheart-beating donor rats by inhibiting PANoptosis via the blockade of RIPK1. As a result of this, Necrostatin-1 may offer novel opportunities for protecting donor kidneys from renal ischemia-reperfusion injury during transplantation in patients with end-stage kidney disease requiring a renal transplantation.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":"2268-2279"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782146","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}

{"title":"Physician-Directed Mycophenolate Mofetil Dose Reduction After Kidney Transplantation: A Multicenter Real Word Experience.","authors":"Hani M Wadei, Namrata Parikh, Sarah Suliman, Ahmed Abdelrheem, Walter D Park, Byron H Smith, Carrie A Schinstock, Hatem Amer, Hasan Khamash, Mark D Stegall","doi":"10.1016/j.transproceed.2024.10.034","DOIUrl":"10.1016/j.transproceed.2024.10.034","url":null,"abstract":"<p><strong>Background: </strong>Mycophenolate mofetil (MMF) dose is commonly reduced after kidney transplantation (KT). This study examined MMF dosing in the first 5 years after KT to determine if a lower MMF dose impacted outcomes.</p><p><strong>Methods: </strong>We retrospectively studied 432 recipients who underwent KT between February 2012 and February 2015 in 3 centers. Induction was with IL-2 receptor blocker (23%) or depleting antibody (67%) and maintenance was with calcineurin inhibitor, MMF 1.5 to 2g/day and in 70% prednisone. MMF dose was reduced within the first post-KT year as clinically indicated or for elevated mycophenolic acid (MPA) levels. All 432 patients underwent 1-year protocol biopsy. Donor-specific antibodies (DSAs) were assessed at 1 year.</p><p><strong>Results: </strong>At 1 year, 219 KT recipients (51%) received standard MMF (> 1 g/day) and 213 (49%) received low MMF (≤ 1 gr/d). Low MMF was for clinical indication (49%) or elevated MPA level (51%). At 1 year, there was no difference in rejection rate, type and degree of rejection, degree of inflammation, or DSA formation between the low and standard MMF groups (P = not significant [NS]). The reason for MMF dose reduction did not impact outcome. By 5 years, 69% of the KT recipients were on ≤ 1 g/d MMF. The 5-year patient and death-censored graft survival were comparable between the low and standard MMF groups.</p><p><strong>Conclusions: </strong>Almost 50% of KT recipients were on low dose MMF at 1 year and this percentage increased by 5 years. We did not observe a difference in outcomes between those on standard or low MMF dose regardless of the reason for dose reduction. Physician-directed MMF dose-reduction may be safe but randomized studies are needed to validate this finding.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":"2124-2133"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788293","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}

{"title":"Knowledge Gaps and Educational Needs in Organ Transplantation: A Study of Portuguese Medical Students.","authors":"Alberto Costa Silva, Teresa Pina-Vaz, Margarida Henriques, João Nóbrega, José La Fuente de Carvalho, Carlos Martins-Silva, Tiago Antunes-Lopes, João Alturas Silva","doi":"10.1016/j.transproceed.2024.11.014","DOIUrl":"10.1016/j.transproceed.2024.11.014","url":null,"abstract":"<p><strong>Objective: </strong>Kidney transplantation has been a life-changing procedure for patients with end-stage renal disease (ESRD). Portugal ranks high globally in transplantation, benefiting from an \"opt-out\" system that presumes consent for organ donation. The effectiveness of transplantation programs depends significantly on public knowledge and the willingness to donate, where medical students play a crucial role. This study assesses the knowledge and educational needs of medical students regarding organ transplantation and donation.</p><p><strong>Design: </strong>A cross-sectional survey was conducted using a structured questionnaire distributed to fifth-year medical students from 2 universities in Porto, Portugal, affiliated with different hospital centers during the 2022-2023 academic year.</p><p><strong>Results: </strong>A total of 427 students responded, with a response rate of 85.0%, higher at Center 1 (93.0%) compared to Center 2 (70.0%) (P-value < .001). The majority were aware of the opt-out legislation (92.3%) and recognized ESRD as the primary cause of kidney transplantation (96.1%). Knowledge of donation types was high, particularly for brain death (92.6%) and living donation (91.5%), but lower for donation after circulatory death (73.1%). Awareness of donation after circulatory death was significantly higher among respondents from Center 1 (79.4%) than Center 2 (59.1%; P < .001). Only a minority were familiar with immunosuppressive drugs (36.0%) and had practical exposure to transplant-related activities. Satisfaction with transplantation education was low (8.2%), with significant differences between the centers.</p><p><strong>Conclusion: </strong>The findings suggest that medical schools should enhance educational content and provide more experiences to prepare future healthcare providers adequately.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":"2298-2301"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775904","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}

{"title":"HLA Compatibility and Graft Survival Rates Among Related and Unrelated Donors in Renal Transplantation.","authors":"Nhat-Minh Le Pham, Thinh Phuc Ong, Nguyen Lam Vuong, Thi Thu Hoai Nguyen","doi":"10.1016/j.transproceed.2024.11.010","DOIUrl":"10.1016/j.transproceed.2024.11.010","url":null,"abstract":"<p><p>Human leukocyte antigen (HLA) compatibility between donors and recipients plays a critical role in graft survival in renal transplantation. This study evaluates the impact of HLA mismatching on graft survival and rejection among renal transplant recipients with related and unrelated donors, considering factors such as age, sex, ABO blood type, and anti-HLA antibodies. We investigated the graft survival rates between related and unrelated donors in a prospective cohort study conducted from 2018 to 2020 at Cho Ray Hospital and People's Hospital 115 in Vietnam, involving 126 related and 82 unrelated donor-recipient pairs. Over 32 months of follow-up, there was no significant difference in the rates of suspected graft rejection (P = .75) or graft loss (P = .095) between the 2 groups. However, related donors exhibited significantly higher overall survival (P = .0086) and better event-free survival (P = .0025) compared with unrelated donors. HLA matching and ABO type did not show any association with suspected graft rejection in either group. Notably, unrelated donors older than 5 years increased the risk of suspected graft rejection (hazard ratio, 4.22), and positive anti-HLA antibodies also increased this risk (hazard ratio, 4.5). Conversely, male-male donor-recipient pairs significantly decreased the risk of graft rejection by 88% compared with female-female pairs. The study concludes that although HLA matching is not different for related and unrelated donor groups, factors such as donor age, same-sex pairs, and the presence of anti-HLA antibodies are significant risk factors for graft rejection in unrelated donors. Enhancing monitoring and developing strategies for unrelated donors are essential to improve graft survival outcomes in renal transplantation.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":"2163-2171"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751934","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}

{"title":"Safety and Efficacy of Everolimus Use to Preserve Renal Function in Intestinal and Multivisceral Transplantation Patients.","authors":"Colin Hartgerink, Avi Toiv, Arif Sarowar, Ella Todd, Shunji Nagai, Yakir Muszkat, Nemie Beltran, Syed-Mohammed Jafri","doi":"10.1016/j.transproceed.2024.10.043","DOIUrl":"10.1016/j.transproceed.2024.10.043","url":null,"abstract":"<p><strong>Background: </strong>As calcineurin inhibitors are associated with renal impairment post intestinal transplant, use of everolimus (EVR) may provide renal-sparing benefits.</p><p><strong>Methods: </strong>We performed a retrospective analysis focused on EVR use and renal function after intestinal or multivisceral transplant. No prisoners were used in the study. This study is compliant with the Helsinki Congress and the Declaration of Istanbul.</p><p><strong>Results: </strong>A total of 28 patients, 18 patients who underwent isolated intestinal transplant, and 10 patients who underwent multivisceral transplant, were included in this study. For 13 patients that never received EVR, the average change in estimated glomerular filtration rate (eGFR) compared to baseline at the time of transplant were as follows: 1 year post-transplant = -18.1%; 2 years = -43.7%; 3 years = -44.1; and 5 years = -43.3%. For 15 patients who received EVR after transplant, average duration of EVR therapy was (579.60 ± 784.15) days with 87% of patients ultimately removed from medication due to side effects. In the EVR group, the average change in eGFR compared to baseline were as follows: 1 year post-transplant = -37.5%; 2 years = -43.5%; 3 years = -54.2%; and 5 years = -42.9%. After the initiation of EVR, the average change in eGFR compared to eGFR at time of EVR initiation was as follows: 1 year = +5.9%; 2 years = -1.57%; 3 years = -5.01%; and 5 years = -1.79%.</p><p><strong>Conclusions: </strong>This study suggests that EVR can play an important role in preserving renal function in intestinal and multivisceral transplant recipients, but tolerance of EVR is highly variable in this patient population.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":"2250-2254"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741824","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}

{"title":"Recoverability of Bladder Function in Patients With Defunctionalized Bladder and Live-Donor Kidney Transplantation.","authors":"Bassem S Wadie, Ahmed S El Hefnawy, Ayman F Refaie","doi":"10.1016/j.transproceed.2024.10.033","DOIUrl":"10.1016/j.transproceed.2024.10.033","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this article was to assess the recoverability of bladder, in a subset of patients with uremia, planned for live-donor kidney transplantation.</p><p><strong>Methods: </strong>Patients referred to the Voiding Dysfunction Unit for evaluation, prior to transplantation, were included in this study during the period 2004 to 2008 in a single institution with a track record in live-donor transplantation. Defunctionalized bladder was defined as patients with complete anuria or oliguria for at least 6 months. All had stage 5 end-stage renal disease (ESRD) and were subjected to invasive urodynamics prior and 6 months after live-donor kidney transplantation. Outcome measurement and statistical method: improvement of urodynamic variables after transplantation was the principal outcome measure. Comparisons were made using the one-sample two-tailed t test. One way analysis of variance was used for comparison of continuous variables and Pearson's Correlation coefficient for studying the correlation between the duration of anuria and different continuous variables.</p><p><strong>Results: </strong>Thirty-two patients were included in this study. The bladder underwent a significant decline of its capacity with defunctionalization with a mean cystometric capacity at baseline of 253 ± 171 mL that increased to 389 (P = .001), compliance increased from 26 to 33 (P = .001), filling pressure decreased by 12 cm H20 (P = .001) and free maximum flow rate (Q max) increased from 13 to 16 mL/s (P = .007). Detrusor overactivity decreased in prevalence (from 26 to 14 cases) and amplitude (from 21 to 12 cm H20). Our study lacks voiding cystometry variables as well as in having diverse causes for defunctionalization.</p><p><strong>Conclusions: </strong>After transplantation, urodynamic parameters significantly improved. With caution, these defunctionalized bladders (DBs) could be utilized for live-donor transplants with favorable functional outcome.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":"2144-2148"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776081","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}