AIM： To investigate the chemopreventive efficacy of the Indian medicinal plant Acanthus ilicifolius L Acanthaceae in a transplantable Ehrlich ascites carcinoma （EAC）- bearing murine model.METHODS： Male Swiss albin...AIM： To investigate the chemopreventive efficacy of the Indian medicinal plant Acanthus ilicifolius L Acanthaceae in a transplantable Ehrlich ascites carcinoma （EAC）- bearing murine model.METHODS： Male Swiss albino mice were divided into four groups： Group A was the untreated normal control; Group B was the EAC control mice group that received serial, intraperitoneal （ip） inoculations of rapidly proliferating 2 × 10^5 viable EAC cells in 0.2 mL of sterile phosphate buffered saline; Group C was the plant extract-treated group that received the aqueous leaf extract （ALE） of the plant at a dose of 2.5 mg/kg body weight by single ip injections, once daily for 10, 20 and 30 consecutive days following tumour inoculation （ALE control）; and Group D was the EAC ＋ ALE- treatment group. The chemopreventive potential of the ALE was evaluated in a murine model by studying various biological parameters and genotoxic markers, such as tumour cell count, mean survival of the animals, haematological indices, hepatocellular histology, immunohistochemical expression of liver metallothionein （MT） protein, sister-chromatid exchanges （SCEs）, and DNA alterations.RESULTS： Treatment of the EAC-bearing mice with the ALE significantly （P 〈 0.001） reduced viable tumour cell count by 68.34% （228.7 × 10^6 ± 0.53） when compared to EAC control mice （72.4 × 10^6 ± 0.49）, and restored body and organ weights almost to the normal values. ALE administration also increased （P 〈 0.001） mean survival of the hosts from 35 ± 3.46 d in EAC control mice to 83 ± 2.69 d in EAC ＋ ALE-treated mice. Haematological indices also showed marked improvement with administration of ALE in EAC-bearing animals. There was a significant increase in RBC count （P 〈 0.001）, hemoglobin percent （P 〈 0.001）, and haematocrit value （P 〈 0.001） from 4.3 ± 0.12, 6.4 ± 0.93, and 17.63 ± 0.72 respectively in EAC control mice to 7.1 ± 0.13, 12.1 ± 0.77, and 30.23 ± 0.57 respectively in EAC ＋ ALE-treated group, along with concurrent decrement （P 〈 0.001） in WBC count from 18.8 ± 0.54 in EAC control to 8.4 ± 0.71 in EAC ＋ ALE. Furthermore, treatment with ALE substantially improved hepatocellular architecture and no noticeable neoplastic lesions or foci of cellular alteration were observed. Daily administration of the ALE was found to limit liver MT expression, an important marker of cell proliferation with concomitant reduction in MT immunoreactivity （62.25 ± 2.58 vs 86.24 ± 5.69, P 〈 0.01）. ALE was also potentially effective in reducing （P 〈 0.001） the frequency of SCEs from 14.94 ± 2.14 in EAC control to 5.12 ± 1.16 in EAC ＋ ALE-treated group. Finally, in comparison to the EAC control, ALE was able to suppress in vivo DNA damage by abating the generations of＇tailed＇ DNA by 53.59% （98.65 ± 2.31 vs 45.06 ± 1.14, P 〈 0.001）, and DNA single-strand breaks （SSBs） by 38.53% （3.14 ± 0.31 vs 1.93 ± 0.23, P 〈 0.01） in EAC-bearing murine liver.CONCLUSION： Our data indicate that, ALE is beneficial in restoring haematological and hepatic histological profiles and in lengthening the survival of the animals against the proliferation of ascites tumour in vivo. Finally, the chemopreventive efficacy of the ALE is manifested in limiting MT expression and in preventing DNA alterations in murine liver. The promising results of this study suggest further investigation into the chemopreventive mechanisms of the medicinal plant A. ilicifolius in vivo and in vitro.展开更多
The antitumor activity of the fourteen polymetalacrylates against two models of murine solid tumors (Lewis lung carcinoma and Acatol adenocarcinoma) as well as the acute toxicity of these compounds has been studied. I...The antitumor activity of the fourteen polymetalacrylates against two models of murine solid tumors (Lewis lung carcinoma and Acatol adenocarcinoma) as well as the acute toxicity of these compounds has been studied. It was shown that polyacrylates of noble metals (argent, aurum, platinum), namely argacryl (М = Ag), auracryl (М = Au) and platacryl (М = Pt) were the most effective agents among tested compounds against studied tumors. Thus, the tumor growth inhibitory effect of argacryl against Lewis lung carcinoma was equal to 90%, the life-span of treated by this compound animals has increased on 50% in comparison with control. Auracryl induced the inhibition of the Lewis lung carcinoma and Acatol adenocarcinoma development on 60 and 65%, correspondingly and the increasing of the mean life-span of animals with Lewis lung carcinoma on 20% in comparison with control. Platacryl inhibited the growth of Lewis lung carcinoma on 40% increasing the mean life-span of animals on 25% in comparison with control. In this way it was established that argacryl is the agent with the strongest antitumor activity among studied polymetalacrylates. On the basis of obtained data it seems possible to consider polymetalacrylates as a group of agents with the potential antitumor activity suitable for the further deep experimental investigation.展开更多
Liver resection(LR) and primary liver transplantation(LT) are two potentially curative treatment modalities for patients with hepatocellular carcinoma(HCC).If an underlying chronic liver disease exists,however,making ...Liver resection(LR) and primary liver transplantation(LT) are two potentially curative treatment modalities for patients with hepatocellular carcinoma(HCC).If an underlying chronic liver disease exists,however,making a decision on which method should be selected is difficult.If a patient has no chronic liver disease,LR may be the preferable option with salvage transplantation(ST) in mind in case of recurrence.Presence of a moderate-to-severe liver failure accompanying HCC usually warrants primary LT.The treatment of patients with HCC and early-stage chronic liver disease remains controversial.The advantages of "LR-followed-by-STif-needed" strategy include less complicated index operation,no need for immunosuppression,use of donor livers for other patients in today's organ shortage setting and comparable survival rates.However,primary LT has its own advantages as it also treats underlying chronic liver disease with carcinogenic potential,removes undetected tumor nodules and potentially eliminates need for a ST.An article recently published by Fuks et al in Hepatology offers an approach by which selecting between LR-followed-by-ST and immediate LT might be easier.Here we discuss the results of the aforementioned report in the light of currently available knowledge.展开更多
MitraClip therapy for mitral regurgitation （MR） in ad- vanced-end stage heart failure （HF）, could open a final bridge to improve symptoms and quality of life in ＂not transplant- able＂ patients. Functional MR is ...MitraClip therapy for mitral regurgitation （MR） in ad- vanced-end stage heart failure （HF）, could open a final bridge to improve symptoms and quality of life in ＂not transplant- able＂ patients. Functional MR is a complicating patho- physiological cofactor of dilated cardiomiopathy （DCM）, associated with poor HF survival.展开更多
The chemopreventive effects of green tea and its polyphenols are well documented in the literature. Epidemiological studies have suggested that green tea consumption might be effective in the prevention of certain hum...The chemopreventive effects of green tea and its polyphenols are well documented in the literature. Epidemiological studies have suggested that green tea consumption might be effective in the prevention of certain human cancers. About 80% of the tea is consumed as black tea. Limited studies have been carried out to assess the usefulness of black tea as anti_carcinogen. The present set of investigations were initiated to study the anti_tumorigenic potential of aqueous black tea extract (ATE) in Swiss albino mice in \%in vivo\% animal bioassay, using 7, 12 dimethyl_benzanthracene (DMBA) as carcinogen. In the experimental group, 2% ATE was given orally as sole source of drinking water, while the control were allowed to drink normal water, \%ad lib.\% The results revealed that drinking of 2% ATE could effectively inhibit the onset of tumorigenesis, cumulative number of tumors and average number of tumors per mouse. In ATE drinking group 44% animals remained tumor free till the termination of experiment, i. e. 26 weeks. In the second set of experiment the preventive efficacy of 2% ATE of different cultivars of black tea, viz orthodox, CTC and dust were tested in Ehrlich Ascites (EA) tumor bearing mice. The preventive effects of ATE were observed in terms of increased life span (ILS). All the cultivars of tea showed more than 25% increase in life span of the animals. Cytotoxic effect of various doses of all three cultivars of black tea was also observed \%in vitro \%on EA cells.展开更多
Objective:Some patients fail to obtain an embryo for transplantation during previousin vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)cycles,and require multiple reproductive treatments.This study ai...Objective:Some patients fail to obtain an embryo for transplantation during previousin vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)cycles,and require multiple reproductive treatments.This study aimed to evaluate whether changing the control ovarian stimulation(COS)protocol during the subsequent stimulation cycle could improve laboratory and clinical outcomes in these patients.Methods:Patients without a transplantable embryo(TE)in the previous IVF/ICSI cycles were recruited during their second cycles.They were classified into two groups according to their first cycle protocol:Group A,patients treated with a gonadotropinreleasing hormone agonist(GnRH-a),and Group B,patients treated with a gonadotropin-releasing hormone antagonist(GnRH-ant).The study group included patients whose stimulation protocols were changed,whereas the control group consisted of patients who used the same stimulation protocol in the second cycle.We then compared the numbers of oocytes collected(OC)and TE,the incidence of non-TE,the pregnancy rate(PR),and the live birth rate(LBR).Results:In Group A,the numbers of OC and TE were significantly lower(6.0±4.7vs.9.4±6.4,2.3±2.2vs.4.5±3.8,P<0.05)in the study group compared with those in the control group.In Group B,the numbers of OC and TE were higher(7.0±5.5vs.4.0±4.3,3.5±3.4vs.1.8±2.1,P<0.05)in the study group.There was a significant increase in the incidence of non-TE(adjusted odds ratio(AOR)=2.12,95%CI:1.04–4.69)of the study group in Group A but not in Group B.No significant differences in the PR or LBR were found between the study and control groups in either Group A or B.Conclusion:Changing the COS protocol from GnRH-ant to GnRH-a or continuing the GnRH-a protocol can improve laboratory outcomes in patients with no TE in the previous IVF/ICSI cycle.展开更多
With advances in solid organ transplantation,the option of combined kidney with other solid organ transplantation is an enticing option for patients with advanced kidney disease and concomitant other solid organ failu...With advances in solid organ transplantation,the option of combined kidney with other solid organ transplantation is an enticing option for patients with advanced kidney disease and concomitant other solid organ failure.Kidney allograft dysfunction is well known to be associated with increased adverse outcomes post solitary kidney transplant however,outcomes for patients and the kidney allograft are somewhat understudied in the setting of kidney transplantation when combined with other solid organ transplantation such as in a simultaneous liverkidney transplant.We will provide an overview of the current literature available on kidney allograft clinical outcome measures in combined solid organ transplant recipients such as delayed kidney allograft function,kidney allograft rejection,kidney allograft and patient survival metrics and how they compare to patients with kidney transplants alone.Worse kidney allograft survival outcomes were noted in most combined other organ with kidney transplantation(liver-kidney,heart-kidney,and lung-kidney)due to comorbidities attributed to non-renal organ dysfunction whereas improved kidney allograft survival outcomes were noted for pancreas-kidney transplantation.展开更多
Diabetes is a widespread disease affecting millions of people,making it one of the leading causes of death in the world.It is a leading cause of cardiovascular disease and end-stage renal disease.Despite advancements ...Diabetes is a widespread disease affecting millions of people,making it one of the leading causes of death in the world.It is a leading cause of cardiovascular disease and end-stage renal disease.Despite advancements in treatment,including insulin therapy and glucose monitoring devices,diabetes continues to significantly impact quality of life and current modalities do not reverse the end-organ damage associated with its progression.While traditionally indicated for type 1 diabetes,recent clinical practice refinements have made pancreas transplants available to select type 2 diabetics meeting specific criteria.These transplants are usually a part of a simultaneous kidney-pancreas transplant.However,although less frequently performed,transplants of pancreas alone or pancreas after kidney transplant are still available.For selected diabetic patients,pancreas transplants offer significant survival benefits and the improvement of cardiovascular and metabolic complications;however,they are not without risks.Complications such as bleeding,vascular thrombosis,infection,organ leak,and rejection are possible.Another challenge to pancreas transplantation is the decreasing number of procedures being performed due to decline in the volume of available highquality allografts and resource constraints of transplant centers.Advancements in monitoring and treatment of diabetes are contributing to the decline in pancreas transplants nowadays.展开更多
Nail changes following upper extremity transplantation(UET)cannot be overlooked as they possess diagnostic and prognostic relevance in allotransplantation of upper limbs.This comprehensive review explores nail and nai...Nail changes following upper extremity transplantation(UET)cannot be overlooked as they possess diagnostic and prognostic relevance in allotransplantation of upper limbs.This comprehensive review explores nail and nail bed related changes encountered in UET recipients in the literature.The differential diagnosis of nail abnormalities in UET includes a wide range of systemic,local and iatrogenic conditions other than immune responses to the allograft.It requires interdisciplinary evaluation by primary transplant surgeons,pathologists,dermatologists and immunologists.The possible underlying mechanisms of nail pathology in UET and the management are discussed.It also underscores the importance of onychodystrophy and need for timely intervention and to improve outcomes in UET recipients.展开更多
Kidney transplantation(KT)accounts for nearly three-fourths of organ transplants in India,with living donors contributing to 82%of cases.Induction immunosuppression is essential to optimize initial immunosuppression,r...Kidney transplantation(KT)accounts for nearly three-fourths of organ transplants in India,with living donors contributing to 82%of cases.Induction immunosuppression is essential to optimize initial immunosuppression,reduce acute rejections,and enable tailored use of maintenance agents.Rabbit anti-thymocyte globulin(rATG)and interleukin-2 receptor anatagonists(IL-2RA/IL-2RBs)are the most widely used induction therapies.However,data on induction practices across India are limited.To evaluate induction immunosuppression practices across KT centers in India and establish a consensus for different subsets of KT recipients.A nationwide online survey was conducted by the Indian Society of Organ Transplantation(ISOT)among its members(400 KT centers).Responses were analyzed to assess induction practices across diverse donor types,age groups,and immunological risk profiles.Heterogeneity in practices prompted consensus building using a modified Delphi process.Literature review and expert panel discussions(April 2024)were followed by structured voting,and 16 consensus statements were finalized.Of 400 centers approached,254 participated.rATG was the most commonly used induction therapy,followed by IL-2RBs;alemtuzumab was least used.Significant heterogeneity was observed in type,dose,and duration of induction therapy.Consensus recommendations were framed:rATG for high immunological risk recipients and deceased donor KTs;IL-2RB or low-dose rATG for low immunological risk;rituximab in ABOincompatible KTs;and tailoring based on age,diabetes,donor type,infection risk,and affordability.This first ISOT consensus provides 16 India-specific statements on induction therapy in KT.It emphasizes risk-stratified,evidenceinformed,and context-appropriate induction strategies,supporting standardization of care across the country.展开更多
Antibody-mediated rejection(AMR)remains a leading cause of kidney allograft failure,posing significant clinical and economic challenges.Donor-specific antibodies against human leukocyte antigens or non-human leukocyte...Antibody-mediated rejection(AMR)remains a leading cause of kidney allograft failure,posing significant clinical and economic challenges.Donor-specific antibodies against human leukocyte antigens or non-human leukocyte antigens are critical risk factors for AMR and graft loss.The diagnostic criteria and classification of AMR have evolved considerably over the past three decades,driven largely by the Banff classification.The latest Banff 2022 classification introduced two additional subcategories of“microvascular inflammation,donor-specific antibody-negative,C4d-negative”and“probable AMR”.Traditionally,graft monitoring has relied on non-specific markers such as serum creatinine and proteinuria,and the invasive biopsies.Noninvasive tools using blood and urine biomarkers,including cellular assays and molecular profiling,are increasingly being investigated.Technologies such as the Molecular Microscope Diagnostic System show promise,with studies reporting 80%sensitivity and 90%specificity in detecting AMR.Treatment of AMR remains inconsistent.Recent advances,including CD38 antibodies,have demonstrated up to 60%efficacy in reversing AMR,while complement inhibition shows potential in severe early cases.Ongoing clinical trials evaluating high-dose intravenous immunoglobulin,efgartigimod,fostamatinib,and other novel therapies aim to expand treatment options.These developments highlight the need for well-designed clinical trials to validate biomarkers and therapies and to improve long-term outcomes for kidney transplant recipients.展开更多
Microplastic contamination has emerged as a threat in transplantation,with evidence of its presence in human tissues and potential to compromise grafts.Transplant recipients,vulnerable due to immunosuppression and sur...Microplastic contamination has emerged as a threat in transplantation,with evidence of its presence in human tissues and potential to compromise grafts.Transplant recipients,vulnerable due to immunosuppression and surgical exposure,face risk from microplastics via airborne particles,surgical materials,and organ preservation systems.These particles trigger inflammation,oxidative stress,and immune dysregulation—pathways critical in rejection.Microplastics support biofilm formation,potentially facilitating antimicrobial resistance in clinical settings.Despite this risk,transplant-specific research is lacking.We urge action through environmental controls,material substitutions,and procedural modifications,alongside research targeting exposure pathways,biological impact,and mitigation strategies.Transplantation has historically led medical innovation and must do so in confronting this environmental challenge.Leadership from global transplant societies is essential to protect recipients and ensure safe procedures.展开更多
Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantati...Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantation process including preoperative evaluation,donation,organ and patient transportation,surgery,postoperative recovery,and follow-up.This is a topic that has not been fully addressed yet,but its importance is being increasingly appreciated in surgery.The aim of this study was to investigate the carbon footprint associated with transplantation and propose sustainable mitigating solutions.A comprehensive review of the existing literature on transplantation was conducted and supplemented with findings from the broader fields of surgical and perioperative care,given the scarcity of available data.The analysis identified the most involved environmental factors and attempted to offer practical solutions based on current sustainability practices.Notably,no study has yet examined the carbon footprint associated with the entire transplantation procedure.Only five studies have attempted to assess the environmental impact of kidney or liver transplants,but they focused,almost explicitly,on specific steps of the process.By employing an extrapolative methodology from the broader surgical field,we determined that the primary contributors to the environmental impact of transplantation are energy,consumables and materials,anesthesia and pharmaceuticals,transportation,and water.This review offers practical solutions utilizing the 5R framework,emphasizing sustainability to ensure transplantation remains clinically and environmentally relevant.展开更多
BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant rec...BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.展开更多
Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have signi...Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.展开更多
Liver transplantation(LT)remains the optimal life-saving intervention for patients with end-stage liver disease.Despite the recent advances in LT several barriers,including organ allocation,donor-recipient matching,an...Liver transplantation(LT)remains the optimal life-saving intervention for patients with end-stage liver disease.Despite the recent advances in LT several barriers,including organ allocation,donor-recipient matching,and patient education,persist.With the growing progress of artificial intelligence,particularly large language models(LLMs)like ChatGPT,new applications have emerged in the field of LT.Current studies demonstrating usage of ChatGPT in LT include various areas of application,from clinical settings to research and education.ChatGPT usage can benefit both healthcare professionals,by decreasing the time spent on non-clinical work,but also LT recipients by providing accurate information.Future potential applications include the expanding usage of ChatGPT and other LLMs in the field of LT pathology and radiology as well as the automated creation of discharge summaries or other related paperwork.Additionally,the next models of ChatGPT might have the potential to provide more accurate patient education material with increased readability.Although ChatGPT usage presents promising applications,there are certain ethical and practical limitations.Key concerns include patient data privacy,information accuracy,misinformation possibility and lack of legal framework.Healthcare providers and policymakers should collaborate for the establishment of a controlled framework for the safe use of ChatGPT.The aim of this minireview is to summarize current literature on ChatGPT in LT,highlighting both opportunities and limitations,while also providing future possible applications.展开更多
AIM:To describe the technique and the outcomes of manual Bowman layer and stroma transplant-onlay(BLST-o)for 2 cases of radial keratotomy(RK).METHODS:Two patients with visual fluctuations and corneal irregularity due ...AIM:To describe the technique and the outcomes of manual Bowman layer and stroma transplant-onlay(BLST-o)for 2 cases of radial keratotomy(RK).METHODS:Two patients with visual fluctuations and corneal irregularity due to RK were offered manual BLST-o as an alternative to penetrating keratoplasty(PKP).Visual acuity,refraction,corneal topography,corneal aberrometry,and corneal optical coherence tomography(OCT)pre-and postoperative were analyzed.Histology was obtained for 1 case.RESULTS:Both patients had corneal anatomical and morphological improvement,with elimination of the visual fluctuations.In one case,a subsequent excimer laser treatment improved corneal shape further,thus improving vision.The other case,whereas initially improved,developed epithelial ingrowth following suture removal.The latter was explanted and had a xenogeneic implant.The explanted sample was sent for histology,showing a viable graft of Bowman layer and anterior stroma.CONCLUSION:Manual BLST-o is a potential option for the management of symptoms post RK.These grafts may facilitate subsequent treatments such as laser corrections,and may not preclude from other interventions after explantation.展开更多
Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progre...Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progression and provide symptomatic improvement in patients with IEM.Each metabolic disorder is unique,with the missing enzyme or transporter protein causing substrate deficiency or toxic byproduct production.Knowledge about the distribution of deficient enzymes,the percentage of enzymes replaced by LT,and the extent of extrahepatic involvement helps anticipate and manage complications in the perioperative period.Most patients have multisystem involvement and can be on complex dietary regimens.Metabolic decompensation can be triggered due to the stress response to surgery,fasting and other unanticipated complications perioperatively.Thus,a multidisciplinary team’s input including those from metabolic specialists is essential to develop disease and patient-specific strategies for the perioperative management of these patients during LT.In this review,we outline the classification of IEM,indications for LT along with potential benefits,basic metabolic defects and their implications,details of extrahepatic involvement and perioperative management strategies for LT in children with some of the commonly presenting IEM,to assist anesthesiologists handling this cohort of patients.展开更多
BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifyi...BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.展开更多
BACKGROUND Organ transplantation has emerged as a globally prevalent therapeutic modality for end-stage organ failure,yet the post-transplantation trajectory is increasingly complicated by a spectrum of metabolic sequ...BACKGROUND Organ transplantation has emerged as a globally prevalent therapeutic modality for end-stage organ failure,yet the post-transplantation trajectory is increasingly complicated by a spectrum of metabolic sequelae,with obesity emerging as a critical clinical challenge.AIM To systematically review the multifactorial mechanisms underlying obesity following organ transplantation and to integrate evidence from pharmacological,behavioral,and molecular perspectives,thereby providing a foundation for targeted interventions.METHODS We conducted a systematic search in PubMed and Web of Science for literature published from 2020 to 15 July 2025.The search strategy incorporated terms including“obesity”,“overweight”and“post organ transplantation”.Only randomized controlled trials,meta-analyses,and systematic reviews were included.Non-empirical publications and irrelevant studies were excluded.Data extraction and quality assessment were performed by two independent reviewers,with disagreements resolved by a third researcher.RESULTS A total of 1457 articles were initially identified,of which 146 met the inclusion criteria.These studies encompassed liver,kidney,heart,and lung transplant recipients.Key findings indicate that immunosuppressive drugs-especially corticosteroids and calcineurin inhibitors-promote hyperphagia,insulin resistance,and dyslipidemia.Post-transplant sedentary behavior and hypercaloric diets further contribute to positive energy balance.At the molecular level,immunosuppressants disrupt adipokine signaling(e.g.,leptin and adiponectin),induce inflammatory and oxidative stress responses,and activate adipogenic pathways leading to lipid accumulation.CONCLUSION Post-transplant obesity arises from a complex interplay of pharmacological,behavioral,and molecular factors.A multidisciplinary approach-incorporating pharmacological modification,nutritional management,physical activity,and molecular-targeted therapies-is essential to mitigate obesity and improve transplant outcomes.Further large-scale and mechanistic studies are warranted to establish evidence-based preventive and treatment strategies.展开更多
基金Supported by The Council of Scientific and Industrial Research, Government of India, No. 9/96(470)2K5-EMR-I
文摘AIM： To investigate the chemopreventive efficacy of the Indian medicinal plant Acanthus ilicifolius L Acanthaceae in a transplantable Ehrlich ascites carcinoma （EAC）- bearing murine model.METHODS： Male Swiss albino mice were divided into four groups： Group A was the untreated normal control; Group B was the EAC control mice group that received serial, intraperitoneal （ip） inoculations of rapidly proliferating 2 × 10^5 viable EAC cells in 0.2 mL of sterile phosphate buffered saline; Group C was the plant extract-treated group that received the aqueous leaf extract （ALE） of the plant at a dose of 2.5 mg/kg body weight by single ip injections, once daily for 10, 20 and 30 consecutive days following tumour inoculation （ALE control）; and Group D was the EAC ＋ ALE- treatment group. The chemopreventive potential of the ALE was evaluated in a murine model by studying various biological parameters and genotoxic markers, such as tumour cell count, mean survival of the animals, haematological indices, hepatocellular histology, immunohistochemical expression of liver metallothionein （MT） protein, sister-chromatid exchanges （SCEs）, and DNA alterations.RESULTS： Treatment of the EAC-bearing mice with the ALE significantly （P 〈 0.001） reduced viable tumour cell count by 68.34% （228.7 × 10^6 ± 0.53） when compared to EAC control mice （72.4 × 10^6 ± 0.49）, and restored body and organ weights almost to the normal values. ALE administration also increased （P 〈 0.001） mean survival of the hosts from 35 ± 3.46 d in EAC control mice to 83 ± 2.69 d in EAC ＋ ALE-treated mice. Haematological indices also showed marked improvement with administration of ALE in EAC-bearing animals. There was a significant increase in RBC count （P 〈 0.001）, hemoglobin percent （P 〈 0.001）, and haematocrit value （P 〈 0.001） from 4.3 ± 0.12, 6.4 ± 0.93, and 17.63 ± 0.72 respectively in EAC control mice to 7.1 ± 0.13, 12.1 ± 0.77, and 30.23 ± 0.57 respectively in EAC ＋ ALE-treated group, along with concurrent decrement （P 〈 0.001） in WBC count from 18.8 ± 0.54 in EAC control to 8.4 ± 0.71 in EAC ＋ ALE. Furthermore, treatment with ALE substantially improved hepatocellular architecture and no noticeable neoplastic lesions or foci of cellular alteration were observed. Daily administration of the ALE was found to limit liver MT expression, an important marker of cell proliferation with concomitant reduction in MT immunoreactivity （62.25 ± 2.58 vs 86.24 ± 5.69, P 〈 0.01）. ALE was also potentially effective in reducing （P 〈 0.001） the frequency of SCEs from 14.94 ± 2.14 in EAC control to 5.12 ± 1.16 in EAC ＋ ALE-treated group. Finally, in comparison to the EAC control, ALE was able to suppress in vivo DNA damage by abating the generations of＇tailed＇ DNA by 53.59% （98.65 ± 2.31 vs 45.06 ± 1.14, P 〈 0.001）, and DNA single-strand breaks （SSBs） by 38.53% （3.14 ± 0.31 vs 1.93 ± 0.23, P 〈 0.01） in EAC-bearing murine liver.CONCLUSION： Our data indicate that, ALE is beneficial in restoring haematological and hepatic histological profiles and in lengthening the survival of the animals against the proliferation of ascites tumour in vivo. Finally, the chemopreventive efficacy of the ALE is manifested in limiting MT expression and in preventing DNA alterations in murine liver. The promising results of this study suggest further investigation into the chemopreventive mechanisms of the medicinal plant A. ilicifolius in vivo and in vitro.
文摘The antitumor activity of the fourteen polymetalacrylates against two models of murine solid tumors (Lewis lung carcinoma and Acatol adenocarcinoma) as well as the acute toxicity of these compounds has been studied. It was shown that polyacrylates of noble metals (argent, aurum, platinum), namely argacryl (М = Ag), auracryl (М = Au) and platacryl (М = Pt) were the most effective agents among tested compounds against studied tumors. Thus, the tumor growth inhibitory effect of argacryl against Lewis lung carcinoma was equal to 90%, the life-span of treated by this compound animals has increased on 50% in comparison with control. Auracryl induced the inhibition of the Lewis lung carcinoma and Acatol adenocarcinoma development on 60 and 65%, correspondingly and the increasing of the mean life-span of animals with Lewis lung carcinoma on 20% in comparison with control. Platacryl inhibited the growth of Lewis lung carcinoma on 40% increasing the mean life-span of animals on 25% in comparison with control. In this way it was established that argacryl is the agent with the strongest antitumor activity among studied polymetalacrylates. On the basis of obtained data it seems possible to consider polymetalacrylates as a group of agents with the potential antitumor activity suitable for the further deep experimental investigation.
文摘Liver resection(LR) and primary liver transplantation(LT) are two potentially curative treatment modalities for patients with hepatocellular carcinoma(HCC).If an underlying chronic liver disease exists,however,making a decision on which method should be selected is difficult.If a patient has no chronic liver disease,LR may be the preferable option with salvage transplantation(ST) in mind in case of recurrence.Presence of a moderate-to-severe liver failure accompanying HCC usually warrants primary LT.The treatment of patients with HCC and early-stage chronic liver disease remains controversial.The advantages of "LR-followed-by-STif-needed" strategy include less complicated index operation,no need for immunosuppression,use of donor livers for other patients in today's organ shortage setting and comparable survival rates.However,primary LT has its own advantages as it also treats underlying chronic liver disease with carcinogenic potential,removes undetected tumor nodules and potentially eliminates need for a ST.An article recently published by Fuks et al in Hepatology offers an approach by which selecting between LR-followed-by-ST and immediate LT might be easier.Here we discuss the results of the aforementioned report in the light of currently available knowledge.
文摘MitraClip therapy for mitral regurgitation （MR） in ad- vanced-end stage heart failure （HF）, could open a final bridge to improve symptoms and quality of life in ＂not transplant- able＂ patients. Functional MR is a complicating patho- physiological cofactor of dilated cardiomiopathy （DCM）, associated with poor HF survival.
文摘The chemopreventive effects of green tea and its polyphenols are well documented in the literature. Epidemiological studies have suggested that green tea consumption might be effective in the prevention of certain human cancers. About 80% of the tea is consumed as black tea. Limited studies have been carried out to assess the usefulness of black tea as anti_carcinogen. The present set of investigations were initiated to study the anti_tumorigenic potential of aqueous black tea extract (ATE) in Swiss albino mice in \%in vivo\% animal bioassay, using 7, 12 dimethyl_benzanthracene (DMBA) as carcinogen. In the experimental group, 2% ATE was given orally as sole source of drinking water, while the control were allowed to drink normal water, \%ad lib.\% The results revealed that drinking of 2% ATE could effectively inhibit the onset of tumorigenesis, cumulative number of tumors and average number of tumors per mouse. In ATE drinking group 44% animals remained tumor free till the termination of experiment, i. e. 26 weeks. In the second set of experiment the preventive efficacy of 2% ATE of different cultivars of black tea, viz orthodox, CTC and dust were tested in Ehrlich Ascites (EA) tumor bearing mice. The preventive effects of ATE were observed in terms of increased life span (ILS). All the cultivars of tea showed more than 25% increase in life span of the animals. Cytotoxic effect of various doses of all three cultivars of black tea was also observed \%in vitro \%on EA cells.
基金grants to W.H.M.from the National Natural Science Foundation of China(81860160)M.J.L.from Guangxi Key Research and Development Program(No.AB20238002)+2 种基金Y.H.Y.from the National Natural Science Foundation of China(81871172)the Natural Science Foundation of Guangxi Zhuang Autonomous Region(2019GXNSFFA245013,2018GXNSFDA050017)the Guangxi Medical University Training Program for Distinguished Young Scholars and the Special Fund of the Female Fertility Preservation Innovation Team of the First Affiliated Hospital of Guangxi Medical University。
文摘Objective:Some patients fail to obtain an embryo for transplantation during previousin vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)cycles,and require multiple reproductive treatments.This study aimed to evaluate whether changing the control ovarian stimulation(COS)protocol during the subsequent stimulation cycle could improve laboratory and clinical outcomes in these patients.Methods:Patients without a transplantable embryo(TE)in the previous IVF/ICSI cycles were recruited during their second cycles.They were classified into two groups according to their first cycle protocol:Group A,patients treated with a gonadotropinreleasing hormone agonist(GnRH-a),and Group B,patients treated with a gonadotropin-releasing hormone antagonist(GnRH-ant).The study group included patients whose stimulation protocols were changed,whereas the control group consisted of patients who used the same stimulation protocol in the second cycle.We then compared the numbers of oocytes collected(OC)and TE,the incidence of non-TE,the pregnancy rate(PR),and the live birth rate(LBR).Results:In Group A,the numbers of OC and TE were significantly lower(6.0±4.7vs.9.4±6.4,2.3±2.2vs.4.5±3.8,P<0.05)in the study group compared with those in the control group.In Group B,the numbers of OC and TE were higher(7.0±5.5vs.4.0±4.3,3.5±3.4vs.1.8±2.1,P<0.05)in the study group.There was a significant increase in the incidence of non-TE(adjusted odds ratio(AOR)=2.12,95%CI:1.04–4.69)of the study group in Group A but not in Group B.No significant differences in the PR or LBR were found between the study and control groups in either Group A or B.Conclusion:Changing the COS protocol from GnRH-ant to GnRH-a or continuing the GnRH-a protocol can improve laboratory outcomes in patients with no TE in the previous IVF/ICSI cycle.
文摘With advances in solid organ transplantation,the option of combined kidney with other solid organ transplantation is an enticing option for patients with advanced kidney disease and concomitant other solid organ failure.Kidney allograft dysfunction is well known to be associated with increased adverse outcomes post solitary kidney transplant however,outcomes for patients and the kidney allograft are somewhat understudied in the setting of kidney transplantation when combined with other solid organ transplantation such as in a simultaneous liverkidney transplant.We will provide an overview of the current literature available on kidney allograft clinical outcome measures in combined solid organ transplant recipients such as delayed kidney allograft function,kidney allograft rejection,kidney allograft and patient survival metrics and how they compare to patients with kidney transplants alone.Worse kidney allograft survival outcomes were noted in most combined other organ with kidney transplantation(liver-kidney,heart-kidney,and lung-kidney)due to comorbidities attributed to non-renal organ dysfunction whereas improved kidney allograft survival outcomes were noted for pancreas-kidney transplantation.
文摘Diabetes is a widespread disease affecting millions of people,making it one of the leading causes of death in the world.It is a leading cause of cardiovascular disease and end-stage renal disease.Despite advancements in treatment,including insulin therapy and glucose monitoring devices,diabetes continues to significantly impact quality of life and current modalities do not reverse the end-organ damage associated with its progression.While traditionally indicated for type 1 diabetes,recent clinical practice refinements have made pancreas transplants available to select type 2 diabetics meeting specific criteria.These transplants are usually a part of a simultaneous kidney-pancreas transplant.However,although less frequently performed,transplants of pancreas alone or pancreas after kidney transplant are still available.For selected diabetic patients,pancreas transplants offer significant survival benefits and the improvement of cardiovascular and metabolic complications;however,they are not without risks.Complications such as bleeding,vascular thrombosis,infection,organ leak,and rejection are possible.Another challenge to pancreas transplantation is the decreasing number of procedures being performed due to decline in the volume of available highquality allografts and resource constraints of transplant centers.Advancements in monitoring and treatment of diabetes are contributing to the decline in pancreas transplants nowadays.
文摘Nail changes following upper extremity transplantation(UET)cannot be overlooked as they possess diagnostic and prognostic relevance in allotransplantation of upper limbs.This comprehensive review explores nail and nail bed related changes encountered in UET recipients in the literature.The differential diagnosis of nail abnormalities in UET includes a wide range of systemic,local and iatrogenic conditions other than immune responses to the allograft.It requires interdisciplinary evaluation by primary transplant surgeons,pathologists,dermatologists and immunologists.The possible underlying mechanisms of nail pathology in UET and the management are discussed.It also underscores the importance of onychodystrophy and need for timely intervention and to improve outcomes in UET recipients.
文摘Kidney transplantation(KT)accounts for nearly three-fourths of organ transplants in India,with living donors contributing to 82%of cases.Induction immunosuppression is essential to optimize initial immunosuppression,reduce acute rejections,and enable tailored use of maintenance agents.Rabbit anti-thymocyte globulin(rATG)and interleukin-2 receptor anatagonists(IL-2RA/IL-2RBs)are the most widely used induction therapies.However,data on induction practices across India are limited.To evaluate induction immunosuppression practices across KT centers in India and establish a consensus for different subsets of KT recipients.A nationwide online survey was conducted by the Indian Society of Organ Transplantation(ISOT)among its members(400 KT centers).Responses were analyzed to assess induction practices across diverse donor types,age groups,and immunological risk profiles.Heterogeneity in practices prompted consensus building using a modified Delphi process.Literature review and expert panel discussions(April 2024)were followed by structured voting,and 16 consensus statements were finalized.Of 400 centers approached,254 participated.rATG was the most commonly used induction therapy,followed by IL-2RBs;alemtuzumab was least used.Significant heterogeneity was observed in type,dose,and duration of induction therapy.Consensus recommendations were framed:rATG for high immunological risk recipients and deceased donor KTs;IL-2RB or low-dose rATG for low immunological risk;rituximab in ABOincompatible KTs;and tailoring based on age,diabetes,donor type,infection risk,and affordability.This first ISOT consensus provides 16 India-specific statements on induction therapy in KT.It emphasizes risk-stratified,evidenceinformed,and context-appropriate induction strategies,supporting standardization of care across the country.
文摘Antibody-mediated rejection(AMR)remains a leading cause of kidney allograft failure,posing significant clinical and economic challenges.Donor-specific antibodies against human leukocyte antigens or non-human leukocyte antigens are critical risk factors for AMR and graft loss.The diagnostic criteria and classification of AMR have evolved considerably over the past three decades,driven largely by the Banff classification.The latest Banff 2022 classification introduced two additional subcategories of“microvascular inflammation,donor-specific antibody-negative,C4d-negative”and“probable AMR”.Traditionally,graft monitoring has relied on non-specific markers such as serum creatinine and proteinuria,and the invasive biopsies.Noninvasive tools using blood and urine biomarkers,including cellular assays and molecular profiling,are increasingly being investigated.Technologies such as the Molecular Microscope Diagnostic System show promise,with studies reporting 80%sensitivity and 90%specificity in detecting AMR.Treatment of AMR remains inconsistent.Recent advances,including CD38 antibodies,have demonstrated up to 60%efficacy in reversing AMR,while complement inhibition shows potential in severe early cases.Ongoing clinical trials evaluating high-dose intravenous immunoglobulin,efgartigimod,fostamatinib,and other novel therapies aim to expand treatment options.These developments highlight the need for well-designed clinical trials to validate biomarkers and therapies and to improve long-term outcomes for kidney transplant recipients.
文摘Microplastic contamination has emerged as a threat in transplantation,with evidence of its presence in human tissues and potential to compromise grafts.Transplant recipients,vulnerable due to immunosuppression and surgical exposure,face risk from microplastics via airborne particles,surgical materials,and organ preservation systems.These particles trigger inflammation,oxidative stress,and immune dysregulation—pathways critical in rejection.Microplastics support biofilm formation,potentially facilitating antimicrobial resistance in clinical settings.Despite this risk,transplant-specific research is lacking.We urge action through environmental controls,material substitutions,and procedural modifications,alongside research targeting exposure pathways,biological impact,and mitigation strategies.Transplantation has historically led medical innovation and must do so in confronting this environmental challenge.Leadership from global transplant societies is essential to protect recipients and ensure safe procedures.
文摘Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantation process including preoperative evaluation,donation,organ and patient transportation,surgery,postoperative recovery,and follow-up.This is a topic that has not been fully addressed yet,but its importance is being increasingly appreciated in surgery.The aim of this study was to investigate the carbon footprint associated with transplantation and propose sustainable mitigating solutions.A comprehensive review of the existing literature on transplantation was conducted and supplemented with findings from the broader fields of surgical and perioperative care,given the scarcity of available data.The analysis identified the most involved environmental factors and attempted to offer practical solutions based on current sustainability practices.Notably,no study has yet examined the carbon footprint associated with the entire transplantation procedure.Only five studies have attempted to assess the environmental impact of kidney or liver transplants,but they focused,almost explicitly,on specific steps of the process.By employing an extrapolative methodology from the broader surgical field,we determined that the primary contributors to the environmental impact of transplantation are energy,consumables and materials,anesthesia and pharmaceuticals,transportation,and water.This review offers practical solutions utilizing the 5R framework,emphasizing sustainability to ensure transplantation remains clinically and environmentally relevant.
文摘BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.
文摘Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.
文摘Liver transplantation(LT)remains the optimal life-saving intervention for patients with end-stage liver disease.Despite the recent advances in LT several barriers,including organ allocation,donor-recipient matching,and patient education,persist.With the growing progress of artificial intelligence,particularly large language models(LLMs)like ChatGPT,new applications have emerged in the field of LT.Current studies demonstrating usage of ChatGPT in LT include various areas of application,from clinical settings to research and education.ChatGPT usage can benefit both healthcare professionals,by decreasing the time spent on non-clinical work,but also LT recipients by providing accurate information.Future potential applications include the expanding usage of ChatGPT and other LLMs in the field of LT pathology and radiology as well as the automated creation of discharge summaries or other related paperwork.Additionally,the next models of ChatGPT might have the potential to provide more accurate patient education material with increased readability.Although ChatGPT usage presents promising applications,there are certain ethical and practical limitations.Key concerns include patient data privacy,information accuracy,misinformation possibility and lack of legal framework.Healthcare providers and policymakers should collaborate for the establishment of a controlled framework for the safe use of ChatGPT.The aim of this minireview is to summarize current literature on ChatGPT in LT,highlighting both opportunities and limitations,while also providing future possible applications.
文摘AIM:To describe the technique and the outcomes of manual Bowman layer and stroma transplant-onlay(BLST-o)for 2 cases of radial keratotomy(RK).METHODS:Two patients with visual fluctuations and corneal irregularity due to RK were offered manual BLST-o as an alternative to penetrating keratoplasty(PKP).Visual acuity,refraction,corneal topography,corneal aberrometry,and corneal optical coherence tomography(OCT)pre-and postoperative were analyzed.Histology was obtained for 1 case.RESULTS:Both patients had corneal anatomical and morphological improvement,with elimination of the visual fluctuations.In one case,a subsequent excimer laser treatment improved corneal shape further,thus improving vision.The other case,whereas initially improved,developed epithelial ingrowth following suture removal.The latter was explanted and had a xenogeneic implant.The explanted sample was sent for histology,showing a viable graft of Bowman layer and anterior stroma.CONCLUSION:Manual BLST-o is a potential option for the management of symptoms post RK.These grafts may facilitate subsequent treatments such as laser corrections,and may not preclude from other interventions after explantation.
文摘Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progression and provide symptomatic improvement in patients with IEM.Each metabolic disorder is unique,with the missing enzyme or transporter protein causing substrate deficiency or toxic byproduct production.Knowledge about the distribution of deficient enzymes,the percentage of enzymes replaced by LT,and the extent of extrahepatic involvement helps anticipate and manage complications in the perioperative period.Most patients have multisystem involvement and can be on complex dietary regimens.Metabolic decompensation can be triggered due to the stress response to surgery,fasting and other unanticipated complications perioperatively.Thus,a multidisciplinary team’s input including those from metabolic specialists is essential to develop disease and patient-specific strategies for the perioperative management of these patients during LT.In this review,we outline the classification of IEM,indications for LT along with potential benefits,basic metabolic defects and their implications,details of extrahepatic involvement and perioperative management strategies for LT in children with some of the commonly presenting IEM,to assist anesthesiologists handling this cohort of patients.
文摘BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.
基金Supported by the National Natural Science Foundation of China,No.82305376the Youth Talent Support Project of the China Acupuncture and Moxibustion Association,No.2024-2026ZGZJXH-QNRC005+2 种基金the 2024 Jiangsu Province Youth Science and Technology Talent Support Project,No.JSTJ-2024-3802025 Jiangsu Provincial Science and Technology Think Tank Program Project,No.JSKX0125035and 2025 College Student Innovation Training Program Project,No.X202510315373。
文摘BACKGROUND Organ transplantation has emerged as a globally prevalent therapeutic modality for end-stage organ failure,yet the post-transplantation trajectory is increasingly complicated by a spectrum of metabolic sequelae,with obesity emerging as a critical clinical challenge.AIM To systematically review the multifactorial mechanisms underlying obesity following organ transplantation and to integrate evidence from pharmacological,behavioral,and molecular perspectives,thereby providing a foundation for targeted interventions.METHODS We conducted a systematic search in PubMed and Web of Science for literature published from 2020 to 15 July 2025.The search strategy incorporated terms including“obesity”,“overweight”and“post organ transplantation”.Only randomized controlled trials,meta-analyses,and systematic reviews were included.Non-empirical publications and irrelevant studies were excluded.Data extraction and quality assessment were performed by two independent reviewers,with disagreements resolved by a third researcher.RESULTS A total of 1457 articles were initially identified,of which 146 met the inclusion criteria.These studies encompassed liver,kidney,heart,and lung transplant recipients.Key findings indicate that immunosuppressive drugs-especially corticosteroids and calcineurin inhibitors-promote hyperphagia,insulin resistance,and dyslipidemia.Post-transplant sedentary behavior and hypercaloric diets further contribute to positive energy balance.At the molecular level,immunosuppressants disrupt adipokine signaling(e.g.,leptin and adiponectin),induce inflammatory and oxidative stress responses,and activate adipogenic pathways leading to lipid accumulation.CONCLUSION Post-transplant obesity arises from a complex interplay of pharmacological,behavioral,and molecular factors.A multidisciplinary approach-incorporating pharmacological modification,nutritional management,physical activity,and molecular-targeted therapies-is essential to mitigate obesity and improve transplant outcomes.Further large-scale and mechanistic studies are warranted to establish evidence-based preventive and treatment strategies.
