Objective To observe the outcomes of living donor liver transplantation ( LDLT) for children with biliary atresia ( BA) and to summarize clinical experiences. Methods Forty - four BA patients ( 26 boys and 18 girls) u...Objective To observe the outcomes of living donor liver transplantation ( LDLT) for children with biliary atresia ( BA) and to summarize clinical experiences. Methods Forty - four BA patients ( 26 boys and 18 girls) underwent LDLT between October 2006 and December 2010. Mean ( SD) and median ( range) age展开更多
To examine the effects of co-culture with bone marrow mesenchymal stem cells on expansion of hematopoietic stem/progenitor cells and the capacities of rapid neutrophil engraftment and hematopoietic reconstitution of t...To examine the effects of co-culture with bone marrow mesenchymal stem cells on expansion of hematopoietic stem/progenitor cells and the capacities of rapid neutrophil engraftment and hematopoietic reconstitution of the expanded cells, we expanded mononuclear cells (MNCs) and CD34+/c-kit+ cells from mouse bone marrow and transplanted the ex-panded cells into the irradiated mice. MNCs were isolated from mouse bone marrow and CD34+/c-kit+ cells were selected from MNCs by using MoFlo Cell Sorter. MNCs and CD34+/c-kit+ cells were co-cultured with mouse bone marrow-derived mesenchymal stem cells (MSCs) under a two-step expansion. The expanded cells were then transplanted into sublethally irradiated BDF1 mice. Results showed that the co-culture with MSCs resulted in expansions of median total nucleated cells, CD34+ cells, GM-CFC and HPP-CFC respectively by 10.8-, 4.8-, 65.9- and 38.8-fold for the mononuclear cell culture, and respectively by 76.1-, 2.9-, 71.7- and 51.8-fold for the CD34+/c-kit+ cell culture. The expanded cells could rapidly engraft in the sublethally irradiated mice and reconstitute their hematopoiesis. Co-cultures with MSCs in conjunction with two-step expansion increased expansions of total nucleated cells, GM-CFC and HPP-CFC, which led us to conclude MSCs may create favorable environment for expansions of hematopoietic stem/progenitor cells. The availability of increased numbers of ex-panded cells by the co-culture with MSCs may result in more rapid engraftment of neutrophils following infusion to transplant recipients.展开更多
AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our...AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTS Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.展开更多
Transplantation of neural stem cells has been reported as a possible approach for replacing impaired dopaminergic neurons. In this study, we tested the efficacy of early-stage human dental papilla-derived stem cells a...Transplantation of neural stem cells has been reported as a possible approach for replacing impaired dopaminergic neurons. In this study, we tested the efficacy of early-stage human dental papilla-derived stem cells and human brain-derived neural stem cells in rat models of 6-hydroxydopamine-induced Parkinson＇s disease. Rats received a unilateral injection of 6-hydroxydopamine into right medial forebrain bundle, followed 3 weeks later by injections of PBS, early-stage human dental papilla-derived stem cells, or human brain-derived neural stem cells into the ipsilateral striatum. All of the rats in the human dental papilla-derived stem cell group died from tumor formation at around 2 weeks following cell transplantation. Postmortem examinations revealed homogeneous malignant tumors in the striatum of the human dental papilla-derived stem cell group. Stepping tests revealed that human brain-derived neural stem cell transplantation did not improve motor dysfunction. In apomorphine-induced rotation tests, neither the human brain-derived neural stem cell group nor the control groups （PBS injection） demonstrated significant changes. Glucose metabolism in the lesioned side of striatum was reduced by human brain-derived neural stem cell transplantation. [18F]-FP-CIT PET scans in the striatum did not demonstrate a significant increase in the human brain-derived neural stem cell group. Tyrosine hydroxylase （dopaminergic neuronal marker） staining and G protein-activated inward rectifier potassium channel 2 （A9 dopaminergic neuronal marker） were positive in the lesioned side of striatum in the human brain-derived neural stem cell group. The use of early-stage human dental papilla-derived stern cells confirmed its tendency to form tumors. Human brain-derived neural stem cells could be partially differentiated into dopaminergic neurons, but they did not secrete dopamine.展开更多
Objective: Recipients usually undergo posttransplant rejection in HLA-identical transplantations. Recent studies have shown that MHC class I related chain A (MICA) has been found to be associated with allograft surviv...Objective: Recipients usually undergo posttransplant rejection in HLA-identical transplantations. Recent studies have shown that MHC class I related chain A (MICA) has been found to be associated with allograft survival. The goal of this study is to investigate the correlation between matching rate of MICA alleles and posttransplant rejection in clinical living related donor transplantation (LRD) organ transplantations. Methods: Twenty pairs of blood samples were detected for HLA/MICA matching through polymerase chain reaction with sequence specific primers and for anti-MICA Abs using Luminex. At the same time, pathologic biopsies of all recipients were diagnosed and classified into different levels by the unified standard. Univariate Spearman’s analysis was established. Log-Rank analysis was performed twice, and Kaplan-Meier survival curves were generated to assess the relationship between MICA matching rates and posttransplant rejection in living-related donor transplantations. Results-The result showed that HLA matching of all recipients and donors were identical, whereas MICA matching was not. There was statistical difference between pathological classification and survival展开更多
Tens of thousands of people worldwide became infected with syndrome coronavirus-2(SARS-CoV-2).Death rate in general population is about 1%-6%,but this rate rises up to 15%in those with comorbidities.Recent publication...Tens of thousands of people worldwide became infected with syndrome coronavirus-2(SARS-CoV-2).Death rate in general population is about 1%-6%,but this rate rises up to 15%in those with comorbidities.Recent publications showed that the clinical progression of this disease in organ recipients is more destructive,with a fatality rate of up to 14%-25%.We aimed to review the effect of pandemic on various transplantation patients.coronavirus disease 2019(COVID-19)has not only interrupted waiting list patients’lives;it has also impacted transplantation strategies,transplant surgeries and broke donation chains.COVID-19 was directly and indirectly accountable for 73%surplus in mortality of this population as compared to wait listed patients in earlier years.The impact of chronic immunosuppression on outcomes of COVID-19 remains unclear but understanding the immunological mechanisms related to the virus is critically important for the lifetime of transplantation and immune suppressed patients.It is hard to endorse changing anti-rejection therapy,as the existing data appraised is not adequate to advise substituting tacrolimus with cyclosporine during severe COVID-19 disease.展开更多
Split-Liver and living-related donor liver transplantation are the newest and both technically and ethically most challenging developments in liver transplantation and have contributed to a reduction in donor shortage...Split-Liver and living-related donor liver transplantation are the newest and both technically and ethically most challenging developments in liver transplantation and have contributed to a reduction in donor shortage.We report the technical aspects of surgical procedures performed to achieve a partial graft from a cadaveric and a live donor.展开更多
renal allograft operations were performed in 969 chronic renal failure patients within 15years,from June 1978 to December 1993.Patients/recipients survival rates were as follows respectively:89.2%/78.7%for 1 year,82.0...renal allograft operations were performed in 969 chronic renal failure patients within 15years,from June 1978 to December 1993.Patients/recipients survival rates were as follows respectively:89.2%/78.7%for 1 year,82.0%/74.7% for 3 years and 67.0%/58.4% fo展开更多
AIM To compare the outcomes between related and unrelated kidney transplantations.METHODS Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and a meta-analysis, whi...AIM To compare the outcomes between related and unrelated kidney transplantations.METHODS Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and a meta-analysis, which included 12 trials that investigated outcomes including the long-term(ten years), midterm(one to five years), and short-term(one year) graft survival rate as well as the acute rejection rate. Metaanalyses were performed using fixed and random-effects models, which included tests for publication bias and heterogeneity.RESULTS No difference in graft survival rate was detected in patients who underwent living related kidney transplantations compared to unrelated(P = 0.44) transplantations after ten years. There were no significant differences between the graft survival rate in living related and unrelated kidney transplantations after a short-and midterm follow-up(P = 0.35, P = 0.46). There were no significant differences between the acute rejection rate in living related and unrelated kidney transplantations(P = 0.06).CONCLUSION The long, mid and short term follow-up of living related and unrelated kidney transplantation showed no significant difference in graft survival rate. Also, acute rejection rate was not significantly different between groups.展开更多
AIM To report the first international living related two way kidney paired donation(KPD) transplantation from India which occurred on 17 th February 2015 after legal per-mission from authorization committee. METHODS D...AIM To report the first international living related two way kidney paired donation(KPD) transplantation from India which occurred on 17 th February 2015 after legal per-mission from authorization committee. METHODS Donor recipient pairs were from Portugal and India who were highly sensitized and ABO incompatible with their spouse respectively. The two donor recipient pairs had negative lymphocyte cross-matching, flow cross-matchand donor specific antibody in two way kidney exchange with the intended KPD donor. Local KPD options were fully explored for Indian patient prior to embarking on international KPD. RESULTS Both pairs underwent simultaneous uneventful kidney transplant surgeries and creatinine was 1 mg/d L on tacrolimus based immunosuppression at 11 mo follow up. The uniqueness of these transplantations was that they are first international KPD transplantations in our center.CONCLUSION International KPD will increases quality and quantity of living donor kidney transplantation. This could be an important step to solving the kidney shortage with additional benefit of reduced costs, improved quality and increased access for difficult to match incompatible pairs like O blood group patient with non-O donor and sensitized patient. To the best of our knowledge this is first international KPD transplantation from India.展开更多
This comprehensive review addresses the global health challenge of disparities in pancreas transplant access,particularly in low-and middle-income countries(LMICs)compared to high-income countries.Despite advancements...This comprehensive review addresses the global health challenge of disparities in pancreas transplant access,particularly in low-and middle-income countries(LMICs)compared to high-income countries.Despite advancements in surgical techniques and immunosuppression for procedures like simultaneous pancreas-kidney,pancreas-after-kidney,and pancreas-transplant alone,LMICs face significant challenges,including limited infrastructure,financial constraints,and a shortage of skilled medical professionals.Donation after brain death remains constrained by sociocultural barriers.Region-specific analyses highlight progress in Latin America,Asia,Russia,and South Africa,showcasing the regional disparities in access and outcomes.Future prospects involve minimally invasive surgeries,telemedicine for enhanced post-operative care,international collaborations with organizations like the European Union of Medical Specialists,and robust funding networks to improve organ availability.In conclusion,the review underscores the importance of multifaceted strategies to address economic,sociocultural,and infrastructural barriers,aiming to improve accessibility,quality,and effectiveness of pancreas transplantation services in LMICs.展开更多
Background Liver transplantation(LT)is a life-saving treatment for patients with end-stage liver disease,with significant improvements in short-term survival over the decades.However,long-term survival and trends in L...Background Liver transplantation(LT)is a life-saving treatment for patients with end-stage liver disease,with significant improvements in short-term survival over the decades.However,long-term survival and trends in LT indications and outcomes remain areas of active research.This registry-based study evaluates 40 years of LT in Finland,assessing patient and graft survival,retransplantation rates,changing recipient and donor demographics,indications and benchmarking outcomes against international standards.Methods Data were extracted from the nationwide Finnish LT registry,covering all LTs performed in Finland between 1982 and 2024.Survival analyses were estimated using the Kaplan–Meier methodology and retransplantation rates were assessed using the cumulative incidence function.Benchmark cases were defined by international criteria.Results A total of 1763 LTs were performed,with a mean recipient age of 46 years.The most common aetiologies were alcohol-related liver disease(19%)and primary sclerosing cholangitis(PSC;16%).Over time,recipient and donor age,body mass index and prevalence of diabetes increased.One-year patient survival improved from 83%in the 1980s to 96%in 2020–2024,with the overall 5-year,10-year,20-year and 30-year patient survival being 83%,73%,53%and 28%,respectively.The retransplantation rate was 13%at 30 years overall and 28%in PSC.Benchmark cases had one-year patient and graft survival rates of 97%and 96%,respectively.Acute rejection rates declined from 62%during 1980–1989 to 19%during 2022–2023.Post-transplant kidney-replacement therapy peaked at 26%in 2010–2021,thereafter decreasing to 8%after the year 2022.Conclusion The Finnish LT programme demonstrates sustained improvements in short-and mid-term survival,with evolving indications and recipient and donor demographics.Benchmark analyses confirm high-quality outcomes.Continued efforts are needed to optimise long-term survival and reduce the need for retransplantation,especially in PSC.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
文摘Objective To observe the outcomes of living donor liver transplantation ( LDLT) for children with biliary atresia ( BA) and to summarize clinical experiences. Methods Forty - four BA patients ( 26 boys and 18 girls) underwent LDLT between October 2006 and December 2010. Mean ( SD) and median ( range) age
文摘To examine the effects of co-culture with bone marrow mesenchymal stem cells on expansion of hematopoietic stem/progenitor cells and the capacities of rapid neutrophil engraftment and hematopoietic reconstitution of the expanded cells, we expanded mononuclear cells (MNCs) and CD34+/c-kit+ cells from mouse bone marrow and transplanted the ex-panded cells into the irradiated mice. MNCs were isolated from mouse bone marrow and CD34+/c-kit+ cells were selected from MNCs by using MoFlo Cell Sorter. MNCs and CD34+/c-kit+ cells were co-cultured with mouse bone marrow-derived mesenchymal stem cells (MSCs) under a two-step expansion. The expanded cells were then transplanted into sublethally irradiated BDF1 mice. Results showed that the co-culture with MSCs resulted in expansions of median total nucleated cells, CD34+ cells, GM-CFC and HPP-CFC respectively by 10.8-, 4.8-, 65.9- and 38.8-fold for the mononuclear cell culture, and respectively by 76.1-, 2.9-, 71.7- and 51.8-fold for the CD34+/c-kit+ cell culture. The expanded cells could rapidly engraft in the sublethally irradiated mice and reconstitute their hematopoiesis. Co-cultures with MSCs in conjunction with two-step expansion increased expansions of total nucleated cells, GM-CFC and HPP-CFC, which led us to conclude MSCs may create favorable environment for expansions of hematopoietic stem/progenitor cells. The availability of increased numbers of ex-panded cells by the co-culture with MSCs may result in more rapid engraftment of neutrophils following infusion to transplant recipients.
文摘AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTS Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.
基金supported by a"KRCF National Agenda Project",by an Asan Life Science Institute Grant(12-241)from the Asan Medical Center,Seoul,Korea
文摘Transplantation of neural stem cells has been reported as a possible approach for replacing impaired dopaminergic neurons. In this study, we tested the efficacy of early-stage human dental papilla-derived stem cells and human brain-derived neural stem cells in rat models of 6-hydroxydopamine-induced Parkinson＇s disease. Rats received a unilateral injection of 6-hydroxydopamine into right medial forebrain bundle, followed 3 weeks later by injections of PBS, early-stage human dental papilla-derived stem cells, or human brain-derived neural stem cells into the ipsilateral striatum. All of the rats in the human dental papilla-derived stem cell group died from tumor formation at around 2 weeks following cell transplantation. Postmortem examinations revealed homogeneous malignant tumors in the striatum of the human dental papilla-derived stem cell group. Stepping tests revealed that human brain-derived neural stem cell transplantation did not improve motor dysfunction. In apomorphine-induced rotation tests, neither the human brain-derived neural stem cell group nor the control groups （PBS injection） demonstrated significant changes. Glucose metabolism in the lesioned side of striatum was reduced by human brain-derived neural stem cell transplantation. [18F]-FP-CIT PET scans in the striatum did not demonstrate a significant increase in the human brain-derived neural stem cell group. Tyrosine hydroxylase （dopaminergic neuronal marker） staining and G protein-activated inward rectifier potassium channel 2 （A9 dopaminergic neuronal marker） were positive in the lesioned side of striatum in the human brain-derived neural stem cell group. The use of early-stage human dental papilla-derived stern cells confirmed its tendency to form tumors. Human brain-derived neural stem cells could be partially differentiated into dopaminergic neurons, but they did not secrete dopamine.
文摘Objective: Recipients usually undergo posttransplant rejection in HLA-identical transplantations. Recent studies have shown that MHC class I related chain A (MICA) has been found to be associated with allograft survival. The goal of this study is to investigate the correlation between matching rate of MICA alleles and posttransplant rejection in clinical living related donor transplantation (LRD) organ transplantations. Methods: Twenty pairs of blood samples were detected for HLA/MICA matching through polymerase chain reaction with sequence specific primers and for anti-MICA Abs using Luminex. At the same time, pathologic biopsies of all recipients were diagnosed and classified into different levels by the unified standard. Univariate Spearman’s analysis was established. Log-Rank analysis was performed twice, and Kaplan-Meier survival curves were generated to assess the relationship between MICA matching rates and posttransplant rejection in living-related donor transplantations. Results-The result showed that HLA matching of all recipients and donors were identical, whereas MICA matching was not. There was statistical difference between pathological classification and survival
文摘Tens of thousands of people worldwide became infected with syndrome coronavirus-2(SARS-CoV-2).Death rate in general population is about 1%-6%,but this rate rises up to 15%in those with comorbidities.Recent publications showed that the clinical progression of this disease in organ recipients is more destructive,with a fatality rate of up to 14%-25%.We aimed to review the effect of pandemic on various transplantation patients.coronavirus disease 2019(COVID-19)has not only interrupted waiting list patients’lives;it has also impacted transplantation strategies,transplant surgeries and broke donation chains.COVID-19 was directly and indirectly accountable for 73%surplus in mortality of this population as compared to wait listed patients in earlier years.The impact of chronic immunosuppression on outcomes of COVID-19 remains unclear but understanding the immunological mechanisms related to the virus is critically important for the lifetime of transplantation and immune suppressed patients.It is hard to endorse changing anti-rejection therapy,as the existing data appraised is not adequate to advise substituting tacrolimus with cyclosporine during severe COVID-19 disease.
文摘Split-Liver and living-related donor liver transplantation are the newest and both technically and ethically most challenging developments in liver transplantation and have contributed to a reduction in donor shortage.We report the technical aspects of surgical procedures performed to achieve a partial graft from a cadaveric and a live donor.
文摘renal allograft operations were performed in 969 chronic renal failure patients within 15years,from June 1978 to December 1993.Patients/recipients survival rates were as follows respectively:89.2%/78.7%for 1 year,82.0%/74.7% for 3 years and 67.0%/58.4% fo
文摘AIM To compare the outcomes between related and unrelated kidney transplantations.METHODS Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and a meta-analysis, which included 12 trials that investigated outcomes including the long-term(ten years), midterm(one to five years), and short-term(one year) graft survival rate as well as the acute rejection rate. Metaanalyses were performed using fixed and random-effects models, which included tests for publication bias and heterogeneity.RESULTS No difference in graft survival rate was detected in patients who underwent living related kidney transplantations compared to unrelated(P = 0.44) transplantations after ten years. There were no significant differences between the graft survival rate in living related and unrelated kidney transplantations after a short-and midterm follow-up(P = 0.35, P = 0.46). There were no significant differences between the acute rejection rate in living related and unrelated kidney transplantations(P = 0.06).CONCLUSION The long, mid and short term follow-up of living related and unrelated kidney transplantation showed no significant difference in graft survival rate. Also, acute rejection rate was not significantly different between groups.
文摘AIM To report the first international living related two way kidney paired donation(KPD) transplantation from India which occurred on 17 th February 2015 after legal per-mission from authorization committee. METHODS Donor recipient pairs were from Portugal and India who were highly sensitized and ABO incompatible with their spouse respectively. The two donor recipient pairs had negative lymphocyte cross-matching, flow cross-matchand donor specific antibody in two way kidney exchange with the intended KPD donor. Local KPD options were fully explored for Indian patient prior to embarking on international KPD. RESULTS Both pairs underwent simultaneous uneventful kidney transplant surgeries and creatinine was 1 mg/d L on tacrolimus based immunosuppression at 11 mo follow up. The uniqueness of these transplantations was that they are first international KPD transplantations in our center.CONCLUSION International KPD will increases quality and quantity of living donor kidney transplantation. This could be an important step to solving the kidney shortage with additional benefit of reduced costs, improved quality and increased access for difficult to match incompatible pairs like O blood group patient with non-O donor and sensitized patient. To the best of our knowledge this is first international KPD transplantation from India.
文摘This comprehensive review addresses the global health challenge of disparities in pancreas transplant access,particularly in low-and middle-income countries(LMICs)compared to high-income countries.Despite advancements in surgical techniques and immunosuppression for procedures like simultaneous pancreas-kidney,pancreas-after-kidney,and pancreas-transplant alone,LMICs face significant challenges,including limited infrastructure,financial constraints,and a shortage of skilled medical professionals.Donation after brain death remains constrained by sociocultural barriers.Region-specific analyses highlight progress in Latin America,Asia,Russia,and South Africa,showcasing the regional disparities in access and outcomes.Future prospects involve minimally invasive surgeries,telemedicine for enhanced post-operative care,international collaborations with organizations like the European Union of Medical Specialists,and robust funding networks to improve organ availability.In conclusion,the review underscores the importance of multifaceted strategies to address economic,sociocultural,and infrastructural barriers,aiming to improve accessibility,quality,and effectiveness of pancreas transplantation services in LMICs.
基金supported by Finska Läaresälskapet,Academy of Finland(#338544),Sigrid Jusélius Foundation,Mary and Georg Ehrnrooth Foundation,Medicinska Understösföening Liv&Häsa and Wilhelm and Else Stockmann Foundation.
文摘Background Liver transplantation(LT)is a life-saving treatment for patients with end-stage liver disease,with significant improvements in short-term survival over the decades.However,long-term survival and trends in LT indications and outcomes remain areas of active research.This registry-based study evaluates 40 years of LT in Finland,assessing patient and graft survival,retransplantation rates,changing recipient and donor demographics,indications and benchmarking outcomes against international standards.Methods Data were extracted from the nationwide Finnish LT registry,covering all LTs performed in Finland between 1982 and 2024.Survival analyses were estimated using the Kaplan–Meier methodology and retransplantation rates were assessed using the cumulative incidence function.Benchmark cases were defined by international criteria.Results A total of 1763 LTs were performed,with a mean recipient age of 46 years.The most common aetiologies were alcohol-related liver disease(19%)and primary sclerosing cholangitis(PSC;16%).Over time,recipient and donor age,body mass index and prevalence of diabetes increased.One-year patient survival improved from 83%in the 1980s to 96%in 2020–2024,with the overall 5-year,10-year,20-year and 30-year patient survival being 83%,73%,53%and 28%,respectively.The retransplantation rate was 13%at 30 years overall and 28%in PSC.Benchmark cases had one-year patient and graft survival rates of 97%and 96%,respectively.Acute rejection rates declined from 62%during 1980–1989 to 19%during 2022–2023.Post-transplant kidney-replacement therapy peaked at 26%in 2010–2021,thereafter decreasing to 8%after the year 2022.Conclusion The Finnish LT programme demonstrates sustained improvements in short-and mid-term survival,with evolving indications and recipient and donor demographics.Benchmark analyses confirm high-quality outcomes.Continued efforts are needed to optimise long-term survival and reduce the need for retransplantation,especially in PSC.
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.
