Successful Sequential Liver and Stem Cell Transplantation for Hepatic Failure Due to Primary AL Amyloidosis

Gastroenterology. Jun, 2002  |  Pubmed ID: 12055607

We report on a patient with primary AL amyloidosis who presented with progressive liver failure secondary to hepatic infiltration in the absence of significant extrahepatic involvement. Orthotopic liver transplantation was performed successfully. After an uneventful postoperative course, the patient developed evidence of significant recurrent amyloidosis requiring treatment. He then underwent stem cell transplantation 10 and 14 months after liver transplantation. After 28 months of follow-up posttransplantation, the patient continues to do well, with no clinical evidence of recurrent disease. This is the first reported patient with primary amyloidosis to undergo sequential liver and stem cell transplantation leading to resolution of the disease and only the second to undergo successful liver transplantation for this disorder.

Enforced C-REL Deficiency Prolongs Survival of Islet Allografts1

Transplantation. Aug, 2002  |  Pubmed ID: 12177605

The NF-kappaB/Rel family of transcription factors regulates biologic processes ranging from apoptosis to inflammation and innate immunity. Whether c-Rel, a lymphoid-predominant member of the NF-kappaB/Rel family, is essential for transplantation immunity is not known.

Analysis of Donor Risk in Living-donor Hepatectomy: the Impact of Resection Type on Clinical Outcome

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons. Sep, 2002  |  Pubmed ID: 12243500

The progressive shortage of liver donors has mandated investigation of living-donor transplantation (LDT). Concerns about increasing risk to the donor are evident, but the impact of the degree of parenchymal loss has not been quantified. We analyzed clinical and biological variables in 45 LDT performed by our team over 2years to assess risks faced in adult LDT. All donors are alive and well with complete follow-up through to February 2001. When the three operations were compared, right hepatectomy (RH) was significantly longer in terms of anesthesia time and blood loss compared with left hepatectomy (LH) and left lobectomy (LL). Donor remnant liver was significantly reduced after RH compared with LH and LL. There were significant functional differences as a consequence of the remnant size, measured by an increase in peak prothrombin time after RH. RH for adults represents a markedly different insult from pediatric donations in terms of parenchymal loss and early functional impairment. Left hepatectomy donation offers modest advantage over right lobes but seems to confer substantial technical risk for a small gain in graft size. Unless novel strategies are developed to enhance liver function of the LH graft in the adult recipient, right lobe donation will be necessary for adult LDT.

Proapoptotic Bax is Hyperexpressed in Isolated Human Islets Compared with Antiapoptotic Bcl-2

Transplantation. Dec, 2002  |  Pubmed ID: 12490780

Apoptosis is a well-documented pathway for islet cell death. One potential mechanism is overexpression of death-promoting Bax compared with antiapoptotic Bcl-2 in islets.

Analysis of Failure in Living Donor Liver Transplantation: Differential Outcomes in Children and Adults

World Journal of Surgery. Mar, 2003  |  Pubmed ID: 12607066

Over the past decade we have reported excellent outcomes in pediatric living-donor liver transplantation (LDLT) with recipient survival exceeding 90%. Principles established in these patients were extended to LDLT in adults. To compare outcomes in donors and recipients between adult and pediatric LDLT in a single center, we reviewed patient records of 45 LDLT performed between 1/98 and 2/01: 23 adult LDLT (54 +/- 6.5 yr) and 22 pediatric LDLT (33.7 +/- 53.5 months). Preoperative liver function was worse in adults (International Normalized Ratio [INR] 1.5 +/- 0.4 vs. INR 1.2 +/- 0.5; p = 0.032). 4 adults (17%) met criteria for status 1 or 2A. Only 1 child was transplanted urgently. Analysis included descriptive statistics and Kaplan-Meier estimation. Donor mortality was 0% with 1 re-exploration, 2.4%. Median hospital stay (LOS) was 6.0 days (range, 4-12 days). Donor morbidity and LOS did not differ by sex, extent of hepatectomy, or adult and pediatric LDLT ( p = 0.49). In contrast, recipient outcomes were worse for adults. Adult 1 year graft survival was 65% (3 retransplants [ReTx], 5 deaths) vs. 91% for children (1 ReTx, 1 death) p = 0.02. Graft losses in adults were due to sepsis (n = 3), small for size (n = 2), suicide, and hepatic artery thrombosis (HAT), whereas in children graft losses were due to portal thrombosis and total parenteral nutrition (TPN) liver failure. Biliary leaks occurred in 22% of adults and 9% of children. Hepatic vein obstruction occurred in 17% of adults and in none of the children. Median LOS was comparable (adult, 16.5 days (range, 7-149 days); child, 17 days (range, 10-56 days), p = 0.2). Graft function (total bilirubin (TBili) < 5mg/dl, INR < 1.2, aspartate aminotransferase (AST) < 100 U/l) normalizing by day 4 in children and by day 14 in adults. Adults fared worse, with an array of problems not seen in children, in particular, hepatic vein obstruction and small-for-size syndrome. Biliary leaks were diagnosed later in adults and were lethal in 3 cases; this was later avoided with biliary drainage in adult recipients. Finally, use of LDLT in decompensated adults led to death in 3 of 4 patients, and should be restricted to elective use.

Outflow Reconstruction in Right Hepatic Live Donor Liver Transplantation

Surgery. Mar, 2003  |  Pubmed ID: 12660634

Inconstant venous anatomy increases the risk of outflow complications in right hepatic live donor liver transplantation (RH-LDT), but no consensus has emerged guiding optimal reconstruction for venous outflow.

CD103 MRNA Levels in Urinary Cells Predict Acute Rejection of Renal Allografts

Transplantation. Apr, 2003  |  Pubmed ID: 12717221

CD103 is displayed on the cell surface of alloreactive CD8 cytotoxic T lymphocytes (CTLs) and is a critical component for the intraepithelial homing of T cells. Because intratubular localization of mononuclear cells is a feature of acute cellular rejection of renal allografts, we explored the hypothesis that CD103 messenger (m)RNA levels in urinary cells predict acute rejection.

Molecular Signatures of Urinary Cells Distinguish Acute Rejection of Renal Allografts from Urinary Tract Infection

Transplantation. May, 2003  |  Pubmed ID: 12777869

Acute rejection (AR) and urinary tract infection (UTI) continue to plague renal transplantation. We tested the hypotheses that UTI does not increase granzyme B mRNA levels in urinary cells, and that the levels distinguish AR from UTI. We measured the levels of granzyme B mRNA in 15 urine specimens from renal allograft recipients with UTI, 29 specimens from patients with AR but without UTI, and 14 specimens from patients without AR and without UTI. We also measured transcript levels in urine specimens from 41 nontransplant individuals, 11 with UTI and 30 without UTI. UTI did not increase granzyme B mRNA levels. Granzyme B mRNA levels were lower in renal allograft recipients with UTI compared with those with AR (P<0.0001). We conclude that bacterial UTI is unlikely to confound AR diagnosis made by measurement of granzyme B mRNA levels in urinary cells.

Serine Proteinase Inhibitor-9, an Endogenous Blocker of Granzyme B/perforin Lytic Pathway, is Hyperexpressed During Acute Rejection of Renal Allografts

Transplantation. May, 2003  |  Pubmed ID: 12792516

Serine proteinase inhibitor (PI)-9 with a reactive center P1 (Glu)-P1' is a natural antagonist of granzyme B and is expressed in high levels in cytotoxic T lymphocytes (CTL). In view of the role of CTL in acute rejection, we explored the hypothesis that PI-9 would be hyperexpressed during acute rejection. Because PI-9 can protect CTL from its own fatal arsenal and potentially enhance the vitality of CTL, we examined whether PI-9 levels correlate with the severity of rejection as well as predict subsequent graft function.

Pulsatile Machine Perfusion with Vasosol Solution Improves Early Graft Function After Cadaveric Renal Transplantation

Transplantation. Apr, 2004  |  Pubmed ID: 15114096

Cold storage is the most common method of preservation in renal transplantation, but pulsatile machine perfusion (MP) is increasingly used for purposes of ex vivo assessment and resuscitation of high risk allografts. Vasosol (VSL) MP solution (MPS) (Pike Laboratories Inc, Eagle, PA) is a novel perfusate with enhanced vasodilatory and antioxidant capacity. We report our experience with VSL in machine preservation of renal allografts.

Noninvasive Detection of Renal Allograft Inflammation by Measurements of MRNA for IP-10 and CXCR3 in Urine

Kidney International. Jun, 2004  |  Pubmed ID: 15149352

We explored the hypothesis that measurements of mRNA encoding interferon-inducible protein-10 (IP-10) or the chemokine receptor CXCR3 in urinary cells offer a noninvasive means of elucidating cellular traffic causing acute rejection of human renal allografts.

Resection of an Intravenous Leiomyoma with Intracardiac Extension with Use of Endovascular Techniques

Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. Sep, 2004  |  Pubmed ID: 15337888

Intravenous leiomyoma with intracardiac extension is a rare entity that necessitates surgical excision to alleviate symptoms and prevent life-threatening complications. These procedures are generally performed under cardiopulmonary bypass, and review of the literature reveals an evolution in management of this disease from 2-stage to single-stage procedures. We report the case of a 45-year-old woman with an intravenous leiomyoma with intracardiac extension after presenting with syncopal symptoms. The intravenous tumor and its supradiaphragmatic extension were ultimately resected via laparotomy without the need for cardiopulmonary bypass. Distal control was achieved by passing an occluding balloon catheter above the tumor through a venotomy with fluoroscopic guidance and echocardiography, thus enabling protected tumor extraction through the intra-abdominal inferior vena cava. In selected patients, we believe use of endovascular techniques combined with proper preoperative imaging can safely permit single-stage resection of these tumors via laparotomy without cardiopulmonary bypass.

Retraction

Transplantation. Jun, 2005  |  Pubmed ID: 15973193

Messenger RNA for FOXP3 in the Urine of Renal-allograft Recipients

The New England Journal of Medicine. Dec, 2005  |  Pubmed ID: 16319383

The outcome of renal transplantation after an episode of acute rejection is difficult to predict, even with an allograft biopsy.

Articles Published in Transplant Proceedings (Guarrera Et Al 36(5):1257- 60, Polyak Et Al 32(1):32-4, Polyak Et Al 31(5):2091-3, Polyak Et Al 29(8):3582-3)

Transplantation Proceedings. Dec, 2005  |  Pubmed ID: 16387191

Intrarenal Color Duplex Ultrasonography: a Window to Vascular Complications of Renal Transplants

Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. Oct, 2007  |  Pubmed ID: 17901143

We analyze and discuss the importance of intrarenal color duplex ultrasonography (CDUS) in the diagnosis and differential diagnosis of vascular complications in renal transplants.

Epidemiology of BK Virus in Renal Allograft Recipients: Independent Risk Factors for BK Virus Replication

Transplantation. Aug, 2008  |  Pubmed ID: 18724220

Identification of risk factors for BK virus (BKV) replication may improve transplant outcome. We investigated the impact of immunosuppressive drugs on the prevalence of BKV replication in recipients of human renal allografts.

Noninvasive Imaging of Living Kidney Donors

Transplantation. Nov, 2008  |  Pubmed ID: 19005395

Color Duplex Sonography in Severe Transplant Renal Artery Stenosis: a Comparison of End-to-end and End-to-side Arterial Anastomoses

Clinical Imaging. Mar-Apr, 2009  |  Pubmed ID: 19237054

The aim of this study was to investigate differences in Doppler parameters between severe transplant renal artery stenosis (TRAS, arterial lumen reduction >80%) with end-to-end (EE) arterial anastomosis and that with end-to-side (ES) arterial anastomosis.

Modulation of Antibody Response in a Sensitized Patient with Ongoing Antibody-mediated Injury

Clinical Transplants. 2009  |  Pubmed ID: 20524322

Use of Bortezomib for Prevention and Treatment of Rejection in Sensitized Patients

Clinical Transplants. 2009  |  Pubmed ID: 20524323

We report 2 cases of sensitized patients who were successfully treated with bortezomib therapy resulting in reduction of donor-specific antibodies (DSA). Our cases illustrate the synergistic effects of combination therapy that includes bortezomib on prevention and treatment of AMR in highly sensitized patients. Moving forward, long-term data on sensitized patients treated with bortezomib are needed to fully evaluate the impact of this therapy.

Validation of Noninvasive Diagnosis of BK Virus Nephropathy and Identification of Prognostic Biomarkers

Transplantation. Jul, 2010  |  Pubmed ID: 20526237

BK virus nephropathy (BKVN) may cause renal allograft dysfunction and failure. The gold standard test is kidney biopsy, which is invasive and costly. A noninvasive, accurate biomarker for diagnosis of BKVN and prognostication of allograft function after BKVN infection may improve allograft survival.

Successful Transplantation of Single Kidneys from Pediatric Donors Weighing Less Than or Equal to 10 Kg into Standard Weight Adult Recipients

Transplantation. Sep, 2010  |  Pubmed ID: 20827243

The outcomes of single kidneys transplanted from pediatric donors into standard adult recipients (>60 kg) are unknown. Furthermore, the outcomes of single kidneys transplanted from pediatric donors less than or equal to 10 kg are also unknown.

Laparoendoscopic Single Site Live Donor Nephrectomy: Initial Experience

The Journal of Urology. Nov, 2010  |  Pubmed ID: 20850822

We present our initial experience in 40 patients undergoing laparoendoscopic single site donor nephrectomy.

Reduction in Proteinuria with Bortezomib Based Therapy for Antibody Mediated Rejection

Clinical Transplants. 2010  |  Pubmed ID: 21696061

Outcomes of Laparoscopic Donor Nephrectomy Without Intraoperative Systemic Heparinization

The Journal of Urology. Jun, 2010  |  Pubmed ID: 20400133

Intravenous heparin has traditionally been given during living donor laparoscopic nephrectomy despite the paucity of evidence supporting its use. We present the results of our experience with laparoscopic donor nephrectomy done without intraoperative systemic heparinization.

Pancreas Transplantation: Does Age Increase Morbidity?

Journal of Transplantation. 2011  |  Pubmed ID: 21766007

Introduction. Pancreas transplantation (PTx) is the only definitive intervention for type 1 diabetes. Medical advancements in diabetes care have led to an aging PTx candidate pool. We report our experience with patients ≥50 years of age undergoing PTx. Methods. We reviewed 136 consecutive PTx patients at our institution from 1996-2010; 17 were ≥50 years of age. We evaluated demographics, surgical complications, acute rejection (AR) rates, nonsurgical infections, and survival outcomes. Results. Demographic data was similar (P > .05) between groups, excluding age. The two groups had comparable major and minor surgical complication rates (P = .10 and P = .25, resp.). The older group had a lower 1-year and overall AR rate (P = .04 and P = .03, resp.). The incidence of non-surgical infections and overall patient and graft survival was similar between groups (P > .05). Conclusion. Older patients with type 1 diabetes are feasible candidates for PTx, as surgical morbidity, incidence of infections, and AR rates are low.

Comparison of Complications of Laparoscopic Versus Laparoendoscopic Single Site Donor Nephrectomy Using the Modified Clavien Grading System

The Journal of Urology. Oct, 2011  |  Pubmed ID: 21855950

We compared postoperative complications of laparoendoscopic single site and standard laparoscopic living donor nephrectomy using a standardized complication reporting system.

Comparison of Laparoendoscopic Single-site Donor Nephrectomy and Conventional Laparoscopic Donor Nephrectomy: Donor and Recipient Outcomes

Urology. Dec, 2011  |  Pubmed ID: 21996107

To present a comparison of perioperative donor outcomes and recipient graft function in a series of patients undergoing laparoendoscopic single-site donor nephrectomy (LESS-DN) versus conventional laparoscopic donor nephrectomy (LDN).

Laparoendoscopic Single Site Live Donor Nephrectomy: Single Institution Report of Initial 100 Cases

The Journal of Urology. Dec, 2011  |  Pubmed ID: 22014813

Laparoendoscopic single site surgery is a recent advance in minimally invasive urology. We report outcomes from our initial 100 consecutive laparoendoscopic single site live donor nephrectomies done by a single surgeon and provide a matched comparison of conventional laparoscopic live donor nephrectomies done by the same surgeon.

Is Right-sided Laparoendoscopic Single-site Donor Nephrectomy Feasible?

Urology. Jun, 2011  |  Pubmed ID: 21397302

To present our initial experience with right-sided laparoendoscopic single-site donor nephrectomy (LESS-RDN). Laparoendoscopic single-site (LESS) donor nephrectomy, although in its infancy, represents a potential exciting advancement over conventional laparoscopic donor nephrectomy (LDN). Almost all of the reported cases thus far have been left-sided kidneys.

Pancreas Transplantation Considering the Spectrum of Body Mass Indices

Clinical Transplantation. Sep-Oct, 2011  |  Pubmed ID: 21554399

In kidney, liver, heart, and lung transplantation, extremes of body mass index (BMI) have been reported to influence post-operative outcomes and even survival. Given the limited data in pancreas transplantation, we sought to elucidate the influence of BMI on outcomes.

Deceased-donor Kidney Transplantation: Improvement in Long-term Survival

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. Jan, 2011  |  Pubmed ID: 20656753

Despite marked improvement in short-term renal allograft survival rates (GSR) in recent years, improvement in long-term GSR remained elusive.

Laparoendoscopic Single-site Nephrectomy in Obese Living Renal Donors

Journal of Endourology / Endourological Society. Feb, 2012  |  Pubmed ID: 22050506

Abstract Background and Purpose: Laparoendoscopic single-site (LESS) surgery has been shown to be feasible in living donor nephrectomies (DNs). Obesity is an established risk factor for perioperative morbidity. We sought to determine whether LESS-DN is safe and effective in the obese (body mass index [BMI] ≥30 kg/m(2)) population. Patients and Methods: Between August 2009 and September 2010, 125 consecutive LESS-DN were performed; 32 patients were obese. This group was matched to 32 nonobese LESS-DN (BMI <30 kg/m(2)) patients, 32 obese conventional laparoscopic DN (obese LAP-DN) patients, and 32 nonobese LAP-DN patients. Comparison parameters included organ recovery time, operative time, estimated blood loss (EBL), warm ischemia time (WIT), incision length, complications, and recipient allograft function. Results: Demographic data were similar between the groups, except BMI (P>0.0001). Organ recovery time, EBL, WIT, complications, and recipient allograft function were similar between the obese LESS-DN group and the other three groups (P>0.05). Total operative time was longer in the obese LESS-DN compared with the nonobese LAP-DN (P<0.0001); however, incision length was shorter in the obese LESS-DN group compared with either LAP group (P<0.0001). Complete LESS-DN was successful in 62 (97%) cases (two obese donor cases were converted to hand-assisted laparoscopy). Conclusions: Our results indicate that LESS-DN can be performed safely in obese donors without increased donor morbidity and similar recipient allograft outcomes compared with ideal-sized donors as well as with conventional LAP-DN patients.

Mean Arterial Blood Pressure While Awaiting Kidney Transplantation is Associated with the Risk of Primary Nonfunction

Transplantation. Jan, 2012  |  Pubmed ID: 22105679

Primary nonfunction (PNF) is a devastating outcome after kidney transplantation and is more common with kidneys from donors without a heartbeat or expanded criteria donors, or both. We investigated recipient-based risk factors for PNF independent of organ donor source.