bluuebunny/crossref_metadata_2025 huggingface dataset:
Fungi as biotechnological allies: Exploring contributions of edible and medicinal mushrooms
Authors: Barua R. Celeste , Coniglio Romina O. , Molina Melisa A. , Díaz Gabriela V. , Fonseca Maria I.
Published: October 2024

Edible and medicinal mushrooms possess excellent nutritional properties due to their incredible versatility in growing on different substrates and producing extracellular enzymes with a wide range of specificity. These features make them excellent candidates for various biotechnological applications. In this context, biotechnological applications using edible and medicinal mushrooms can focus on the bioprocessing of agro‐industrial wastes, an economical and environmentally friendly strategy. This review, based on recent original research and scientific reviews, highlights the versatility and potential of mushrooms in terms of sustainability and efficiency. We emphasized the biotechnological applications of edible and medicinal mushrooms and their enzymes including food production with high nutraceutical value by enhancing the quality and flavor of food industry products. Other biotechnological applications addressed in this review were cosmeceutical and biomedical development using mushroom extracts with bioactive compounds; wood pulp pretreatment processes in the pulp and paper industry; bioethanol production; and bioremediation for decontaminating soils and polluted effluents. These applications explain how edible and medicinal mushrooms have gained significance in biotechnology over the years, opening new avenues for innovation. The current tendency to study edible and medicinal mushrooms has gained the attention of researchers because these are still less known organisms becoming an attractive and natural source of novel bioactive compounds that could be integrated into a circular model production.
Strength, pliability, and hydrophobicity of mung bean starch straws: Orientation change caused by annealing time
Authors: Wang Kun , Sun Shuo , Xie Jixun , Guo Li , Cui Bo , Zou Feixue
Published: October 2024

To achieve starch straws with high strength and large toughness, the effects of annealing time on structural and functional performances of mung bean starch straws were studied. The results revealed that with increasing annealing time from 0to 60 min, the ratios of 1047 cm−1/1022 cm−1 in Fourier transform infrared spectroscopy decreased from 1.37 to 1.20, and the relative crystallinities decreased from 12.09% to 11.01%. The relative crystallinity increased to 13.28% when annealing time increased to 120 min. The maximum bending force increased from 10.93 to 104.24 N, and modulus of elasticity enhanced from 0.93 to 62.68 N/mm when annealing time increased from 0 to 120 min. Starch straws annealed for 120 min had the lowest water absorption (94.61%), while starch straws annealed for 60 min had the highest water absorption (127.38%). This outcome not only lay a theoretical foundation for preparing biodegradable starch straws with excellent performance, but also apply for beverages, food container, food packaging films, and so on, strongly promoting starch industrial transformation and development.
Prokinetic agents in adult intensive care unit patients (PATIENCE)—An international inception cohort study protocol
Authors: Crone Vera , Møller Morten Hylander , Perner Anders , Alhazzani Waleed , Granholm Anders , Krogsgaard Laura Rindom , Al‐Fares Abdulrahman , Hästbacka Johanna , Ostermann Marlies , Pfortmueller Carmen A. , Ferrer Richard , Blaser Annika Reintam , Sigurdsson Martin I. , Wall Olof , Keus Eric , Szczeklik Wojciech , Krag Mette
Published: October 2024

Background

Feeding intolerance is common in critically ill patients and can lead to malnutrition. Prokinetic agents may be used to enhance the uptake of nutrition. However, the evidence on the effectiveness and safety of prokinetic agents is sparse, and there is a lack of data on their use in intensive care units (ICU).

Methods

We will conduct an international 14‐day inception cohort study of 1000 acutely admitted adult ICU patients. Data will be collected from ICU admission and daily during ICU stay for up to 90 days. The primary outcome will be the proportion of ICU patients who receive prokinetic agents. Secondary outcomes include mortality, days alive without life support, days alive out of ICU, days alive out of hospital (all within 90 days) and the number of patients with one or more serious adverse events.

Results

We will present data on the use of prokinetic agents descriptively and use Cox regressions with death and ICU discharge as competing events to evaluate the association between patient characteristics and the use of prokinetic agents. We will use extended Cox models with time‐varying covariates and linear regression models to assess the associations between the use of prokinetic agents and the secondary outcomes.

Conclusion

The outlined international cohort study will provide valuable epidemiological data on the use of prokinetic agents in adult, acutely admitted ICU patients.
Women as decision‐makers in the Australian wine industry, 1960s–1990s
Authors: McIntyre Julie
Published: October 2024

In the early 2000s international business scholar Ann Matasar declared of the rapidly globalising grape wine sector that no other industry had ‘so resolutely excluded women from positions of influence for so long.’ Following Florine Livat and Clara Jaffré that women on the supply side of wine remain understudied, this article draws upon a large‐scale oral history project (Treading Out the Vintage 2000–2003) to make visible women as industry decision‐makers between the 1960s and 1990s. This qualitative data set nuances Matasar's findings about the relatively limited opportunities for women to exert industry influence in a historically male domain. With family farming as the main entry point to the Australian industry, few women became decision‐makers in this era, compared with women in urban sectors of the economy that benefited from gains in gender equality. Women who attained industry influence demonstrated enthusiasm and resilience while experiencing sexism and, often, balancing reproductive and domestic labour with agricultural business.
An integrative review of challenges and strategies in the work of cultural entrepreneurs
Authors: Näsholm Malin H. , Eriksson Jessica
Published: October 2024

The growing recognition of the importance of cultural and creative sectors as sources of creativity and innovation has put emphasis on the development of entrepreneurs within this field. Cultural entrepreneurs are often described as being driven by artistic, rather than entrepreneurial, ambitions, where value creation is based on unique expressions, requiring them to engage in continuous innovation to sustain their activities, as well as facing challenging conditions. However, more understanding is needed on the work of these entrepreneurs and how they deal with challenges. The purpose of this paper is thus to explore the work of cultural entrepreneurs by integrating the current understanding of its challenges and strategies. Through reviewing empirical articles focusing on entrepreneurs in these industries and analyzing how the activities of entrepreneurs are described, we argue that the academic conversation around these entrepreneurs revolves around broad questions: who they are, what they have and where they are. These questions constitute three domains of entrepreneurial activity. We outline the challenges and strategies of cultural entrepreneurs and discuss the dynamics in the interplay between challenges and strategies within and across these domains. In highlighting the interplay between challenges and strategies, we advance the knowledge of entrepreneurship in the cultural and creative sectors and provide avenues for further research.
BI‐LAVA: Biocuration With Hierarchical Image Labelling Through Active Learning and Visual Analytics
Authors: Trelles Juan , Wentzel Andrew , Berrios William , Shatkay Hagit , Marai G. Elisabeta
Published: October 2024

In the biomedical domain, taxonomies organize the acquisition modalities of scientific images in hierarchical structures. Such taxonomies leverage large sets of correct image labels and provide essential information about the importance of a scientific publication, which could then be used in biocuration tasks. However, the hierarchical nature of the labels, the overhead of processing images, the absence or incompleteness of labelled data and the expertise required to label this type of data impede the creation of useful datasets for biocuration. From a multi‐year collaboration with biocurators and text‐mining researchers, we derive an iterative visual analytics and active learning (AL) strategy to address these challenges. We implement this strategy in a system called BI‐LAVA—Biocuration with Hierarchical Image Labelling through Active Learning and Visual Analytics. BI‐LAVA leverages a small set of image labels, a hierarchical set of image classifiers and AL to help model builders deal with incomplete ground‐truth labels, target a hierarchical taxonomy of image modalities and classify a large pool of unlabelled images. BI‐LAVA's front end uses custom encodings to represent data distributions, taxonomies, image projections and neighbourhoods of image thumbnails, which help model builders explore an unfamiliar image dataset and taxonomy and correct and generate labels. An evaluation with machine learning practitioners shows that our mixed human–machine approach successfully supports domain experts in understanding the characteristics of classes within the taxonomy, as well as validating and improving data quality in labelled and unlabelled collections.
A population‐based study of incidence, aetiology, treatment and outcome of enterocutaneous fistula
Authors: Härle Karolina , Myrelid Pär , Landerholm Kalle , Börjeson Sussanne , Thylén Ingela , Hallböök Olof
Published: October 2024

Aim

The aim of this work was to investigate the incidence of enterocutaneous fistula (ECF), including both small bowel and colonic fistulas, in a defined population of 1.04 million during a 10‐year period and to describe aetiology, treatments, care consumption and outcome.

Method

A comprehensive search algorithm including diagnostic and procedural codes, enterostomal therapy nurse notes and in‐hospital care for >60 days yielded 1970 search hits. After reviewing medical records, 187 patients with ECF were identified.

Results

The annual incidence of ECF was 2.3 per 100 000, the incidence of ECF with intestinal failure type II was 0.9 per 100 000. Spontaneous closure of the fistula occurred in 16.0% of patients, while closure was seen in 97.3% of patients who underwent reconstructive surgery with recurrences in 6.7% and 8.3%, respectively. Cumulative ECF‐related in‐hospital care until closure or end of follow‐up was 4 (range 0–61) weeks. Eighty‐eight patients (47%) received home‐based healthcare including parenteral feeding and/or fistula wound care. The estimated overall mortality at 1, 3 and 5 years was 33.7%, 42.1% and 47.6% respectively. Mortality was mainly in patients without spontaneous closure or reconstructive surgery, and the risk of ECF‐related death was 30.2%.

Conclusion

This study defines the population‐based incidence of ECF and reports a high overall mortality rate. Initial survivors were characterized by either spontaneous closure or eligibility for later reconstructive surgery, but with an eventual mortality rate of approximately 20%. ECF patients are high consumers of care: 55.1% needed ≥4 weeks in hospital and many received home‐based healthcare.
The extent and diversity of harm from the drinking of unknown others in Australia: An analysis of data from during the COVID‐19 pandemic
Authors: Willoughby Bree , Room Robin , Jiang Heng , Kuntsche Sandra , Anderson‐Luxford Dan , Laslett Anne‐Marie
Published: October 2024

Introduction

This paper aims to produce a comprehensive estimate of alcohol's harm to others (AHTO) from strangers among Australia adults in 2021. This survey was undertaken during COVID‐19 and aims to compare AHTO results with those from 12 years before and identify differences across socio‐demographics.

Methods

Cross‐sectional data of 2574 Australian adults were collected in November 2021 via two survey modes: random digit dialling and the Life in Australia™ panel. Questions pertained to harms from the drinking of known and unknown others (‘strangers’) in the previous 12 months. Multivariable logistic regression is used to analyse differences in the experience of AHTO from strangers across age, gender and other socio‐demographics.

Results

Under half of Australian adults reported experiencing AHTO from a stranger (42.2%) during the period of COVID‐19. Women were at significantly higher odds of reporting harm than men. Significantly higher percentages of participants aged 18–49 reported harm than those 65 and over. Rates of experience of harm from strangers' drinking varied between different Australian regions. Adults engaging in less frequent risky drinking (less than 4 days a month) reported significantly greater experiences of harm than those not engaging in risky drinking in the past year.

Discussion and Conclusions

The current study provides a national estimate of AHTO from strangers in Australia during the COVID‐19 pandemic. Finding greater risk of experiencing AHTO from strangers among women than men differs from previous AHTO literature, and further research is required to determine if this is an emerging trend.
Tree Germination Sensitivity to Increasing Temperatures: A Global Meta‐Analysis Across Biomes, Species and Populations
Authors: Vicente Eduardo , Benito Garzón Marta
Published: October 2024

Aim

Climate change is altering forest communities at an unprecedented pace. Current knowledge on trees' responses to climate shifts is based mostly on adults. Yet, germination traits and intraspecific variation can notably modulate species niches. This paper provides a quantitative review about warming effects on tree species' germination, the role of population effects and its implications under future climate.

Location

Global; covering boreal, temperate, Mediterranean and tropical–subtropical biomes.

Time Period

1996–2024.

Major Taxa Studied

Tree species.

Methods

We reviewed 50 papers addressing 63 species and 250 populations. Then, we conducted a meta‐analysis to assess warming effects on germination percentage and time, and how germination is modulated by climate at seed origin. We further evaluated populations' adaptation to local temperature on 27 species. Finally, we estimated population‐based germination niches in eight of these species under current climate conditions and a 2080 climate scenario (SSP5‐8.5).

Results

Warming induced more consistent shifts in germination time than in percentage across biomes, hastening germination. Temperature at seed origin shaped responses to warming in boreal and temperate species. In Mediterranean and tropical–subtropical species, different responses were associated with variation in precipitation‐related variables. Local adaptation was more frequent in species from the tropics, while adaptation lags towards warmer‐than‐today conditions observed in the other biomes. Simulation of germination niches yielded slight although extensive germination reductions in tropical–subtropical species under future climate, whereas the temperate and boreal ones showed overall increases.

Main Conclusions

Population‐level adjustments are key moderators of germination percentage and phenology response to warming. Their roles vary depending on the prevailing climate in each biome. Temperature at seed origin is an important factor modulating temperate and boreal species' responses, while precipitation‐related variables are more relevant in Mediterranean and tropical–subtropical ones. Local adaptation in the tropical species increases their vulnerability to warming.
Border Interceptions Reveal Variable Bridgehead Use in the Global Dispersal of Insects
Authors: Worm Thom , Saffer Ariel , Takeuchi Yu , Walden‐Schreiner Chelsey , Jones Chris , Meentemeyer Ross
Published: October 2024

Aim

The global, human‐mediated dispersal of invasive insects is a major driver of ecosystem change, biodiversity loss, crop damage and other effects. Trade flows and invasive species propagule pressure are correlated, and their relationship is essential for predicting and managing future invasions. Invaders do not disperse exclusively from the species' native range. Instead, the bridgehead effect, where established, non‐native populations act as secondary sources of propagule, is recognised as a major driver of global invasion. The resulting pattern of global spread arises from a mixture of global interactions between invasive species, their vectors and, their invaded ranges, which has yet to be fully characterised.

Location

Global.

Time Period

1997–2020.

Major Taxa Studied

Insects.

Methods

We analysed 319,283 border interception records of 514 insect species from a broad range of taxa from four national‐level phytosanitary organisations. We classified interceptions as coming from species native range or from bridgehead countries and examined taxonomic autocorrelation of global movement patterns between species.

Results

While 65% of interceptions originated from bridgehead countries, highlighting the importance of the bridgehead effect across taxa, patterns among individual species were highly variable and taxonomically correlated. Forty per cent of species originated almost exclusively from their native range, 28% almost exclusively from their non‐native range and 32% from a mix of source locations. These patterns of global dispersal were geographically widespread, temporally consistent, and taxonomically correlated.

Conclusions

Dispersal exclusively from bridgeheads represents an unrecognised pattern of global insect movement; these patterns emphasise the importance of the bridgehead effect and suggest that bridgeheads provide unique local conditions that allow invaders to proliferate differently than in their native range. We connect these patterns of global dispersal to the conditions during the human driven global dispersal of insects and provide recommendations for modellers and policymakers wishing to control the spread of future invasions.
Renal satellite units in Pakistan: Challenges, efforts, and recommendations
Authors: Nadeem Abdullah , Khan Afsheen , Amir Ayesha , Siddiqui Tasmiyah , Shakeel Laiba
Published: October 2024

This commentary delves into the complexities surrounding chronic kidney disease management in Pakistan, specifically examining the critical role played by renal satellite units in providing accessible dialysis services. Chronic kidney disease in Pakistan accounts for 3.9% of total deaths, warranting a focused exploration of challenges and potential solutions. RSUs, smaller entities affiliated with main renal units, emerge as key players in addressing issues of geographic accessibility and diminishing travel burdens for chronic kidney disease patients. Challenges such as financial constraints, limited resources, and staff shortages, particularly in rural settings, pose significant hurdles to the effective functioning of RSUs. This commentary emphasizes the importance of clear eligibility criteria, robust vascular access support, regular physician engagement, and the strategic integration of telemedicine. It explores diverse funding models, including government allocations, community contributions, and philanthropic partnerships, as potential solutions to alleviate cost‐related concerns. The commentary advocates for a holistic, cost‐effective approach to chronic kidney disease care, highlighting the transformative potential of renal satellite units in improving health outcomes across varied settings.
Regional organ procurement (ROP) trays in renal allograft distribution and outcome
Authors: MacQueen J. M. , Sanfilippo F. P. , Thacker L. , Ward F. E.
Published: October 2024

ROP trays containing patient serum samples and distributed by the South‐Eastern Organ Procurement Foundation (SEOPF) were instituted to increase the likelihood of transplanting potential renal recipients who are highly sensitized to HLA antigens. This study examines kidney distribution and transplant outcome to assess equitable placement and clinical function post transplant with and without the use of ROP trays. Data were collected over a 26‐month period on the distribution of kidneys from 328 consecutive SEOPF donors from whom at least 1 kidney was procured. Shared kidneys were placed via the UNOS and SEOPF‐variance computer match programs. Of 656 kidneys, 596 were placed into 582 recipients; 60 were not used. ROP trays were used in placement of 492 kidneys and were not used for placement of 104 kidneys. Outcome was determined for 435 kidneys transplanted into SEOPF recipients. Only 33 (6.9%) recipients with ROP tray use and 10 (9.8%) without were sensitized to HLA. A 10% increase in placement to the originally intended recipient was seen with ROP tray usage over kidneys placed without ROP tray use (p ≤ 0.025). Recipients matched using ROP tray data averaged 29 positions higher on the match printout. There was no difference in tray use regarding placement of kidneys within or outside the donor's local UNOS region, nor was there a difference in mean HLA match of transplant pairs with and without ROP tray use, 3.2 and 3.1 antigens, respectively. Cold ischemia time was similar, 22.9 and 23.6 h, respectively, for kidneys placed with and without ROP trays. At post‐transplant discharge, there were no differences in patient status, graft failure, rejection treatment, dialysis need, or urine output whether or not ROP trays were used. Significantly, however, plasma creatinine at discharge and at 12 months was lower for those placed with ROP trays (2.5 mg/dl and 1.7 mg/dl) vs (3.1 mg/dl and 1.9 mg/dl), respectively. During this time period, all kidneys transplanted with use of ROP trays functioned as well or better than those transplanted without ROP tray placement. Thus, the use of ROP trays appeared to have a beneficial effect in getting more recipients of higher priority transplanted with equivalent, if not better, graft function.
A model of human anti‐T‐cell monoclonal antibody therapy in SCID mice engrafted with human peripheral blood lymphocytes
Authors: Tsuchida Masanori , Brown Stephen A. , Tutt Libby M. , Tan Jian , Seehafer Darin L. , Harris Jason P. , Xun Chang Q. , Thompson John S.
Published: October 2024

A chimeric severe combined immunodeficient mouse engrafted with human peripheral blood (hu‐PBL‐SCID) model has been developed to test anti‐T‐cell monoclonal antibody (mAb) effects on systemic symptoms. of the host and the survival of human skin grafts. To obtain consistent engraftment without lethal acute graft‐versus‐host disease (GVHD), SCID mice were pretreated with a combination of total body irradiation (2.5 Gy, day 0) and anti‐asialo GM1 (anti‐mouse natural killer cell) antiserum (50) ug i.p., day 3) before the intraperitoneal injection of 40‐50 × 106 human PBL on day 4. With this protocol, the engraftment rate was 82% with 5‐98% human CD45‐positive cells in the peripheral blood. Mortality at 30 days was 0% in the mice bearing 5‐50% human cells compared with 70% in those with more than 50%. Using hu‐PBL‐SCID mice with 5‐50% human cells in their peripheral blood, we demonstrated the following results: 1) Human T cells isolated from these mice proliferated in response to immobilized OKT3 stimulation in vitro. 2) Hu‐PBL‐SCID mice but not normal SCID mice were able to reject human skin grafts in vivo 16‐21 days after grafting. 3) Both OKT3 (anti‐human CD3 mAb) and T10B9 (anti‐human αβ T‐cell receptor mAb) treatment prevented human skin graft rejection in hu‐PBL‐SCID mice. 4) OKT3 but not T10B9 induced first dose reactions characterized by hypothermia and hypoactivity which were consistently observed within 90 min of intravenous injection into hu‐PBL‐SCID mice. 5) Human cytokines were detected in the serum of the hu‐PBL‐SCID mice treated with anti‐T‐cell mAbs. The close similarity of these responses to human clinical mAb immunosuppressive therapy suggests that the hu‐ PBL‐SCID mouse model may be an excellent tool for investigating the immunosuppression, side effects, and mechanism of action of agents that are specific for human and higher apes and not reactive with lower animals.
Acute renal allograft rejection in patients with Epstein‐Barr virus associated post‐transplant lymphoproliferative disorder
Authors: Purighalla Raman , Shapiro Ron , Jordan Mark L. , Scantlebury Velma P. , Gritsch H. Albin , Vivas Carlos , Randhawa Parmjeet S.
Published: October 2024

Background. There is a reciprocal relationship between posttransplant lymphoproliferative disorder (PTLD) and rejection: aggressive treatment of rejection can result in PTLD, while treatment of PTLD by reducing immunosuppression can result in recrudescence of rejection. The literature on the relationship between PTLD and rejection episodes is limited. Methods. The clinical course and outcome of rejection episodes occurring prior to and following a diagnosis of PTLD were studied in 20 renal transplant recipients. Results. The diagnosis of PTLD was preceded by rejection in 12/20 (60%) patients. OKT3 treatment was associated with early onset PTLD, which involved the allograft in 6/7 patients (86%). The risk of rejection following reduced immunosuppression was 7/14 (50%). Post‐ PTLD rejection left untreated led to graft loss in 3 patients. The remaining 4 patients responded satisfactorily to anti‐rejection therapy. Conclusions. Reduction of immunosuppression for PTLD is frequently, but not invariably, complicated by rejection. The clinical outcome of PTLD does not correlate with the occurrence or reversibility of rejection episodes.
Elevation of cyclosporin A blood levels during carvedilol treatment in renal transplant patients
Authors: Kaijser Magnus , Johnsson Cecilia , Zezina Lilija , Backman Ulla , Dimény Emöke , Fellström Bengt
Published: October 2024

In a consecutive study of 21 renal transplant patients suffering from chronic vascular rejection (CVR) we added the beta‐receptor‐blocking drug carvedilol to their regular medication. The purpose was to investigate possible pharmacokinetic interactions between carvedilol and cyclosporine (CSA), since carvedilol will soon be used in clinical trials in renal transplant patients with CVR. On the first day of the study the patients received 6.25 mg of carvedilol added to their daily medication. The dose was increased stepwise to 50 mg while the doses of other beta‐blocking drugs were decreased. The goal was to exchange atenolol with carvedilol at a ratio of 2:1 when substituting atenolol with carvedilol. The patients' blood pressure was the final determinant of the dose of carvedilol. The trough levels of CsA were measured on days 1. 14, 30, 90 and 180. It was found that the blood levels of CsA increased when carvedilol was introduced. Thus, the doses of CsA had to be reduced in order to keep the blood levels within the theurapeutic range. At 90 d, the daily doses of CsA had been reduced from 3.7±0.3 to 3.0±0.2 mg/kg BW (p<0.001). The present results suggest an interaction between carvedilol and CsA that demands a 20% average reduction of CsA doses to maintain the CsA blood levels within the therapeutic range. However, the interaction shows a great interindividual variation, calling for careful monitoring of the CsA blood levels.
Effect of initial slow graft function on renal allograft rejection and survival
Authors: Humar Abhinav , Johnson Eric M. , Payne William D. , Wrenshall Lucille , Sutherland David E. R. , Najarian John S. , Gillingham Kristen J. , Matas Arthur J.
Published: October 2024

Cadaver renal allografts with immediate excellent function have good long‐term outcomes, while grafts with delayed function have been associated with an increased incidence of acute rejection (AR) and subsequent poor long‐term graft survival. There is, however, an intermediate group with initial slow function whose outcome is not well defined. This group was examined by reviewing 510 patients that received primary cadaver transplants between 1/85 and 8/95. Recipients were grouped by initial function into: 1) those with immediate graft function (IGF), defined by serum creatinine (Cr) level<3 mg/dl on post‐operative day (POD) 5 (n=237); 2) those with slow graft function (SGF), defined by serum Cr>3 mg/dl on POD 5 but no need for dialysis (n=160); and 3) those with delayed graft function (DGF), defined by the need for dialysis in the first week post‐transplant (n=113). Five‐year graft survivals were determined for each group by Kaplan‐Meier methods and compared by a generalized Wilcoxon test. The incidence of AR in the first 6 months was significantly higher in those with SGF (40%) vs. those with IGF (30%) (p<0.05); both groups had a lower incidence than those with DGF (47%) (p<0.05). In the absence of AR, 5‐yr graft survival was similar between the 3 groups, 94%, 97% and 92% for IGF, SGF and DGF respectively. In the presence of AR, 5‐yr graft survival was significantly reduced in all groups, but most notably in those with SGF (51%) or DGF (53%), as compared to those with IGF (80%), (p<0.001).

We conclude that recipients with SGF, but no AR, have excellent outcomes. comparable to those with IGF. However, there is an increased incidence of early AR associated with SGF. In recipients with SGF or DGF, AR has a more profound detrimental effect on long‐term graft survival than in the IGF group. Thus, recipients with SGF are at increased risk for AR with resultant poor long‐term graft survival, and may need modified immunosuppressive protocols.
Efficacy of oral ganciclovir in prevention of cytomegalovirus infection in post‐kidney transplant patients*
Authors: Ahsan Nasimul , Holman Michael J. , Yang Harold C.
Published: October 2024

Unlike parenteral gancicovir, the efficacy of oral ganciclovir in the prevention and treatment of cytomegalovirus (CMV) infection in kidney transplantation has not been well documented. This study prospectively evaluated the episodes of CMV infection within the first nine months after transplantation in renal transplant recipients treated prophylactically with oral ganciclovir (750 mg twice a day) over a period of 3 months (oral ganciclovir, N=22), compared with patients randomly assigned as controls (controls, N=22) who did not receive any anti‐viral prophylaxis. Diagnosis of CMV infection at presentation included serological determination of CMV‐specific immunoglobulin M antibodies, CMV immunofluorescence assay [standard culture tube and shell vial] (blood) and virus isolation (urine and tissue). CMV infection occurred in one patient (5%) in the oral ganciclovir group and 6 patients (27%) in the control group (p<0.05). The episodes of biopsy proven allograft rejections were 5% (1/21) and 18% (4/22) in the oral ganciclovir and control groups, respectively. Except for one, none of these patients developed CMV infection either before or after rejection(s). Controlling for the reason (induction or treatment of rejection) for using cytolytic antibody therapies, we found that prophylactic oral ganciclovir was protective against CMV infection (adjusted risk reduction 0.83; 95% confidence interval, 0.33‐0.98; p< 0.05). Neither, the CMV status of donors and recipients nor the treatment for acute rejection had any significant impact on the occurrence of CMV infections. Our results show that oral ganciclovir is an effective and well tolerated therapy in the prevention of CMV infection in renal transplant patients.
Hepatitis C status of heart transplant recipients
Authors: Fagiuoli S. , Cooper D. K. C. , Zuhdi N.
Published: October 2024

The records of 155 consecutive patients who underwent successful heart transplantation (HTx) were reviewed to document the incidence of hepatitis C (HCV) infection. One patient was HCV RNA positive pre‐HTx, and 12 patients (8%) developed transient or permanent HCV positivity post‐HTx. HCV RNA positivity was associated with biochemical features of liver injury. Liver biopsy was performed in 8, and demonstrated features of chronic hepatitis in all. Two patients died of chronic liver failure at 50 and 56 months post‐HTx, respectively. Interferon therapy was given to three patients, two of whom converted to HCV negativity. This study suggests that HCV infection is more common than previously anticipated in HTX patients, and varies from a mild transient condition to a fatal chronic liver failure.
Urinary tract infections following renal transplantation
Authors: Takai Kimio , Tollemar Jan , Wilczek Henryk E. , Groth Carl‐Gustav
Published: October 2024

The incidence of urinary tract infections (UTIs) in 363 adult renal transplant recipients transplanted during the period 1990‐96 has been analysed. UTI occurred in 96 patients (26%), most frequently during the first year after transplantation. Female recipients had significantly more UTI than male recipients (49% vs. 14%, p<0.0001). There was no difference in the incidence of UTI between recipients receiving pig‐tail catheters as ureteral stents or not, the figures being 21% vs. 28%, respectively. Age had no influence on the incidence of UTI. In 341 patients treated with cyclosporine the incidence of UTI was 28%, while in 15 patients treated with FK‐506 only 1 patient (7%) had a UTI (ns). The majority of organisms cultured were gram‐negative (76%), with approximately 1/3 being Escherichia coli and 1/5 being Enterococcus and Klebsiella Enterobacter. The bacterial spectrum was not influenced by the recipient's age. UTI had no effect on the number of rejections, or on graft and patient survival in living donor transplant recipients. No significant difference was found in graft and patient survival rates at 3 yr between patients who had UTI or no UTI.
Possible involvement of Von Willebrand factor in pancreatic graft thrombosis after kidney‐pancreas transplantation: a retrospective study
Authors: Kessler Laurence , Wiesel Marie‐Louise , Boudjema Karim , Lutun Elisabeth , Moulins Bauno , Cazenave Jean‐Pierre , Wolf Philippe , Pinget Michel
Published: October 2024

Early postoperative graft thrombosis remains the second cause of failure in pancreas transplantation. Thus, the aim of this study was to compare retrospectively coagulation and fibrinolysis in type I diabetic recipients of simultaneous kidney‐pancreas transplants having or not experienced thrombosis of their pancreatic graft. From December 1990 to August 1996, 30 simultaneous kidney pancreas transplants were performed in 30 uremic type I diabetic patients. Acute thrombosis of the pancreatic graft was observed among 6 patients (group A). whereas 24 did not develop thrombosis (group B) although 4 died from other causes. The control groups were composed of kidney transplant (group C) or haemodialysed (group D) non‐diabetic patients, type I diabetics with HbA1C <8% (group E) or ≥8% (group F) who were not in end‐stage renal failure and kidney, transplant type I diabetic patients (group G). Beginning at least 6 months after transplantation, we analysed hemostatic factors (fibrinogen, thrombin, and prothrombin times), coagulation inhibitors (proteins C and S), fibrinolysis (plasminogen activator inhibitor) and endothelial cell abnormalities (Von Willebrand factor: VWf). Micro and macrovascular complications were evaluated on a score ranging from 0 to 12. Hemostatic factors, coagulation inhibitors and fibrinolysis were similar in groups A and B whereas VWf differed significantly in group A (3.49±0.93 IU/ml) as compared to group B (2.04±0.92 IU/ml) (p<0.05). VWf was also significantly increased in group A relative to the control groups C, D, E, F, and G. The score of vascular complications was increased in groups A and B and significantly higher in group A (9±0.81 vs. 6.07 ± 1.75) (p<0.01), while a correlation (r = 0.812. p > 0.05) was observed between VWf levels and the severity of vascular complications. These results point out the possible involvement of VWf in the pathogenesis of pancreatic vein thrombosis in kidney‐pancreas transplantation.
Use of glucose disappearance rates (kG) to monitor endocrine function of pancreas allografts1
Authors: Elmer Debra S. , Hathaway Donna K. , Abdulkarim A. Bashar , Hughes Thomas A. , Shokouh‐Amiri Hosein , Gaber Lillian W. , Gaber A. Osama
Published: October 2024

We have reported that a decline in glucose disappearance rate (k) in pancreas transplant recipients is associated with pancreatic rejection. The purpose of this study was to determine test‐retest reliability of kG monitoring and to establish the kG criteria for diagnosing abnormal graft function. Six healthy non‐diabetic volunteers and 14 stable pancreas recipients underwent 2 intravenous glucose tolerance tests 7 d apart. All kG values in non‐diabetic volunteers had < 15% variation between the two determinations (r = 0.96, P ≤ 0.0006). Similarly, 13/14 recipients experienced <20% variation in kG with one patients experiencing a 23% variation (r = 0.90, P ≤ 0.0001).

Using a 20% change from baseline as the reference value, we monitored 28 pancreas recipients for 2‐36 months post‐transplant. Of 253 kG values, 160 (64%) did not exceed the 20% change from baseline, 65 (26%) declined > 20% and 28 (11%) increased > 20%. Of 160 stable kG values, 154 (96%) were associated with normal graft function while 6 (4%) occurred in the context of rejection. Of 65 kG values declining by ≥ 20%, 47 (72%) accurately identified acute rejections diagnosed by biopsy (70%) or response to treatment (30%), 12 (19%) were associated with identifiable causes of increased insulin resistance and only in 6 (9%) cases a cause for the decline was unidentifiable. The kG values with > 20% rise from baseline were, in 15%, associated with identifiable causes of decreased insulin resistance. The sensitivity of the kG as a marker for rejection was 88.7%, specificity 91%, positive predictive value 72.3%, negative predictive value 96.8%, and accuracy 90.5%. These data confirm that a > 20% deterioration of glucose disappearance rate is associated with pancreas allograft rejection, and confirms the utility of k monitoring in clinical follow‐up of pancreas transplant recipients.
Experience of ABO‐incompatible living kidney transplantation after double filtration plasmapheresis
Authors: Ishikawa Akira , Itoh Michiko , Ushlyama Tomomi , Suzuki Kazuo , Fujita Kimio
Published: October 2024

We achieved success in ABO‐incompatible renal allografting after removing anti‐A and/or anti‐B antibodies from the recipient's plasma using double filtration plasmapheresis (DFPP). We report here the results of our initial 2 cases. Case I was a 40‐yr‐old female whose blood group was A+. The donor was her younger brother, a 37‐yr‐old male, whose blood group was B+. The human lymphocyte antigens. (HLAs) were one haplotype identical, and the stimulation index of the mixed lymphocyte culture (MLC‐SI) was 34. Case 2 was a 28‐yr‐old male whose blood group was B+. The donor was his father, a 58‐yrold male, whose blood group was AB+. The HLAS were one‐haplotype identical as well, and the MLC‐SI was 71. We carried out 4 sessions of DFPP pre‐operatively; i.e. on days 6, 4, 2 and ‐ L. 2.5 1 of plasma were treated with 500 ml of 4.4% plasma protein fraction in each procedure. The pre‐operative target titer of anti‐A/B antibody, measured by the saline tube test, was set at less than × 8. We also used 5 kinds of immunosuppressants. Cyclosporine was administered on day ‐ 2 beginning with 8 mg/kg/d, and its dose was modified according to the trough level. 500 mg of methylprednisolone were administered intravenously during the operation, and prednisolone was started on day 1 with 60 mg/d and tapered. Azathioprine was started on day 2 with 2 mg/kg/d for 7 d and 1 mg/kg/d thereafter. 5 mg/kg/d of gusperimus was given intravenously from day 0 for 5 d. 30 mg/kg/d of ALG was given intravenously from day 0 for 14 d. Along with these immunosuppressants, 0.1 mg/kg/h of nafamostat mesilate was administered intravenously from day 0 for 3 d, and 4 mg/kg/d of ticlopidine was given orally from day 3. X‐Ray irradiation to the renal graft was not done. Following splenectomy standard renal allografting was performed. In Case 1, the titer of anti‐B antibody was reduced from × 16 to × 4. In Case 2, the titer of anti‐A antibody was reduced from × 32 to × 4. The post‐operative courses of these 2 cases were satisfactory. Although our experience is limited, ABO incompatible kidney transplantation can safely be performed using DFPP.
Is kidney graft biopsy indicated in recipients with newly developed, microscopic hematuria?
Authors: Kim Yu Seun , Jeong Hyeon Joo , Kim Myoung Soo , Kim Soon II , Han Dae Suk , Park Kill
Published: October 2024

We actively performed renal allograft biopsies on 87 living donor renal transplant recipients presenting with stable serum creatinine but showing newly developed recurrent microscopic hematuria with a small amount of proteinuria during the maintenance phase of immunosuppression and found definite pathological lesions in 56 cases (64%). Chronic rejection of a mild grade (n = 27) and various kinds of glomerulonephritis (n = 27) were the major pathological diagnoses, and from 14 cases singular or complicated cyclosporine (CSA) toxicity was found. Twenty‐four out of the 27 glomerulonephritis cases were IgA nephropathy, which is the most common glomerulonephritis in Korea. Through this study, the authors found chronic rejection or glomerulonephritis even in grafts which are generally considered to be normal. CSA nephrotoxicity, which was not expected clinically, could be found. In summary, renal allograft biopsy on patients, even with stable graft. function when they start to show microscopic hematuria with or without a small amount of proteinuria, should be perfomed to document the early intragraft events if there are no medical contraindications.
Renal transplantation in secondary systemic amyloidosis
Authors: Heering P , Hetzel R , Grabensee B , Opelz G
Published: October 2024

When renal amyloidosis has progressed to end‐stage renal failure, most patients are severely affected by systemic amyloidosis and nephropathy. An alternative to chronic dialysis is renal transplantation. We present a patient with amyloid nephropathy who developed recurrent transplant amyloidosis. Renal transplantation was performed in 1985 with a living related donor. In 1990 the patient developed amyloidosis of the graft with membranous nephropathy and tubular acidosis due to hyporeninemic hypoaldosteronism. Secondary amyloidosis has been reported to involve glandular organs inducing hypothyroidism, hypocortisolism and hypoaldosteronism. Cyclosporine has been reported to induce hyporeninemic hypoaldosteronism and tubular acidosis, but not hypocortisolism and hypothyroidism. Progression of the amyloidosis of the graft was confirmed by a renal biopsy in 1993. Data published in the literature indicate that the survival rate of amyloidotic graft recipients is worse than those of non‐amyloidotic graft recipients. This was confirmed in an analysis of the current CTS data which showed an impaired survival rate at 5‐yr of 66+4% (± SE) for patients with amyloidosis (n = 413) as compared with 86 ± 1% (p<0.0001) for patients with glomerulonephritis and 84±1 (p <0.01) for patients with polycystic kidney disease. Graft survival after 5 years was 55±4% in patients with amyloidosis as compared with 63±1% (p=0.02) in patients with glomerulonephritis and 68±1% in patients with polycystic kidney disease. Graft survival was improved in amyloidotic patients treated with cylosporine as compared with patients on steroids and azathioprine (554% vs. 38±8%, p <0.05). It is concluded that renal transplantation is the renal replacement therapy of choice for patients with AA‐type amyloidosis although the overall patient survival is impaired in comparison with patients with other discases.
Usefulness of surveillance endomyocardial biopsy after pediatric cardiac transplantation
Authors: Braunlin Elizabeth A , Shumway Sara J , Bolman R Morton , McDonald Kenneth M , Ring W Steves , Olivari Maria Teresa , Nakhleh Raouf E
Published: October 2024

Endomyocardial biopsy remains the ‘gold standard’ for the diagnosis of acute rejection after cardiac transplantation, but few guidelines exist to determine the indications for its use in pediatric cardiac transplant recipients. To determine the usefulness of surveillance endomyocardial biopsy, 176 biopsies were reviewed from 12 patients, aged 0.5‐16 (average 9.7) yr, maintained on cyclosporine, azathioprine and prednisone immunosuppression, and followed 2.8‐ 45.5 (average 26.3) months after cardiac transplantation. Children old enough to cooperate (n = 6) underwent biopsy on nine occasions in the first 6 months after transplantation and quarterly thereafter. Children too young to cooperate (n = 6) underwent biopsy with general anesthesia on four occasions in the first 6 months after transplantation and every 6 months thereafter. Additional biopsies were performed as warranted by symptoms or noninvasive tests.

A new episode of acute rejection was present in 13 biopsies (7%); continuing or resolving rejection in 19 others (11%). Remaining biopsies had no evidence of rejection (82 biopsies, 47%), had lymphocytic infiltrates insufficient for diagnosis (47 biopsies, 27%), were inadequate for diagnosis (14 biopsies, 8%), or were consistent with ischemia (1 biopsy, 0.5%). During the first 6 postoperative months, eight of 101 biopsies were positive for rejection, three occurring on routine surveillance biopsy. After 6 months, five of 75 biopsies showed a new episode of rejection, only one occurring on routine surveillance biopsy. Based on this data, it is concluded that: 1) episodes of rejection are relatively uncommon with triple drug immunosuppression; 2) surveillance biopsies in the first 6 months after cardiac transplantation may show unsuspected rejection; and 3) routine surveillance biopsies more than 6 months after cardiac transplantation are unlikely to show rejection in the absence of symptoms or other tests.
Increased intragraft IL‐15 mRNA expression after liver transplantation
Authors: Baan Carla C , Niesters Hubert GM , Metselaar Herold J , Mol Wendy M , Loonen Elisabeth HM , Zondervan Pieter E , Tilanus Huug W , IJzermans Jan MN , Schalm Solko W , Weimar Willem
Published: October 2024

To study T‐cell/macrophage interactions at the molecular level in clinical allograft rejection, we measured intragraft mRNA expression of the T‐cell derived cytokine IL‐2 and the macrophage derived chemokine IL‐15, a novel cytokine associated with T‐cell activation, in post‐transplant liver biopsies (n = 33) and in non‐transplanted control liver tissue by reverse transcriptase‐polymerase chain reaction (RT‐PCR). We analyzed biopsies without evidence of rejection (n = 12), with spontaneously resolving histological rejection (n = 10), or with histological rejection accompanied with clinical rejection (n = 11) defined by rising serum bilirubin and aspartate amino transaminase levels. IL‐15 mRNA expression was present in the majority of post‐transplant liver biopsies (91%, 30/33) and was significantly upregulated as compared with non‐transplanted liver tissue (p = 0.005). However, the increased intragraft IL‐15 mRNA level was not indicative for rejection. In contrast to intragraft IL‐15 mRNA expression, IL‐2 mRNA transcription was measured in the minority of the post‐transplant liver biopsies (15%, 5/33) and not detectable in control specimens. In addition, IL‐2 mRNA was almost specifically measured in rejection biopsies concurrent with graft dysfunction (36%, 4/11 versus 1/22 without clinical rejection; p = 0.03). No relation between intragraft IL‐2 and IL‐15 mRNA expression was found. The IL‐15 mRNA expression levels were not higher in the IL‐2 negative rejections compared with those in IL‐2 positive rejections. To conclude, in contrast to IL‐2, the function of IL‐15 in T‐cell mediated rejection remains unclear. The overall high IL‐15 mRNA levels in sites of immune responses suggests that the macrophage‐derived mediator IL‐15 is involved in a constant flow of T‐cells from the circulation into the graft.