bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative effects of renal transplantation and maintenance dialysis on arterial stiffness and left ventricular mass index
Authors: Keven Kenan , Calayoglu Reyhan , Sengul Sule , Dincer Irem , Kutlay Sim , Erturk Sehsuvar , Erbay Bulent , Nergizoglu Gokhan
Published: August 2010

Abstract:  Background:  Arterial stiffness and left ventricular hypertrophy (LVH) are major independent risk factors for cardiovascular disease in healthy and renal population. In this study, we aimed to investigate comparative long‐term effects of renal transplantation (RTx) and of hemodialysis (HD) on both arterial stiffness and LVH.

Methods:  Twenty‐eight RTx patients, 23 HD patients, and 20 healthy subjects were included in this prospective study. In addition to demographical and laboratory parameters, arterial stiffness [pulse wave velocity (PWV)] and left ventricular mass index (LVMi) were assessed before and one‐yr after RTx, and at the baseline and one‐yr later in HD patients.

Results:  There were no differences in the parameters between HD and RTx patients at baseline. PWV was significantly higher than that of healthy controls. After one yr, PWV had significantly decreased in RTx patients, but was unchanged in HD patients. Changes in PWV were significant when both groups were compared (p < 0.0001). Although LVMi significantly decreased after RTx (p = 0.02), changes were not significant between the groups.

Conclusions:  Renal transplantation markedly improved arterial stiffness, while it remained elevated in HD patients at the one‐yr follow‐up. There was no difference between maintenance HD and RTx groups with respect to impact on LVMi in the one‐yr follow‐up.
Early, abrupt conversion of de novo renal transplant patients from cyclosporine to everolimus: results of a pilot study
Authors: Holdaas H. , Bentdal Ø. , Pfeffer P. , Mjørnstedt L. , Solbu D. , Midtvedt K.
Published: August 2010

Abstract:  In a single‐center study, 20 kidney transplant patients without prior rejection were abruptly converted from cyclosporine to everolimus at seven wk post‐transplant. All patients received basiliximab induction with maintenance enteric‐coated mycophenolate sodium and corticosteroids. Biopsy‐proven acute rejection had occurred in three of 20 patients (15.0%) by the end of week seven post‐conversion. All episodes were mild and reversible, with subsequent recovery of renal function. Calculated glomerular filtration rate (GFR) improved significantly (51 ± 11 mL/min at time of conversion, 58 ± 12 mL/min at week seven post‐conversion, 57 ± 17 mL/min at month six post‐conversion; p = 0.001). No patient developed proteinuria in the nephrotic range. Twenty‐two adverse events were reported in 10 patients, three of which had a suspected relationship to everolimus. Mean leukocyte and platelet count decreased significantly, and triglyceride level increased. This study suggests that kidney transplant patients without prior rejection can be converted abruptly from cyclosporine to everolimus at seven wk post‐transplant, resulting in significantly improved renal function with no apparent increase, in risk of rejection and good tolerability.
Predictors of employment after successful kidney transplantation – a population‐based study
Authors: Bohlke Maristela , Marini Stela Scaglioni , Gomes Rafael Hissé , Terhorst Lisoneide , Rocha Marcos , Poli de Figueiredo Carlos Eduardo , Sesso Ricardo , Irigoyen Maria Claudia
Published: August 2010

Abstract:  Introduction:  Kidney transplantation is currently the treatment of choice for end‐stage renal disease. As the successful transplantation improves the physical and mental quality of life, it is expected that the transplant recipient should play a productive role in the society. The present study evaluates the occurrence and predictors of employment after kidney transplantation.

Methods:  Population‐based cross‐sectional study in which 272 adult kidney recipients assisted in a Brazilian Southern state were evaluated.

Results:  At the moment of the interview, 29% of the patients were employed. After analysis with logistic regression, the predictors of employment were male sex (OR 4.04; 95% CI 1.99–8.23), pre‐transplant employment for non‐diabetic (OR 4.35; 95% CI 3.79–4.99), diabetes for individuals who worked while on dialysis (OR 0.06; 95% CI 0.008–0.5), high educational level for individuals with mental quality of life scores above the 25th percentile (OR 3.06; 95% CI 2.98–3.14 for 50th percentile of mental quality of life). The Hosmer–Lemeshow test was of 3.33 (p = 0.91).

Conclusion:  The participation of the kidney transplant recipients with functioning graft into the work force in the Brazilian state of Rio Grande do Sul is low, being predicted mainly by sociodemographic factors. It was not detected any influence of patient perception of his/her physical conditions or other clinical variables, except for the presence of diabetes.
Effect of procurement‐related organ lesions on renal transplant outcome
Authors: Bentas Wassilios , Jones Jon , Urbschat Anja , Tilp Ursula , Probst Michael , Scheuermann Ernst , Hauser Ingeborg A. , Blaheta Roman A. , Jonas Dietger , Gossmann Jan
Published: August 2010

Abstract: Background:  The purpose of our study was to examine the nature and incidence of renal injuries during organ procurement, to identify risk factors and to analyse the effects of organ lesions on the following transplantation.

Methods:  All cadaveric kidney transplantations performed at our centre from 1996 to 2006 with an organ donated within the Eurotransplant (ET) region were retrospectively analysed.

Results:  Five hundred and sixty‐three renal grafts procured in 62 centres throughout the ET region were transplanted in the analysed period. One hundred and twenty (21.3%) kidneys were inadequately procured with 143 errors in total. The frequency of procurement errors did not differ significantly between kidneys procured by urologists and general surgeons (19.2% vs. 24.6%) nor when kidneys were procured alone or together with pancreas and/or liver (19.3% vs. 22.0%). Inadequate procurement lead to a discard rate of 0.2% and ultimately resulted in a surgical complication rate of 3.4%. Primary graft function (75.8% vs. 78.6%), three‐yr graft survival (76.6% vs. 82.4%) and cumulated long‐term graft survival were not significantly influenced by procurement errors.

Conclusion:  Additional measures to improve procurement quality are necessary. Nevertheless, adequate repair of organ lesions is possible and most organs can be successfully transplanted with very good short‐ and long‐term results.
Malignancy after kidney transplantation: results of 400 patients from a single center
Authors: Stratta Piero , Morellini Veronica , Musetti Claudio , Turello Ernesto , Palmieri Daniela , Lazzarich Elisa , Cena Tiziana , Magnani Corrado
Published: August 2010

Abstract: Background:  Post‐transplant malignancies (PTM) occur in a percentage as high as 50% in patients followed 20 yr and have become a main cause of mortality and are expected to be the first cause of death within the next 20 yr in kidney transplant recipients.

Patients and methods:  We analyzed the PTM incidence in our kidney transplant recipients, and its main risk factors. The records of 400 patients (min follow up = one yr) have been retrospectively reviewed and categorized into three groups: patients without any tumor, with a non‐melanoma skin cancer and with a solid or hematologic cancer. A cancer‐free multivariate survival study was performed stratified by age, sex, immunosuppressive therapy, time on dialysis, body mass index (BMI), smoke, diabetes and nephropathy.

Results:  Thirty patients developed PTM: 12 non‐melanoma skin cancer, three lymphomas and 15 solid malignancies (seven genitourinary, three lung, two breast, two gastrointestinal and one sarcoma). The mean age at diagnosis was 55 yr, with a mean time from transplant of 27 months. We observed six deaths and two graft losses. Non‐melanoma skin cancer‐free survival and the solid/hematologic cancer‐free survival was 99.5% and 98.5% at one yr, and 95.2% and 94.6% at five yr, respectively. At univariate analysis, age and induction therapy were significant risk factors for both types of PTM, while only recipient age significantly increased the risk of all PTM, and anti CD25 significantly reduced the risk of non‐melanoma skin cancer at the multivariate study.

Conclusions:  These data confirm the role of age and induction strategies in modulating the risk of neoplasia. To look for which strategies might reduce the PTM risk, including a personalized therapy to minimize the effects of chronic immunosuppressant, will be a crucial goal.
Diffuse large B‐cell lymphoma in a renal allograft associated with Epstein‐Barr virus in the recipient: a case report and a review of lymphomas presenting in a transplanted kidney
Authors: Cobo Fernando , García César , Talavera Paloma , Ruiz‐Cabello Francisco , Bravo Juan , Concha Ángel
Published: August 2010

Abstract:  The purpose of this review was to evaluate the case reports with lymphoproliferative disorders exclusively localized in the allograft transplanted kidney. We also report a rare case of diffuse large B‐cell lymphoma originated from the lymphocytes of the recipient with exclusive localization in the kidney allograft. We searched the medical literature for case reports of this condition. We found only 16 cases of lymphoma presenting in the kidney allograft without systemic affectation. The most frequent clinical manifestations were graft dysfunction and fever. In the majority of patients included in this review, the diagnosis was established from the tissue of explanted allograft. Seven patients were diagnosed with B‐cell lymphoma, and the relationship with Epstein‐Barr virus could only be demonstrated in four patients. However, the outcome was satisfactory in all cases, except in one case in which death was not related with the lymphoma etiology. Health care providers should be aware of this clinical entity and heightened index of suspicion should be used so as not to delay diagnosis and not to lose the allograft.
Split liver transplantation with extended right grafts under patient‐oriented allocation policy. Single center matched‐pair outcome analysis
Authors: Sainz‐Barriga Mauricio , Ricciardi Salvatore , Haentjens Ivo , Colenbie Luc , Colle Isabelle , Van Vlierberghe Hans , De Hemptinne Bernard , Troisi Roberto
Published: August 2010

Abstract: Background:  Split liver transplantation (SLT) is an established technique developed to optimize the number of available grafts. Few data are available on SLT with extended right liver grafts (eRLG) in the context of patient‐oriented allocation policy.

Methods:  Between July 1, 2001 and December 31, 2005, 12 whole liver graft (WLG) recipients were matched with 12 eRLG recipients according to their clinical status, indication and year of liver transplantation.

Results:  There were no differences according to recipient Model for End‐stage Liver Disease score, total serum bilirubin, creatinine levels and international normalized ratio in both groups. Fifty percent of donors in eRLG group presented 2 or more extended criteria. Liver transplantation was performed in UNOS status 1/2A in 58% of cases in both groups. Vascular and biliary complications were observed in three patients in the eRLG group. The median follow‐up was 25.3 months (range 0.4–63). Early mortality (≤3 m) was 16.7% in WLG vs. 0% in eRLG, respectively (p = n.s.). Five‐yr patient and graft survival rates were 84% and 77%, and 75% and 68%, respectively, for WLG and eRLG.

Conclusion:  Split liver transplantation with eRLG according to the patient‐oriented allocation policy can be performed under emergency or urgent care circumstances with acceptable morbidity and adequate long‐term survival.
Validation of the HCC‐MELD for dropout probability in patients with small hepatocellular carcinoma undergoing locoregional therapy
Authors: Huo Teh‐Ia , Huang Yi‐Hsiang , Su Chien‐Wei , Lin Han‐Chieh , Chiang Jen‐Huei , Chiou Yi‐You , Huo Samantha C. , Lee Pui‐Ching , Lee Shou‐Dong
Published: August 2010

Abstract: Background:  The model for end‐stage liver disease (MELD) is used in prioritizing cirrhotic patients awaiting liver transplantation. Patients with small hepatocellular carcinoma (HCC) are eligible candidates. An HCC‐MELD equation was recently proposed to predict the dropout rate of HCC patients on the waiting list. This study aimed to validate the accuracy of this equation.

Methods:  We investigated 390 patients with small HCC who were candidates for liver transplantation and underwent locoregional therapy.

Results:  The estimated probability of dropout according to the equation was 8.2% for T1 stage and 13.5% for T2 stage HCC (p < 0.0001). The actual disease progression rate at three months was 2.1% for T1 and 3.0% for T2 stage HCC. At six months, the progression rate was 5.3% for T1 stage and 6.8% for T2 stage. The area under receiver operating characteristic curve of the HCC‐MELD equation was 0.81 at three months and 0.80 at six months. Patients undergoing radiofrequency ablation (RFA) had significantly lower dropout rates compared with other treatment groups according to the equation (p = 0.0007). The actual tumor progression rate was also the lowest for the RFA group at both three and six months.

Conclusion:  The HCC‐MELD equation is a feasible predictive model for patients with small HCC undergoing locoregional therapy.
Optimal interventional treatment and long‐term outcomes for biliary stricture after liver transplantation
Authors: Lee Sang Hyub , Ryu Ji Kon , Woo Sang Myung , Park Joo Kyung , Yoo Ji Won , Kim Yong‐Tae , Yoon Yong Bum , Suh Kyung‐Suk , Yi Nam‐Joon , Lee Jeong Min , Han Joon Koo
Published: August 2010

Abstract:  We undertook an evaluation of the clinical outcomes of endoscopic cholangioplasty (ECP) and percutaneous cholangioplasty (PCP) for biliary strictures after liver transplantation. We compared success rates of intervention, patency after successful intervention and procedure‐related morbidities in 79 patients with anastomotic stricture (n = 54) or non‐anastomotic stricture (n = 25). Twenty‐five ECP and 61 PCP procedures were performed; seven PCP procedures were consecutively performed after failure of ECP. Fifty‐one (64.6%) patients were successfully treated by cholangioplasty. Successful intervention rates (60.0% in ECP vs. 59.3% in PCP, p = 1.00) and patencies after successful intervention (44.8 ± 7.4 months in ECP vs. 41.9 ± 3.4 months in PCP, p = 0.47) were no different for the two techniques. However, the number of intervention sessions for PCP (7.2 ± 0.6) was higher than for ECP (2.9 ± 0.6) (p < 0.01). Multivariate analysis showed that only an anastomotic stricture was found to be related with a longer patency with an estimated odds ratio of 5.74 (p = 0.04) and had a tendency to be associated with successful intervention with an estimated odds ratio of 3.12 (p = 0.07) irrespective of techniques. Endoscopic access should be the preferred first approach in patients with biliary stricture after liver transplantation irrespective of the type of stricture, in view of its less invasive nature and patient convenience.
The prevalence of BK polyomavirus infection in outpatient kidney transplant recipients followed in a single center
Authors: Yeo Fred E , Yuan Christina M , Swanson Sydney J , Reinmuth Bruce , Kiandoli Luana C , Kaplan Keith J , Abbott Kevin C , Reynolds Joel C
Published: August 2010

Abstract: Background:  BK polyomavirus (BKV) infection has emerged as an important cause of renal allograft loss. There is no proven therapy, and much basic clinical information is still lacking.

Methods:  We serially enrolled 95 outpatient renal transplant recipients (43% of whom were African American) in a single center cross‐sectional screening study to determine the prevalence of BKV infection by whole blood polymerase chain reaction, and the prevalence of decoy cells by urinalysis and cytology. We also investigated the demographic and clinical factors associated with BKV infection, and the performance of urinalysis for decoy cells as a screening test for BKV infection.

Results:  The point prevalence of active BKV viremia was 7.4%. When subjects without active viremia but with a history of viremia and/or nephropathy were included, the overall prevalence was 15.8%. Urinary decoy cells were common, present in 50% of subjects at study entry. Urinalysis for decoy cells as a screen for BKV viremia had a sensitivity of 86%, specificity of 52%, positive predictive value of 13% and negative predictive value of 98%.

Conclusions:  Decoy cells on urinalysis were the only factor independently associated with an increased risk of BKV infection on multivariate analysis. Although associated with BKV infection on univariate analysis, thymoglobulin, mycophenolate mofetil, and tacrolimus use were not independently associated with BKV infection on multivariate analysis, neither were history of acute rejection, gender, race, nor cause of end‐stage renal disease.
Does circulating BNP normalize after heart transplantation in patients with normal hemodynamic and right and left heart functions?
Authors: Talha S. , Di Marco P. , Doutreleau S. , Rouyer O. , Piquard F. , Geny B.
Published: August 2010

Abstract:  Background:  Increased brain natriuretic peptide (BNP) in cardiovascular disease is thought to be a compensatory protective mechanism allowing to delay the occurrence of terminal heart failure. Heart transplantation should normalize the neuroendocrine balance but BNP remains elevated in stable heart‐transplant recipients (Htx). Such increase has been related to persistent endothelial and cardiac dysfunctions. The purpose of this study was to determine whether selected Htx, presenting with normal hemodynamic and cardiac systolic and diastolic functions on both side of the heart, show a normalization of their BNP plasma values.

Methods:  Of a cohort of well‐being 26 Htx, we selected 12 patients with normal hemodynamics and left and right heart systolic and diastolic functions and compared their circulating BNP, cyclic guanosine monophosphate (cGMP) (the BNP second messenger) and endothelin‐1 (ET) values with that of 12 age‐, body mass index‐ and mean arterial pressure‐matched controls. Cardiac function determination by echodoppler included cardiac filling pressures assessment using tissue Doppler imaging. Blood samples for biological and hormonal determinations were drawn at rest, within 15 min before echocardiography.

Results:  As selected, hemodynamic and left and right heart systolic and diastolic functions were located in the normal range in Htx. Plasma ET value was also similar in Htx and controls (20.7 ± 0.9 vs. 19.6 ± 0.9 fmol/mL). However, circulating BNP, like cGMP, was still significantly increased after heart transplantation, when compared with controls (33.8 ± 8.5 vs. 4.0 ± 0.9 pg/mL, p = 0.002 and 8.2 ± 1.1 vs. 4.4 ± 0.3 nmol/L, p = 0.003) for BNP and cGMP, respectively, in Htx and controls. Interestingly, the sole correlation observed was between BNP and cGMP (r = 0.85, p < 0.0001) after heart transplantation.

Conclusions:  After heart transplantation, BNP remained increased despite the normalization of hemodynamic and cardiac systolic and diastolic functions. This suggests that such endocrine heart stimulation should not be viewed only as a hemodynamic marker in Htx. Further studies will be useful to investigate the role of pro‐inflammatory cytokines and whether elevated BNP still possesses antifibrotic properties, further supporting the interest of enhancing its activity after heart transplantation.
Alveolar Echinococcosis induced liver failure: salvage by liver transplantation in an otherwise uniformly fatal disease
Authors: Haider Hani H. , Nishida Seigo , Selvaggi Gennaro , Levi David , Tekin Akin , Moon Jang I. , Tzakis Andreas G.
Published: August 2010

Abstract:  A technically difficult liver transplant was performed in a 68‐yr‐old male with Alveolar Echinococcosis causing end‐stage liver disease. The pathology was extensive and included hepatic artery thrombosis, Budd‐Chiari syndrome, and right hemidiaphragm invasion necessitating resection of this portion of diaphragm and direct donor cava anastomosis to the right atrium. The patient is now 21 months since transplant disease free with normal liver function.
Functional analysis of CD4+ CD25bright T cells in kidney transplant patients: improving suppression of donor‐directed responses after transplantation
Authors: Sewgobind Varsha D.K.D. , Van Der Laan Luc J.W. , Klepper Mariska , IJzermans Jan N.M. , Tilanus Huug W. , Weimar Willem , Baan Carla C.
Published: August 2010

Abstract:  Background:  The role of CD4+ CD25bright regulatory T cells (Treg) in controlling alloreactivity is established, but little is known whether antigen‐specific Treg are induced in fully immunosuppressed kidney transplant patients.

Methods:  The frequency and function of CD25bright T cells of nine stable kidney transplant patients before and 0.5–2 yr after transplantation were measured. Patients received triple therapy consisting of cyclosporine, mycophenolate mofetil and prednisone. To investigate the influence of transplantation and immunosuppression on Treg function, we compared their suppressive capacities pre‐ and post‐transplantation using mixed lymphocyte reactions and kept the CD25−/dim effector T‐cell (Teff) population constant.

Results:  After transplantation, the percentage of CD4+ CD25bright T cells significantly decreased from 8.5% pre‐transplant to 6.9% post‐transplant (median, p = 0.05). However, the lower percentage of post‐transplant CD4+ CD25bright T cells was not associated with reduced, but rather improved suppressor function of these cells. The proliferative response of pre‐transplant Teff to donor‐antigens was more profoundly suppressed by post‐transplant Treg than by pre‐transplant Treg (pre‐transplant 18% vs. post‐transplant 55% median, p = 0.03) and was comparable against third party antigens at a CD25bright:CD25−/dim ratio of 1:20.

Conclusions:  In immunosuppressed kidney transplant patients, the donor‐directed suppressive capacity of CD4+ CD25bright regulatory T cells improved, which may contribute to the development of donor‐specific hyporesponsiveness against the graft.
Calcineurin inhibitor withdrawal and conversion to mycophenolate mofetil and steroids in cardiac transplant recipients with chronic renal failure: a word of caution
Authors: Groetzner Jan , Kaczmarek Ingo , Schirmer Johannes , Überfuhr Peter , Gulbins Helmut , Daebritz Sabine , Meiser Bruno , Reichart Bruno
Published: August 2010

Abstract:  Background:  Chronic renal failure (CRF) is a common complication of calcineurin inhibitor (CNI)‐based immunosuppression following cardiac transplantation (HTx). The aim of this prospective study was to evaluate the impact of an immunosuppressive conversion from CNIs to mycophenolate mofetil (MMF) and steroids in cardiac transplant recipients with CRF on renal and cardiac graft function.

Methods:  Since 1999, 12 HTx recipients (10 men; 58 ± 3.6 yr of age; 8.7 ± 4.2 yr after HTx) with CNI‐based immunosuppression and a calculated creatinine clearance (CreaCl) <50 mL/min were included. Most patients (10/12) were on cyclosporine and two patients were on tacrolimus prior inclusion. MMF was started with 0.5 g/d and adjusted according to the target trough levels (2–4 ng/mL). Prednisone dosage was 0.4 mg/kg. Subsequently, CNIs were completely withdrawn. Acute rejection episodes were excluded one and three months after conversion by endomyocardial biopsy and by echocardiography every three months thereafter.

Results:  After a mean follow‐up of 20 ± 16 months, CreaCl improved significantly: pre‐conversion vs. post‐conversion: 32.8 ± 12.2 mg/dL vs. 42.8 ± 21.14 mg/dL, p = 0.03. However, four acute rejection episodes occurred and patients were reconverted to CNIs. Additionally, six patients had a new onset of graft vessel disease (GVD) one yr after conversion. As a result of these adverse events, the study was stopped after inclusion of only 12 of the scheduled 30 patients.

Conclusions:  Conversion to MMF and steroids after HTx improves renal function, but increases the risk for recurrent rejection and GVD. Therefore, MMF and steroids should only be considered in patients with a markedly low risk for rejection.
Combination therapy with tacrolimus and mycophenolate mofetil: effects of early and late minimization of mycophenolate mofetil after renal transplant
Authors: Walker Rowan , Thomas Mark , Goodman David , Campbell Scott , Chadban Steven ,   on behalf of the AUS‐13 study group
Published: August 2010

Abstract:  The objectives of the study were: (i) to compare the efficacy and safety of minimizing mycophenolate mofetil (MMF) early (30 d) or late (90 d) after renal transplantation, when used in combination with tacrolimus; (ii) to retrospectively investigate factors associated with early, acute rejections and (iii) to investigate the pharmacokinetic interaction between tacrolimus and diltiazem. A prospective, randomized, multicenter, open‐label study was conducted in 124 de novo kidney transplant recipients. Efficacy and safety outcomes were assessed for 180 d after transplantation and subjects were followed‐up for a mean duration of 5.1 yr. The efficacy and safety outcomes were comparable whether the dose of MMF was minimized early or late. The incidence of early, acute rejection episodes was higher for recipients who were younger, received a graft from an unrelated donor or failed to achieve adequate tacrolimus concentrations (trough > 10 ng/mL) in the first seven d after transplant. Concomitant use of diltiazem had a tacrolimus‐sparing effect in some subjects. Based on these results, we support the achievement of a high target tacrolimus concentration within the first week after renal transplant and suggest that early minimization of MMF can be achieved when used in combination with tacrolimus.
Retroperitoneal pancreas transplantation with systemic–enteric drainage – case report
Authors: Kahn Judith , Iberer Florian , Kniepeiss Daniela , Duller Doris , Jakoby Estrella , Tscheliessnigg Karlheinz
Published: August 2010

Abstract:  Enteric drainage and intraperitoneal graft position is the preferred technique for pancreas transplantation at most transplant centers. The technique of retroperitoneal pancreas transplantation was first described by Boggi et al. [Transplantation,79 (2005), 1137]. In this case report, a modified model of retroperitoneal pancreas transplantation with systemic–enteric drainage is presented. A 48‐yr‐old patient underwent combined retroperitoneal pancreas and kidney transplantation because of type‐I‐diabetes, and diabetic nephropathy. At the time of transplantation, the patient had a body mass index of 31 and severe atherosclerosis of the iliac vessels. After mobilization of the colon and mesocolon ascendens, the vessels of the pancreas graft were anastomosed end‐to‐side to the aorta and to the inferior caval vein of the recipient. For exocrinous drainage, a side‐to‐side duodenojejunostomy was performed after bringing a jejunal loop through a window in the right colon mesentery. The graft was in a retroperitoneal position. The patient was insulin‐independent after 48 h, the lipase and amylase levels were within the normal range. The first experience with retroperitoneal pancreas transplantation with systemic–enteric drainage showed that the technique was safe and had technical advantages when compared with the classic method.
Ezetimibe effectively lowers LDL‐cholesterol in cardiac allograft recipients on stable statin therapy
Authors: Konstandin Mathias H , Blessing Erwin , Doesch Andreas , Ammon Kerstin , Koch Achim , Wabnitz Guido H , Gleissner Christian A , Remppis Andrew , Katus Hugo A , Dengler Thomas J
Published: August 2010

Abstract:  We investigated tolerability and efficacy of ezetimibe treatment (10 mg/d) in 25 heart allograft recipients already on stable statin therapy. Total cholesterol (TC), low‐density cholesterol (LDL‐C), high‐density cholesterol (HDL‐C), triglycerides (TG), immunosuppressant drug levels, laboratory and clinical parameters were assessed before, four months and one yr after initiation of ezetimibe treatment. Mean equivalent statin dose was 53.5 ± 12.3 mg of pravastatin, remaining unchanged throughout the study period. Ezetimibe was generally well tolerated, only two patients (8%) discontinued ezetimibe due to stomach pain or headache. Mean TC decreased from 231.8 ± 6.4 mg/dL before therapy to 202.2 ± 8.8 mg/dL after four months and 192.9 ± 7.0 mg/dL after one yr (p < 0.001). Mean LDL‐C decreased from 143.1 ± 5.4 mg/dL to 121.4 ± 7.9 mg/dL (month 4; p < 0.05) and 107.1 ± 5.6 mg/dL (one yr; p < 0.001). TG decreased from 182 ± 14.3 mg/dL to 173.3 ± 17.5 mg/dL after one yr (p < 0.05), whereas HDL‐C was unchanged. Initial LDL‐C and cardiac diagnosis before transplantation were identified as predictors of absolute LDL‐C reduction. Immunosuppressant drug doses and blood concentrations were unchanged as well as other laboratory and clinical parameters. Ezetimibe appears safe and effective for further reduction of TC and LDL‐C in heart allograft recipients already on stable statin therapy. Extent of pre‐treatment LDL‐C and cardiac disorder prior to transplantation appear to correlate with the efficacy of ezetimibe therapy.
Is patchy tubular injury a histopathological marker of acute rejection?
Authors: Kanetsuna Yukiko , Horita Shigeru , Tanabe Kazunari , Teraoka Satoshi , Hattori Motoshi , Toki Daisuke , Yamaguchi Yutaka
Published: August 2010

Abstract:  Renal allograft specimens often show patchy tubular injury (PTI), or patches of injured tubular sections. PTI reflects damage to the proximal tubules, and the histologic findings consist of tubular cell necrosis and tubular regeneration without tubulitis. Unlike acute tubular necrosis (ATN) in cadaveric donors, PTI can be observed in kidneys from living donors when there is no history of acute renal failure after transplantation. In this study, we examined the clinicopathological importance of PTI in acute rejection. Between April 2000 and May 2007, 2252 biopsies of living kidney grafts were performed at least one d after the transplant operation. Acute rejection was observed in 877 biopsies. Of these cases, 78 (8.9%) biopsies from 43 patients showed PTI. The severity of the PTI was graded semiquantitatively as follows: grade 1 cases had three or four damaged tubular sections, grade 2 cases had >5 sections, and grade 3 cases had >10 sections. The incidence of PTI was significantly higher in vascular rejection (VR) and antibody‐mediated rejection (AMR) patients than in those experiencing tubulointerstitial rejection (TIR). The mean PTI score was significantly higher (2.00 ± 0.12) in VR than in TIR (1.39 ± 0.10) and AMR (1.68 ± 0.08) patients. The mean serum creatinine (sCr) at the time of biopsy was higher in VR patients than in AMR and TIR patients. Moreover, in VR patients, those with severer PTI developed higher sCr levels. These data suggest that PTI has a strong relationship with local ischemic damage delegated by VR, and the severity of PTI could be a practical histological marker in acute vascular rejection.
Ischemia–reperfusion injury as the leading cause of primary non‐function in renal transplantation using donors with prolonged warm ischemic time
Authors: Asaka Mitsuhiro , Imumura Hidetsugu , Sato Kazutaka , Atsumi Hirokatsu , Okuyama Hiroshi , Yamaya Hideki , Yokoyama Hitoshi , Ishikawa Isao
Published: August 2010

Abstract:  Renal transplantation (RTx) from marginal donors has been performed in most Japanese transplant centers because of severe donor organ shortage. RTx using marginal donors with prolonged warm ischemic time (WIT) has sometimes resulted in primary non‐function (PNF). Among 53 cadaveric RTx performed at Kanazawa Medical University between October 1986 and May 2006, five cases using non‐heart‐beating donors resulted in PNF. In these five patients, histologic examination of one h RBx (graft biopsy one h after revascularization) revealed extensive congestion in glomerular and peritubular capillaries. Glomerular subendothelial swelling and mesangiolysis were also detected, and electron microscopic examination showed widening of the subendothelial spaces of glomerular capillaries. Such findings of endothelial damage were not detected in the other 48 cases without PNF. In contrast, no distinct abnormalities other than acute tubular necrosis were found in zero h RBx (graft biopsy before implantation) obtained from three patients with PNF. Prolonged WIT was the prominent feature of the five patients with PNF, and multiple logistic analysis showed that prolonged WIT was a significant risk factor for the development of endothelial damage on reperfusion. Paired allografts from the same donors of these five cases also ended in PNF. It is conceivable that the endothelial damage was caused by ischemia–reperfusion injury and extensive congestion followed as a result of endothelial injury. Ischemia–reperfusion injury is the leading cause of PNF in RTx using donors with prolonged WIT. Guidelines to assess the viability of marginal grafts should be established in the future to prevent transplantation of non‐functioning grafts.
Severe acute‐hybrid rejection occurring nine months after kidney transplantation: a report of rescue by orchestration of antirejection therapies
Authors: Harada Hiroshi , Miura Masayoshi , Morooka Kanako , Ogawa Yayoi , Tanabe Tatsu , Takada Norikata , Seki Toshimori , Togashi Masaki , Takenouchi Toshinao , Hirano Tetsuo
Published: August 2010

Abstract:  Although a majority of acute rejection (AR) in non‐sensitized recipients is T‐cell‐mediated by primed T cells, recent studies have shown that antibody‐mediated acute rejection occurs in 20–30% of AR, and that it is often refractory to conventional antirejection therapy; possibly leading to graft loss. We report a case of severe acute‐hybrid rejection consisting of both features in a non‐sensitized kidney recipient, which was rescued by the orchestration of antirejection therapies. A 33‐yr‐old Japanese male, with advanced‐stage chronic kidney disease with an unknown etiology, underwent a HLA 3/6 mismatch and ABO‐compatible living‐related kidney transplantation preemptively. He had an excellent clinical course, except for initial cytomegalovirus infection, with good graft function [serum creatinine (sCr) 1.1 mg/dL]. Nine months later, his creatinine abruptly increased to 2.1 mg/dL, when graft biopsy revealed acute T cell‐mediated rejection (ATMR) grade IA, and simultaneous acute antibody‐mediated rejection (AAMR) grade I. Antirejeciton therapy, comprising methyl‐prednisolone pulse and 15‐deoxyspergualin, and second line rituximab and plasmapheresis, was ineffective. Moreover, histologically and clinically, the rejection status deteriorated (ATMR grade III and AAMR grade III, max sCr 4.0 mg/dL). Next, we administered muromonab CD3 and basiliximab, which could eradicate the complicated severe AR without opportunistic infection, even under the strong immunosuppression. The present case implies that high‐grade combined rejection can respond to anti‐CD 20 and anti‐CD25 mAbs, without serious complication; however, post‐operative, thorough appropriate monitoring of immunosuppression is important because its effects are limited.
Detection of anti‐HLA antibody by flow‐cytometric panel reactive antibody in kidney transplant recipient with frequent episodes of acute rejection
Authors: Masutani Kohsuke , Fujisaki Akiko , Yamada Shunsuke , Noguchi Hideko , Okabe Yasuhiro , Kitada Hidehisa , Sugitani Atsushi , Katafuchi Ritsuko , Tsuruya Kazuhiko , Tanaka Masao , Iida Mitsuo
Published: August 2010

Abstract:  A 43‐yr‐old woman with end‐stage renal disease caused by lupus nephritis received living kidney transplantation with ABO minor mismatch from her mother. Urine output decreased rapidly from fifth postoperative day, and serum creatinine (sCr) concentration increased rapidly. The clinical diagnosis was antibody‐mediated rejection. The patient was treated with pulse methylprednisolone, plasma exchange (PEX), and OKT3. A graft biopsy revealed vascular rejection with linear C4d deposition on peritubular capillary (PTC). She was treated with additional PEX and intravenous cyclophosphamide, which improved urine output and resulted in a gradual decrease in sCr. She subsequently developed frequent episodes of acute rejection (AR) with a rise in sCr. Repeated graft biopsies revealed acute T‐cell‐mediated rejection with progressive interstitial fibrosis and tubular atrophy. Severe peritubular capillaritis with mononuclear infiltrates were present, but C4d deposition on PTC was persistently negative or weak. Flow‐cytometric panel reactive antibody performed retrospectively revealed both donor‐ and non‐donor‐specific HLA antibodies, which were persistently present after the treatment of the first AR. We added rituximab to the treatment of AR, but she developed cytomegalovirus enteritis, and eventually hemodialysis was induced again 45 months after the transplantation. Recent flow‐cytometry‐based antibody detection methods are useful even in cases lacking diffuse and strong C4d deposition on PTC.
An ABO‐incompatible renal transplant patient who developed severe antibody‐mediated vascular rejection 36 days after transplantation
Authors: Fujii Akiko , Horita Shigeru , Sannomiya Akihito , Fuchinoue Shohei , Teraoka Satoshi , Yamaguchi Yutaka
Published: August 2010

Abstract:  A 44‐yr‐old man had an ABO‐incompatible renal transplantation from his 41‐yr‐old wife. He was diagnosed with IgA nephropathy at the age of 31 and began hemodialysis to treat chronic renal failure at the age of 39. Preoperative flow panel reactive antibody was negative. An episode biopsy on post‐operative day (POD) 18 showed mild infiltrative vasculopathy (v1, g2, ptc1, TMA, PTC+). The serum creatinine (sCr) was 2.26 mg/dL. Anti‐A antibody was x32. Double filtration plasmapheresis and plasma exchange were performed. A second episode biopsy was performed on POD 36. The Cr was 3.73 mg/dL. Anti‐A antibody was x32. Histologically, antibody‐mediated vascular rejection with severe fibrinoid necrosis in the lobular arteries was detected (v3, g2, ptc2, TMA, PTC+). Steroid pulse therapy was performed, and OKT‐3 was administered for 10 d. The anti‐A antibody titer was x128 on POD 47. A biopsy specimen obtained on POD 55 showed severe vascular rejection with stenosis of the vascular lumen and fibrinoid necrosis (v3, cv2, g1, cg2, ptc1, TMA, PTC+). The sCr was 7.09 mg/dL. Despite double‐filtration plasmapheresis, the patient was reintroduced to hemodialysis. Here, we report a case showing the typical histological features of antibody‐mediated vascular rejection.
Successful rescue and maintenance of long‐term remission of anti‐HLA antibody‐mediated acute allograft rejection by rituximab‐containing therapy: case report
Authors: Takeuchi Yasuo , Yoshida Kazunari , Wakai Haruki , Obata Fumiya , Aita Kumi , Koike Junki
Published: August 2010

Abstract:  A 38‐yr‐old man with chronic renal failure received a second kidney transplantation from a cadaveric donor. Complement‐dependent cytotoxicity cross‐match (CDC) was negative against T cells, but positive with the B‐cell warm test. Human leukocyte antigen (HLA)‐typing showed a one haplo‐identical match. The blood type was compatible. He was treated with tacrolimus, mycophenolate mofetil (MMF), methylpredonisolone (MP), and basiliximab as immunosuppressive therapy. A clinical episode graft biopsy and Flow‐PRA on post‐operative day (POD) 19 showed anti‐HLA antibody‐mediated acute rejection (AHR). The patient was treated with plasmapheresis (PP). Renal biopsy performed on POD 65 because of re‐rise of serum creatinine level showed worsening of renal injury. The patient was treated with rituximab (100 mg/body) with PP and MP pulse therapy, followed by tacrolimus and MMF. Graft function thereafter improved. A renal allograft biopsy specimen on POD 300 and Flow‐PRA showed the remission of AHR within one‐yr after transplantation.
A case of renal allograft loss associated with thrombotic microangiopathy during pregnancy
Authors: Tsuchimoto Akihiro , Yotsueda Hideki , Shinozaki Michiya , Nagara Tadashi , Kuroki Yusuke , Mizumasa Tohru , Motoyama Kentaro , Matsumoto Megumi , Umezu Takashi , Ikeda Kiyoshi , Kitamura Hiroshi , Katafuchi Ritsuko , Hirakata Hideki
Published: August 2010

Abstract:  A case with graft loss during pregnancy associated with thrombotic microangiopathy (TMA) is reported. The patient was a 27‐yr‐old female who had end‐stage renal disease because of immunoglobulin A (IgA) nephropathy at age 18. She received a kidney transplant at age 20 from her mother. Immunosuppressive therapy consisted of cyclosporine A (CyA), azathioprine (AZ), and prednisolone (PSL). The amount of serum creatinine (SCr) was 0.72 mg/dL at discharge one month after transplantation. Urinary occult blood and protein appeared five and 14 months after transplantation, respectively. SCr was gradually elevated. When she was 27‐yr old, she became pregnant. The amount of SCr was 1.74 mg/dL. The dose of CyA was 150 mg/d, AZ was 50 mg/d, and PSL was 5 mg/d. At 18 wk of gestation, severe hypertension and edema occurred and she was hospitalized. SCr was elevated to 3.26 mg/dL and severe hemolytic anemia with thrombocytopenia was recognized. On the third day after hospitalization, she underwent an abortion. Renal biopsy was performed on the seventh hospitalized day. Fibromyxomatous intimal thickening including foam cells, extensive hyaline changes, and fibrin thrombi were observed in the interlobular arteries or arterioles. Recurrent IgA nephropathy with extensive crescent formation was also diagnosed. Severe chronic tubulointerstitial damage was observed and tubulitis was mild. After the biopsy, she underwent plasma exchange and methyl‐prednisolone pulse therapy. Thrombocytopenia improved one month after the abortion. However, the graft function was lost and maintenance hemodialysis was started on the 46th day after termination of the pregnancy. In this case, it is suggested that pregnancy triggered TMA resulting in graft loss. Moreover, acute exacerbation of recurrent IgA nephropathy, pre‐existing CyA arteriopathy, and severe chronic tubulointerstitial damage also caused the deterioration of graft function as well as TMA.
Insidious transmission of membranous nephropathy from kidney donor with no clinical manifestations before and after transplantation
Authors: Horike Keiji , Takeda Asami , Kitamura Ken , Ogiyama Keiko , Sakai Kaoru , Onoda Hiroshi , Goto Norihiko , Sato Tetsuhiko , Nagasaka Takaharu , Uchida Kazuharu , Morozumi Kunio
Published: August 2010

Abstract:  Live kidney donors are supposed to have no clinical kidney disease. Here, we present a unique case of subclinical membranous nephropathy (MN) from a living donor, who had urinalysis‐free stable kidney function pre‐ and post‐transplant. A 39‐yr‐old Asian woman received a second kidney graft from her spouse whose urinalysis and blood chemistry were stable and normal. Her intraoperative one‐h core biopsy revealed thick glomerular basement membrane (GBM) and a bubbly type appearance, compatible with stage II MN on Churg’s classification. According to two other protocol biopsies, GBM thickening persisted until month six post‐transplant. Interestingly, both the donor and the recipient had stable kidney function without overt proteinuria at each monthly visit until one yr post‐transplant. Taken together, we speculate that “silent” MN may exist in certain healthy individuals, who present only with histopathologically compatible MN and no other findings.
Acute graft dysfunction after viral enteritis in a patient with cadaveric kidney transplantation: Norovirus infection is a possible cause of linear deposition of C4d in peritubular capillaries of renal allograft
Authors: Takeda Asami , Ueki Tsuneo , Goto Norihiko , Uchida Kazuharu , Morozumi Kunio
Published: August 2010

Abstract:  We describe a cadaveric kidney transplant recipient with graft dysfunction after Norovirus infection. The graft biopsy specimen revealed no acute rejection findings, including antibody‐mediated rejection in light microscopy. However, immunofluorescent study showed the linear and bright deposition of C4d along peritubular and glomerular capillaries. Norovirus brings formation of infection by binding to the histo‐blood group antigens in epithelial cells of small intestine, and uses secretory H‐antigen or A‐antigen as a receptor. The recipient and donor had blood type A; the virus possibly bound to the histo‐blood A‐antigen in endothelial cells of vasculature in his graft after viremia. We consider Norovirus infection a possible cause of linear deposition of C4d in peritubular capillaries as a result of activation of complement pathways in endothelial cells of graft vasculature.
An autopsy case of late‐onset Epstein–Barr virus associated post‐transplant lymphoproliferative disorders 11 yr after kidney transplantation
Authors: Aita Kumi , Noguchi Masayuki , Nagata Michio
Published: August 2010

Abstract:  A 42‐yr‐old Japanese female presented with right cervical lymphadenopathy. She had been diagnosed with IgA glomerulonephritis at the age of 19 and had a one‐yr history of hemodialysis after giving birth to her first child. At the age of 31, she had a living‐related renal transplantation from her mother. On admission, she was diagnosed with diffuse large B‐cell lymphoma (DLBL) by lymph node biopsy and was treated with Rituxymab plus CHOP (Rituximab/Cyclophosphamide/Doxorubicin/Vincristine/Prednisone). However, the therapy was not successful, and the patient had a rapidly deteriorating clinical course with elevated Epstein–Barr virus (EBV) loads in her peripheral blood. She died four months after the onset of lymphoma, because of disseminated intravascular coagulation and multiple organ failure. In kidney transplantation, the incidence of post‐transplant lymphoproliferative disorders (PTLD) is between 0.4% and 2% and mostly occurs within a year after transplantation, in strong association with EBV infection. Late‐onset PTLD, however, is more like standard lymphomas and is rarely induced by EBV. The present case was quite atypical of late‐onset PTLD because the patient’s high viral load was first detected 11 yr after transplantation and presented as a monomorphic B‐cell lymphoma.
Model for the end‐stage liver disease and death prediction in a cohort of Brazilian patients on the waiting list for liver transplantation
Authors: Brandão Ajacio , Fuchs Sandra C , Gleisner Ana L , Marroni Claudio , Zanotelli Maria L , Cantisani Guido
Published: August 2010

Abstract:  Background/aim:  To examine the performance of the model for end‐stage liver disease (MELD) score to predict mortality three and six months after enlistment of patients with chronic diseases for their first liver transplantation (LT) and to compare the performances of the Child–Turcotte–Pugh (CTP) and the Erasmus Model for End‐stage Resistant‐to‐therapy All etiology Liver Disease (EMERALD) scores with the MELD to predict mortality.

Methods:  Cohort study. Receiver operating characteristics curve (ROC) curves were used to determine the ability of the scores for predicting three and six month mortality, the c‐statistic to establish the predictive power of each score and the Cox proportional hazard model to estimate the risk of dying.

Results:  We studied 271 patients. At enlistment, the mean MELD and EMERALD scores were 14.8 and 26.6, respectively. Approximately 61% of the cases were in the CTP B category. During the three or six month follow‐up period, the percentage of patients dying, receiving LT or remaining on the list were 11.8%, 9.2%, and 79.0% or 19.2%, 17.7%, and 63.1%, respectively. The three‐month mortality was similarly predicted by the scores MELD, EMERALD and CTP (c‐statistic of 0.79, 0.74, and 0.70, respectively). Six‐month mortality presented similar AUC and ROC curves.

Conclusion:  The scores predicted mortality for the three or six months, but the performance of the MELD was better than CTP and EMERALD scores.