bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pure red cell aplasia due to parvovirus B19 infection in solid organ transplantation
Authors: Ahsan Nasimul , Holman Michael J. , Gocke Christopher D. , Groff James A. , Yang Harold C. 
Published: September 2024

AbstractHuman parvovirus B19 disease is an infrequent but recognized rare cause of anemia in immunocompromised patients. A few cases of parvovirus B19 infections have been reported in transplant recipients, of those only four patients underwent renal transplantation. The primary immunosuppressive therapy in these patients included prednisone with either cyclosporine or tacrolimus. In one patient the disease was self‐limiting, while in three others the hematocrit improved following 10‐15 d of treatment with commercial intravenous immunoglobulin (IVIG). Herein, we report the fifth case of pure red cell aplasia due to parvovirus B19 infection in a renal transplant recipient who responded to a 5‐d course of IVIG. To our knowledge, this is the first case of parvovirus B19 infection in a patient with solid‐organ transplantation whose immunosuppressive regimen included both mycophenolate mofetil and tacrolimus and in whom an excellent clinical response was achieved with a short course of IVIG infusion.
Bacterial translocation in organ donors: clinical observations and potential risk factors
Authors: Kane Timothy D. , Johnson Scott R. , Alexander J. Wesley , Craycraft Thomas K. 
Published: September 2024

AbstractThirty‐nine solid‐organ donors were evaluated to determine the incidence of bacterial translocation to mesenteric lymph nodes. In addition, clinical variables from 59 local recipients of renal allografts from these donors were examined to assess whether translocation in donors was associated with increased morbidity in the recipients of organs from node‐positive donors. Ileocecal lymph node cultures were positive in 18 of 39 donors (46%). Sixteen donors (41%) were hypotensive [systolic blood pressure (SBP)< 90 mmHg] and 27 (69%) received blood product transfusions before organ donation. The presence of hypotension and blood product transfusion were associated with positive and negative cultures, respectively. In 24 (41%) of 59 organs transplanted from donors with periods of hypotension, significantly more (16 of 24, 67%) were associated with positive lymph node cultures than with negative cultures (8 of 24, 33%; p=0.029). In recipients of organs from node‐positive versus node‐negative donors there was a trend toward higher incidence of infection (32% vs. 25%), need for hemodialysis post‐transplant (29% vs. 23%), graft loss within 1 yr (24% vs. 19%), and lack of blood transfusion prior to organ procurement (43% vs. 23%), although these variables were not significantly different between the groups. Hypotension or inadequate resuscitation may contribute to increased bacterial translocation to mesenteric lymph nodes. The overall impact upon the recipients of organs from donors with demonstrable translocation to lymph nodes remains undefined.
Graft outcome in cadaver renal transplants treated with full‐dose cyclosporine induction without antibody, irrespective of graft function
Authors: Douzdjian Viken , Bhaskar S. Shanmuga , Baliga Prabhakar K. , Rajagopalan P. R. 
Published: September 2024

AbstractCyclosporine (CSA) induction has been shown to prolong delayed graft function which in turn may compromise graft outcome. In this study we report our experience with full‐dose CsA induction without antibody treatment irrespective of graft function and stress the importance of achieving therapeutic CsA levels in the early post‐transplant period. The records of 293 first cadaver renal transplant recipients who were transplanted between January 1992 and December 1995 were reviewed. Patients were divided into those who had immediate graft function (IGF, n=197) and the ones who had delayed graft function (DGF, n=96). Twenty‐six (13%) patients in the IGF group and 27 (28%) patients in the DGF group experienced at least one episode of acute rejection (AR), (P=0.002). Patient and graft survival rates at 1, 2 and 5 yr were similar in the IGF and DGF groups. Cox regression analysis revealed that the absence of both DGF and AR was independently associated with a 0.44 times lower risk of graft failure (P=0.06), whereas AR without DGF was associated with a 1.9 times increased risk of graft failure (P=0.02). DGF, with or without AR, did not affect the risk of graft failure. Logistic regression analysis showed that DGF was associated with a 3.6 times higher risk of AR (P=0.003). A non‐traumatic cause of donor death and preservation time > 24 h were associated with 1.9 and 2.4 times higher risks of DGF (P=0.1, P=0.08), whereas female donor gender reduced the risk of DGF by 0.6 (P=0.1). In conclusion, our results suggest that full‐dose CsA induction with achievement of therapeutic target levels in the early post‐transplant period is associated with an acceptable graft outcome. Graft outcome was not compromised by delayed function, whereas acute rejection was an independent predictor of graft failure.
Anemia following renal transplantation: erythropoietin response and iron deficiency
Authors: Miles Anne Marie V. , Markell Mariana S. , Daskalakis Paula , Sumrani Nabil B. , Hong Joon , Sommer Bruce G. , Friedman Eli A. 
Published: September 2024

AbstractTo define the etiology of anemia post‐renal transplantion, we assessed hematologic parameters and EPO levels in 38 anemic and 16 nonanemic control renal transplant recipients (RTRS) with varying degrees of allograft function at periods >3 months post‐transplantation. Significant differences between the two groups were found for serum creatinine (Cr) 291.7±26.5 vs. 203.3±26.5 μmol/l, p<0.01; iron 9.3±0.92 vs. 13.6±1.7 μmol/l, p<0.05; and ferritin 345.5±90.8 vs. 91.1±18.5 μg/l, p<0.01. Serum. EPO levels were inappropriately low in anemic patients with no significant correlation between EPO and Cr or hematocrit (Hct) levels. Serum iron was the only predictive factor for anemia on regression analysis (p<0.05). Ferritin levels did not correlate with serum iron or Hct, and may be falsely elevated in iron deficient RTRS. Iron deficiency, poor renal function and inappropriately low EPO levels are major contributors to the 12% of our outpatient renal transplant population who are anemic.
Changes in phenotypes of apolipoprotein E and apolipoprotein(a) in liver transplant recipients
Authors: Fernández‐Miranda Consuelo , Cancelas Pilar , de la Calle Angel , Gómez Ramon , Moreno Enrique , Gómez‐Gerique Juan , del Palacio Angel 
Published: September 2024

AbstractThe aim of this study has been to confirm that liver is the main site of apolipoprotein (apo) E and apo(a) synthesis, based in the changes of their phenotypes after transplantation. Apo E phenotypes were studied in 34 patients and apo(a) phenotypes in 27 of them before and after liver transplant. Thirteen patients changed the apo E phenotype after transplantation. Eight patients with E3/3 phenotype changed to the others with 2 or 4 alleles. Three patients with E4/3 phenotype changed to E3/3, one changed from E3/2 to E3/3 and another one changed from E4/2 to E3/2 phenotype after transplantation. Twenty one of the 27 patients changed the apo(a) phenotype. Thirteen of them also changed lipoprotein (Lp)(a) serum concentration at least twofold, showing in 11 an increase and in 2 a decrease, in relation with the change to phenotype associated with high and low Lp(a) concentration, respectively. Changes in apo E and apo(a) phenotypes in liver transplant recipients studied show that most of these apolipoproteins are synthesized by the liver.
Variations of the intrahepatic bile ducts: application in living related liver transplantation and splitting liver transplantation
Authors: Cheng Yu Fan , Huang Tung Liang , Chen Chao Long , Chen Yaw Sen , Lee Tze Yu 
Published: September 2024

AbstractThe variations in the anatomy of intrahepatic bile ducts complicate operations in living related liver transplantation (LRLT) and therefore preoperative delineation of the biliary system is important to achieve a successful outcome. The aim of this study was to establish a standard relationship between the biliary variations and the methods of the graft splitting and anastomosis. Of 958 endoscopic retrograde cholangiographies with good visualization of bile duct branches were selected and were available for evaluation of their ramifications and variants. According to drainage of right hepatic duct and left hepatic duct, we classified the bile ducts into two major groups. Unusual routes of the intrahepatic ducts were present in 105 cases (11% in group A) the right sectoral duct drained into the left hepatic duct directly; in 200 cases (21% in groups B) the duct of segment IV drained into right side or common hepatic duct; and in 29 cases (3% in groups B) the duct of segment II and III drained into the CBD and right hepatic duct separately. There is no specific bile duct variation that forbids someone from LRLT and SLT, but unusual intrahepatic ducts routes may require a change both in the cutting plane during graft retrieval and pattern of ductoenteral anastomosis to avoid potential complications to both donors and recipients. Cholangiography for screening intrahepatic duct variations is therefore important for safe bile drainage for both donors and recipients.
Graft‐versus‐host disease after liver and small bowel transplantation in a child
Authors: Reyes Jorge , Todo Satoru , Green Michael , Yunis Eduardo , Schoner David , Kocoshis Samuel , Furukawa Hiro , Abu‐Elmagd Kareem , Tzakis Andreas , Bueno Javier , Starzl Thomas E. 
Published: September 2024

AbstractAn 8‐month‐old child with an immunodeficiency disorder characterized by abnormal lymphocyte function and by low IgG and IgA levels had combined liver and small bowel transplantation under tacrolimus and steroid immunosuppression for the treatment of short gut syndrome and hepatic cirrhosis. The patient developed an early postoperative episode of Pneumocystis carinii pneumonia, and a subsequent surgical complication, prompting discontinuance of tacrolimus. A skin rash eventually shown to be graft‐versus‐host disease (GVHD) developed in the flank on the 12th post‐transplant day and gradually became generalized. Peritonitis, sepsis, multisystem organ failure including the liver allograft led to death on the 23rd post‐operative day. The mechanisms leading to post‐transplant GVHD under the specific circumstances in this case are discussed.
Potential for bilateral nephrectomy to reduce oxalate release after combined liver and kidney transplantation for primary hyperoxaluria type 1
Authors: Mizusawa Youichi , Parnham Alan P. , Falk Michael C. , Burke John R. , Nicol David , Yamanaka Junichi , Lynch Stephen V. , Strong Russell W. 
Published: September 2024

AbstractPrimary hyperoxaluria type 1 (PH‐1) is frequently associated with end stage renal failure due to urinary calculi, obstructive uropathy and interstitial deposits of calcium oxalate. The currently accepted treatment for PH‐1 is liver transplantation to replace the deficient enzyme peroxisomal alanine glycoxylate aminotransferase (AGT) and a simultaneous renal transplant to restore renal function. The transplanted kidney may become significantly impaired or fail when systemic calcium oxalate is eliminated by renal excretion. The native kidneys are a major source of this oxalate. This study was undertaken to determine whether there is a difference in oxalate clearance following combined liver‐kidney transplant in patients with PH‐1 by comparing the effect of native kidney nephrectomy at the time of transplantation against leaving the native kidneys in situ. Regression analysis was used to compare daily urinary oxalate excretion corrected for body surface area. There was a significant reduction in urinary oxalate excretion (P<0.05) in the patient who had undergone bilateral nephrectomy compared to the patient whose native kidneys remained in situ for the first 100 d following combined liver and kidney transplantation. No difference was observed in the serum oxalate levels between patients over the same period or in the renal function assessed by creatinine clearance corrected for body surface area. Total body oxalate load was not determined in this study. A larger study should be undertaken to examine the benefits of nephrectomy in reducing oxalate deposition in recently inserted allografts for patients with PH‐1.
Significance of the donor age effect on kidney transplants
Authors: Terasaki Paul I. , Gjertson David W. , Cecka J. Michael , Takemoto Steve , Cho Yong Won 
Published: September 2024

AbstractThe shortage of cadaveric donor kidneys for transplantation has forced a re‐evaluation of the limits on donor age acceptability. However, as more kidneys from older donors have been transplanted, a significantly lower graft survival has been noted among their recipients. The impact of utilizing older donor kidneys and the relative importance of donor age with respect to other factors has not been clarified. A total of 43 172 cadaver donor transplants reported to the UNOS Scientific Renal Transplant Registry between 1987 and 1995 were the subjects of this study. Cox regression analysis was utilized to assess the joint effects on graft survival of donor age and HLA mismatch, recipient sex, race, age, original disease, donor death cause, cold ischemia time, and transplant year. Increased first day anuria, dialysis requirement, and discharge serum creatinine were noted with increasing donor age. Moreover, long‐term graft and patient survival diminished as donor age increased. The 5‐yr graft survival of zero HLAA,B,DR mismatched kidneys fell steadily from 81% when the donor was aged 21‐30 to 39% when the donor was over age 60. The reported causes of kidney transplant failure were remarkably similar for old and young donors. The best transplant results were obtained with zero HLA‐A,B,DR mismatched transplants from young donors and the worst with older donor kidneys, regardless of HLA compatibility. We calculated that up to 21% of kidney failures resulted from insufficient renal mass due to age and were incorrectly attributed to chronic rejection.
Poor initial graft function after orthotopic liver transplantation: can it be predicted and does it affect outcome? An analysis of 125 adult primary transplantations
Authors: Maring John K. , Klompmaker Ids J. , Zwaveling Jan H. , Kranenburg Koos , Vergert Els M. Ten , Slooff Maarten J. H. ,   Liver Transplant Group Groningen
Published: September 2024

AbstractDonor liver shortage is a persistent problem in liver transplantation. A more liberal donor acceptance policy may be a possible solution. However, this might put recipients at risk for initial poor function or even non‐function of the graft. Therefore risk factors for initial graft dysfunction should be identified, preferably by using an uniform definition of primary graft dysfunction or non‐function. We retrospectively analysed 125 adult liver transplantations in order to identify risk factors for initial poor function and primary non‐function. Donor, recipient pretransplant and surgical parameters were evaluated. Since there is no consensus on the criteria of dysfunction we used two definitions known from literature. No risk factors for postoperative dysfunction could be identified for either of the two definition sets. Furthermore, the definition set that included ALAT, prothrombin time and bile production in the first 72 h to identify poor graft function showed no relation with graft or recipient outcome. The other set, using ASAT and prothrombin time, determined from day 2 to day 7, showed that patients with a primary dysfunction had significantly higher morbidity and mortality compared to patients with a well functioning graft. We conclude that initial poor function after liver transplantation remains unpredictable. irrespective of the way it is defined. Moreover, our analysis shows that initial poor function can also develop in recipients that receive ‘non‐marginal’ grafts without prolonged ischemia times. These results may support a more liberal selection of donor livers.
Hepatic arterial complications in pediatric segmental liver transplantations from living donors: assessment with color Doppler ultrasonography
Authors: Fujimoto Masazumi , Moriyasu Fuminori , Nada Takayuki , Inomoto Takuya , Tanaka Koichi , Yamaoka Yoshio 
Published: September 2024

AbstractTo investigate the clinical utility of color Doppler ultrasonography in detecting hepatic arterial complications in pediatric living‐related liver transplantation, we studied peak systolic velocity (Vp) and pulsatility index (PI) in intrahepatic artery during and after surgery in 122 transplants. Six cases with hepatic artery thrombosis were detected by Doppler studies. In 2 cases with dampened waveforms at intraoperative flowmetry (Vp≤23 and PI≤0.6), thrombosis occurred soon after surgery. A further 2 cases had a rapid decrease in Vp and PI values postoperatively, leading to absence of arterial signals. Follow‐up Doppler studies suspected collateral formation after thrombosis in 2 survivors. Normal Doppler waveforms were obtained in all of the 116 cases without arterial complications. Among them, 6 cases had absent signals or dampened waveforms at initial intraoperative flowmetry (Vp≤30 and PI≤0.9), and maneuvers such as re‐reanastomosis of the artery improved flow signals with an increase in Vp and PI values. Serial intraand post‐operative Doppler examinations are useful for early detection of arterial complications.
Long‐term prognosis of renal transplant surviving for over 10 yr, and clinical, renal and rehabilitation features of 20‐yr successes
Authors: Yasumura Tadaki , Oka Takahiro , Nakane Yoshihiro , Ohmori Yoshihiro , Aikawa Ichiro , Yoshimura Norio , Nakai Ichiro , Hamashima Takashi , Nakajima Hiroo , Nakamura Kenji 
Published: September 2024

AbstractLong‐term mortality and morbidity was evaluated in 267 patients with a minimum follow‐up of 10 yr and the physical status, graft function and quality of life in 15 patients with a functioning graft surviving for over 20 yr were reviewed. Actual patient and graft survival rates were 80.2% and 51.1% at 10 yr (n=267) and 56.4% and 32.7% at 20 yr (n=55), respectively. Although the rate of graft failure due to rejection was 4 times higher than that of patient death within 10 yr, it decreased to the level of patient death in the second decade. Dominant causes of death in patients with graft surviving for over 10 yr were hepatic failure due to viral hepatitis and malignancies. In 15 patients with graft currently surviving beyond 20 yr, while all patients have excellent graft function, malignancy occurred in 5, viral hepatitis in 3, aseptic necrosis in 3, and diabetes mellitus in one patient. No patient has suffered cardiovascular complications. Despite a high rate of morbidity, they show a satisfying status of rehabilitation (full time working 11/ 15, 73.3%). In order to attain more improved QOL in patients with longterm surviving renal transplant, close follow‐up aiming at diminution of complications is required throughout the period after transplantation.
Vulnerability to psychologic distress and depression in patients with end‐stage liver disease due to hepatitis C virus
Authors: Singh Nina , Gayowski Timothy , Wagener Marilyn M. , Marino Ignazio R. 
Published: September 2024

AbstractPsychosocial sequelae and quality of life impairment in patients with end‐stage liver disease due to hepatitis C virus (HCV) are not known. Quality of life, psychological distress (Profile of Mood States scale), depression (Beck Depression Inventory), and coping (Ways of Coping scale) were prospectively assessed in 82 liver transplant candidates; comparisons were made between patients with HCV hepatitis versus patients with other liver diseases. Patients with HCV were significantly younger than all other patients (p = 0.002). Total mood disturbance (p = 0.038), tension and anxiety (0.047), confusion and bewilderment (p = 0.035) and depression and dejection (p = 0.035), as assessed by Profile of Mood States Scale were significantly higher in patients with HCV than other patients. Patients with HCV were significantly more depressed as assessed by Beck Inventory scores (p = 0.014). Karnofsky performance scores, Child‐Pugh score, and liver function tests were not significantly different for patients with HCV vs. all other patients. However, somatic manifestations of the illness (e.g. pain) were greater in patients with HCV and may have contributed towards greater depression in these patients. Our findings warrant replication in other studies, since depression is a modifiable and treatable disorder.
Evaluation of neurotoxicity in pediatric renal transplant recipients treated with tacrolimus (FK506)
Authors: Neu Alicia M. , Furth Susan L. , Case Barbara W. , Wise Barbara , Colombani Paul M. , Fivush Barbara A. 
Published: September 2024

AbstractThe presence of severe and mild neurotoxicity in our pediatric renal transplant recipients treated with tacrolimus was determined by chart review (severe neurotoxicity) and patient survey (mild neurotoxicity). 14 patients were studied (mean age 15 yr, 5 month,± 4.4 yr). 1 patient experienced seizures, felt to be related to malignant hypertension. No other episode of severe neurotoxicity was documented. Most patients (12/14) reported at least one mild neurologic symptom, and half stated their symptoms were present at least ‘most of the time‘. The most frequent complaints were myalgias (7/14, 50%) and tremors (7/14, 50%) followed by fatigue (5/14, 38%). Severe neurotoxicity may be relatively infrequent in pediatric renal transplant patients treated with tacrolimus. Milder neurologic complaints may be commonly seen in this population, but in general are not severe enough to cause discontinuation of tacrolimus.
Preservation of pancreatic endocrine function by hemodynamic stabilization following brain death
Authors: Yoshida Hiroyoshi , Hiraide Atsushi , Iwai Atsushi , Kawaguchi Naomasa , Yoshioka Toshiharu , Sugimoto Tsuyoshi 
Published: September 2024

AbstractA protocol achieving for long‐term hemodynamic stability enabled us to evaluate pancreatic endocrine function for up to 1 wk following brain death. The glucose disappearance rate was significantly lower in brain‐dead patients (N = 21) than in normal controls (N = 10) (p<0.001). In 19 brain‐dead patients whose plasma epinephrine concentrations exceeded 0.4 ng/ml, the mean early insulin release was significantly lower than in controls, while early insulin release was markedly higher in the remaining two patients. It is possible that early insulin released may be due to increased plasma epinephrine concentrations following brain death. Late insulin release in brain‐dead patients was not lower, but was higher than controls and was accompanied by a decrease in the glucose disappearance rate. No evidence of abnormalities in histopathology of pancreas was detected at autopsy. Our results indicate that intrinsic insulin secretory function can be preserved during the first week following brain death.