bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immunohistochemical manifestations of unilateral kidney ischemia
Authors: Ibrahim Sherif , Jacobs Frank , Zukin Yakov , Enriquez Debi , Holt David , Baldwin William , Sanfilippo Fred , Ratner Lloyd E. 
Published: September 2024

AbstractEvents in the early post‐transplant period have been correlated with increased renal allograft loss. Immunologic reactions and ischemic injury have been implicated in this process. While the immunologic aspects of allograft injury have been studied extensively, ischemic effects remain less well understood. To study the effects of ischemia in rats with different genetic backgrounds without the introduction of an alloimmune response, a clamp was placed on the vascular pedicle of the left kidney for 60 min. The short‐term effects (1 wk) of ischemia were studied in groups of PVG (RT1c), LEW (RT11), DA (RT1a) and WF (RT1u) rats. Immunoperoxidase staining demonstrated limited infiltration of monocytes, macrophages, and T‐cells accompanied by upregulation of low levels of MHC class II antigens on tubular epithelial cells, peritubular capillaries, and interstitial cells in kidneys of PVG and WF rats. Kidneys of LEW and DA rats had greater influxes of monocytes, macrophages, and T cells in addition to higher amounts of MHC class II antigen upregulation on tubular epithelium and interstitial cells. The long‐term effects of ischemia were studied in kidneys of WF rats. These kidneys had a progressive increase in infiltrating T cells, monocytes, macrophages and MHC class II expression on the tubular epithelium and the interstitial cells at 14, 30, and 90 d after the ischemic insult. The differences in MHC class II expression between ischemic kidneys of PVG and LEW rats were not associated with differences in production of mRNA for IL‐2, IFN‐γ, and TNF‐α. In summary, transient renal ischemia in the absence of an allogeneic immune response triggers a progression of inflammatory responses, including leukocyte infiltration, cytokine production and MHC class II antigen upregulation which appears to be strain‐dependent.
Renal function in cardiac transplant recipients: retrospective analysis of 133 consecutive patients in a single center
Authors: Tinawi Mohammad , Miller Leslie , Bastani Bahar 
Published: September 2024

AbstractWe retrospectively studied 133 consecutive cardiac transplant patients who had lived more than 5 months post‐transplantation. All patients had received a cyclosporine (CyA) based triple immunosuppressive protocol. Mean (± SE) duration of follow‐up was 32±1.8 months (range 5‐60 months). Serial mean serum creatinines significantly increased from 1.26±0.025 mg/dl at 1‐2 months post‐transplant to 1.4±0.05 at 3 months, 1.48±0.03 at 6 months, and 1.55±0.04 at 9 months with a subsequent plateau in serum creatinine levels up to 60 months of follow‐up, at which point it had reached 1.66±0.1 mg/dl. The reciprocal creatinine (1/Cr) curve also showed a biphasic decline in renal function, with a rapid decline in the first 6 months followed by no further decline up to 60 months of follow‐up. Approximately 4% of the patients at 1‐2 months, 8% at 3 months, and 12‐ 17% at 6‐60 months had serum creatinine ≥ 2.0 mg/dl. None of the patients developed end‐stage renal disease requiring dialysis. At all time points, patients with serum creatinines ≥2.0 mg/dl received a lower CyA dose than those with serum creatinines <2.0 mg/dl (3.1±0.1 vs. 4.0±0.1 mg/kg/d, respectively, p<0.0001), suggesting that the CyA dose had been appropriately reduced in response to a rise in serum creatinine. There was no significant rise in serum potassium (4.4±0.04 vs. 4.5±0.1 meq/1, 1‐2 vs. 60 months, respectively, p=NS) or serum cholesterol (205.5±4.1 vs. 211±6.5 mg/dl, 1‐2 vs. 60 months, respectively, p=NS). However, there was a significant rise in systolic (134±1.5 vs. 140.5±2.7 mmHg, p<0.05), diastolic (84±1.0 vs. 90±2.1 mmHg, p<0.05), and mean arterial (101±1.0 vs. 107 2.1 mmHg, p<0.05) pressures at 1‐2 vs. 60 months. Serum trough CyA levels and CyA doses were significantly reduced over the follow‐up period (1746.7 vs. 110.5 12.5 ng/ml, and 4.4±0.1 vs. 2.5±0.2 mg/kg/d, at 1‐ 2 vs. 60 months, respectively, p<0.05). At 1 yr, 56% of the patients were treated with antihypertensive medications (predominately calcium channel blockers) and 14% received lipid lowering medications (predominately an HMG‐CoA reductase). We conclude, after an initial rise in serum creatinine and decline in 1/Cr curve, during the first 6‐9 months post‐cardiac transplant, renal function remains stable up to 5 yr of follow‐up, if serum CyA levels and CyA doses are monitored and adjusted closely. However, we cannot rule out the possibility of subclinical progressive histopathologic changes, due to chronic CyA nephrotoxicity, which could become clinically apparent after a longer duration of follow‐up.
Recurrent type I membranoproliferative glomerulonephritis after renal transplantation and protective role of cyclosporine in acute crescentic transformation
Authors: Ahsan Nasimul , Manning Eric C. , Dabbs David J. , Gifford Robert R. M. , Yang Harold C. 
Published: September 2024

AbstractAlmost all diseases affecting the native kidney may recur in the transplanted kidney, with one of the most frequent being recurrent glomerulonephritis. Among the glomerulonephritides, membranoproliferative glomerulonephritis (MPGN), immunoglobulin A nephropathy (IgA), and focal‐segmental glomerulosclerosis (FSGS) have the highest rates of recurrence. Here we report a patient who, after living‐related kidney transplantation, suffered allograft loss shortly after surgery due to recurrence of glomerulonephritis. Two weeks prior to transplant nephrectomy light microscopic examination of the allograft biopsy failed to show glomerulonephritis. Subsequent histopathology of the transplant nephrectomy specimen demonstrated a crescentic form of type I MPGN following withdrawal of cyclosporin A (CSA) and intense course of oral steroid therapy. The entity of recurrent type I MPGN in kidney transplantation is reviewed, and a possible protective role of CSA against rapidly progressive crescentic type I MPGN is explored.
Rescuing Prometheus: a policy proposal to alleviate excess demand for liver transplantation
Authors: Ferguson Melissa E. , Ferguson Ronald M. 
Published: September 2024

AbstractA growing demand for liver transplantation coupled with a static supply of organs results in an excess demand crisis. Excess demand for liver transplantation equals the number of patients left on the UNOS waiting list at the end of the year who have not expired, undergone transplant, or been withdrawn. Only in the arena of transplantation doses the United States medical community confront a true rationing dilemma stemming from a scarcity of livers available for transplantation. An excess demand crisis intensifies debate in policy areas such as allocation and patient listing criteria. A cohesive rationing policy should manage both the demand for transplantation and the supply of transplantable organs. Demand‐side management as applied to liver transplantation could decrease the incidence of critically ill patients waiting for transplants, the number of retransplants performed and the total cost of transplantation to the health care system.
Application of a tissue expander for stabilizing graft position in living‐related liver transplantation
Authors: Inomata Yukihiro , Tanaka Koichi , Egawa Hiroto , Uemoto Shinji , Kiuchi Tetsuya , Satomura Kazunari , Uyama Shiro , Okajima Hideaki 
Published: September 2024

AbstractIn living‐related liver transplantation, a portion of the whole liver, usually the left lateral segment or the left lobe, is harvested for use as the graft liver. A relatively small graft may twist around the hepatic venous anastomosis, causing outflow blockage. After an initial experience of such a complication in the early post‐transplantation period in one case, we began to apply a tissue expander to obliterate the dead space left after emplacement of a relatively small graft. Commercially available tissue expanders, ordinary employed in plastic surgery, were used for five pediatric recipients (6–14 yr old) whose ratio of graft weight to recipient body weight ranged from 0.74 to 1.72. The expander, filled with 240‐350 ml saline, was put into the space to the right of the graft. Aspiration of the expander content was started after the 5th‐7th postoperative day (POD), at a rate of 50 ml of fluid a day. The expanders were taken out on the 11th‐14th POD after complete removal of the content. Complications observed in the five cases were right shoulder pain (5/5), fluid collection after removal of the expander (2/5), chylous ascites (1/5), and one instance of bile leakage. All the complications were successfully managed and controlled conservatively. There was no outflow obstruction detected by Doppler ultrasonography before or after removal of the expander. This is a simple and safe method for preventing the early onset of outflow block after partial liver transplantation.
A liver transplantation technique in a patient with a thrombosed portal vein and a functioning renal‐lieno shunt
Authors: Sheil A.G. Ross , Stephen Michael S. , Chui Albert K.K. , Ling Juanita , Bookallil Michael J. 
Published: September 2024

AbstractA liver transplant technique is described in a patient with a thrombosed portal vein and a functioning surgically created renal‐lieno shunt. Permanent portal inflow to the graft was provided by division of the left renal vein (LRV) at its junction with the inferior vena cava and anastomosis of the LRV end‐to‐end with the donor portal vein. Although this results in splanchnic blood traversing a 360° roundabout from the superior mesenteric vein via the splenic and disconnected left renal veins to the donor portal vein, the anastomosis lay well and the procedure was successful.
Successful reversal of acute vascular rejection in a renal allograft with combined mycophenolate mofetil and tacrolimus as primary immunotherapy
Authors: Ahsan Nasimul , Holman Michael J. , Katz Douglas A. , Abendroth Catherine S. , Yang Harold C. 
Published: September 2024

AbstractDespite the use of newer immunosuppressive drugs, early allograft rejection is still a major cause of graft loss and diminished graft survival. The pathological picture of acute interstitial rejection usually responds to high dose steroids, whereas the treatment of acute vascular (AVR) rejection characterized by an intense vasculitis and/or endotheliolitis is more formidable. The use of newer monoclonal antibodies specific for T lymphocytes and their subsets has only been occasionally successful in reversing AVR. Here we report a case of successful reversal of acute vascular renal allograft rejection with mycophenolate mofetil (MMF) and tacrolimus as primary therapy.
Bench reconstruction of pancreas for transplantation: experience with 192 cases
Authors: Gill Inderbir S. , Sindhi Rakesh , Jerius John T. , Sudan Debra , Stratta Robert J. 
Published: September 2024

AbstractWhole organ pancreaticoduodenal transplantation with bladder drainage by the duodenal segment technique is currently the preferred method of vascularized pancreas transplantation but is associated with a finite risk of surgical complications. Meticulous bench reconstruction of the pancreaticoduodenal allograft may minimize complications following transplantation. Over a 6.5‐yr period, 192 pancreas transplants were performed in 181 diabetic patients by the same transplant team. A retrospective review was performed in order to describe a stepwise approach to bench preparation of the pancreaticoduodenal allograft that has developed from this experience. In this series of 192 consecutive pancreaticoduodenal reconstructions, no procured pancreas was deemed non‐usable solely from an anatomic standpoint. The mean backtable pancreas preparation time was 2 h. The operative complication rate was 19%, the incidence of technical graft loss was 6.8%, and there was no mortality related to technical problems. Conclusions: Using a standardized approach, meticulous bench reconstruction of the pancreaticoduodenal allograft: 1) can be performed in virtually any anatomic setting; 2) decreases complications following transplantation; 3) improves initial allograft function; and 4) minimizes organ wastage.
Magnetic resonance venography in potential pediatric liver transplant recipients
Authors: Cheng Yu Fan , Huang Tung Liang , Lui Chun Chung , Lee Tze Yu , Chen Chao Long 
Published: September 2024

AbstractVascular anomalies may be hazardous to liver transplantation, and pre‐operative vascular evaluation is important for a safe and successful operation. The purpose of this study was to assess the utility and accuracy of time‐of‐flight (TOF) magnetic resonance venography (MRV) with threedimensional (3D) reconstruction as an alternative for conventional catheter angiography in evaluating the portal venous system and inferior vena cava (IVC) in potential pediatric liver transplant recipients. Twenty consecutive cases of small children with biliary atresia were evaluated with TOF MRV with 3D reconstruction by Advantage Window workstation. All 20 cases underwent conventional angiography; two cases received transhepatic portography and three cases received splenoportographic study. The whole MRV examination and filming required less than 30 min. Findings of portal vein and IVC completely agreed with or were superior to the successful catheter angiographic images. The portal vein was occluded in five cases. and patent in fifteen cases which included: twelve hepatopetal flow, two hepatofugal flow and one small caliber portal vein. Varices were found in 18 cases. In the case of the IVC, 18 of them were normal and 2 had congenital abnormalities which included paired vena cava and hypoplasia vena cava with compensatory enlargement of the azygos and hemiazygos systems. Eight of the cases received liver transplantation, and the MRV findings totally correlated with the final anatomy as found intraoperatively. MRV is accurate for evaluating the condition of the portal venous system and IVC, detection, and determining the distribution and extents of the varices. It is a reliable, noninvasive and rapid technique which can be considered as an alternative workup for the invasive angiography and or portography in small children for pre‐transplantation evaluation.
Interaction between panel reactive antibodies, auto‐ and cold reactive antibodies, and a positive B cell cross‐match in renal and cardiac allograft survival
Authors: Creemers Pauline , Brink Johan , Kahn Delawir 
Published: September 2024

AbstractWe analyzed the influence on allograft survival of pretransplant panel reactive antibodies (PRA) <10%, PRA>10%, autoantibodies, cold antibodies and a positive B cell crossmatch in 807 renal and 237 cardiac transplant recipients. Donors and recipients were predominantly of mixed ancestry (Khoi, San, Xhosa and Caucasoid). Log rank analysis showed that PRA<10%, cold antibodies, and a positive B cell cross‐match did not influence allograft survival. Autoantibodies were present only in renal recipients; they appeared to have a beneficial effect on allograft survival (P=0.06). PRA>10% appeared to have a detrimental effect on allograft survival in both renal (P=0.07) and cardiac (P=0.06) recipients. Since autoantibodies and PRA>10% had opposing effects, the results of renal recipients were reanalyzed after omission of the recipients with autoantibodies and coexisting and ghoul PRA>10%. This resulted in augmentation of the protective effect for autoantibodies (P=0.027) and of the detrimental effect for PRA>10% (P=0.020), Two‐year survival curves showed that when autoantibodies coexisted with PRA>10%, the long term, but not the short‐term, detrimental effect of PRA>10% was attenuated. Patients with a positive B cell cross‐match clustered in the PRA>10% group in both renal (PRA negative vs. PRA<10%: P=0.0251; PRA<10% vs. PRA>10%: P=0.0011) and cardiac (PRA negative vs. PRA>10%: P=0.0085) recipients. We conclude that PRA>10% is the best indicator to identify recipients at high risk for rejection, and that the influence of antibodies on graft survival can not reliably be established without taking coexisting antibodies into account.
A randomized controlled trial of pentoxifylline for the prevention of delayed graft function in cadaveric kidney graft
Authors: Noël Christian , Hazzan Marc , Coppin Marie‐Christine , Codaccioni Marie‐Xavière , Pruvot François‐René , Labalette Myriam , Lelièvre Gaston 
Published: September 2024

AbstractIschemia/reperfusion has been implicated in the mechanism of delayed graft function (DGF). Pentoxifylline (PTX) has been shown to suppress TNFa (released by activated macrophages, inhibiting subsequent superoxide anion release from neutrophil activation. In addition, PTX decreases cyclosporine (CSA) induced renal endothelial release and vasoconstriction. Thus, administration of PTX to renal transplant patients could be an excellent approach to prevent DGF and vascular toxicity of CsA in the early graft period. One hundred‐and‐forty consecutive patients receiving cadaveric kidney transplantation were registered in a randomized doubleblind study comparing PTX vs. a placebo. PTX had no demonstrable effect on the incidence of DGF, on the rapidity of the renal function recovery, and on the ability to use higher doses of CsA in the first month post‐graft.
Allograft infiltrating cytotoxic T lymphocytes recognize kidney‐specific human minor histocompatibility antigens
Authors: Poindexter Nancy , Shenoy Surendra , Howard Todd , Flye M. Wayne , Mohanakumar T. 
Published: September 2024

AbstractThe role of minor histocompatibility antigens (mH) in allograft immunity has been proposed, but the nature of these antigens and their immunogenicity are not well understood. We have shown that tissue‐specific cytolytic T lymphocytes (CTL) can be isolated form graft infiltrating lymphocyte (GIL) populations from renal transplant recipients undergoing acute cellular rejection. In most cases these CTL were allorestricted recognizing donor mismatched kidney MHC class I antigens. In contrast, one patient's GIL T cells demonstrated specific lytic activity against HLA‐B35 expressed on primary kidney epithelial cell lines (KCL) but not on B‐lymphoblastoid cell lines (LCL). Since HLA‐B35 was a shared antigen between donor and recipient, these results suggest that CTL within the GIL population are recognizing a tissue‐specific minor histocompatibility antigen presented in the context of self‐HLA‐B35.
Highly successful long‐term outcome of kidney transplantation in Chinese recipients: an enhancing race effect?
Authors: Hawkins Brian R. , Chan Peter , Chan Y. T. , Cheng Ignatius K. P. , Cheung K. O. , Fenn John , Ho K. K. , Lai K. N. , Li C. S. , Lui S. F. , Opelz Gerhard , Tong Matthew K. L. 
Published: September 2024

AbstractWe report on 352 cadaveric kidney transplants and 294 living related transplants performed over a 25‐yr period among the Chinese population of Hong Kong. There is a marked preference for transplanting male patients, especially from living donors, and we argue that this represents a cultural phenomenon within the Chinese population. The 10‐yr graft survivals for related and cadaveric transplants are 86.2% and 67.4%, respectively. These figures are appreciably higher than corresponding figures in Caucasian populations. We show beneficial effects of using cyclosporin A, minimizing the cold ischemia time and avoiding very young and very old donors. There is a clear benefit of transplanting kidneys with zero or one mismatched HLA antigen against the recipient but no stepwise decrease in outcome as the number of mismatched antigens increases. There is close concordance between the outcome of living related grafts with zero, one, and two mismatched haplotypes against the recipient and no observable benefit of haplotype matching. We show that Chinese renal transplant recipients in other centers also have better long‐term graft outcome than Caucasians, both for cadaveric and living related transplants. We draw attention to the existence of a detrimental “race effect” in other studies when Black recipients are compared with Caucasians and consider whether an enhancing. race effect exists for Chinese or whether the better outcome reflects different underlying diseases in Chinese.
Development of microchimerism in pediatric patients after living‐related liver transplantation
Authors: Ueda Mikiko , Hundrieser Joachim , Hisanaga Michiyoshi , Tanaka Koichi , Wonigeit Kurt , Pichlmayr Rudolf , Schlitt Hans J , Yamaoka Yoshio 
Published: September 2024

Abstract.Microchimerism has been suggested to play an important role in the long‐term acceptance of allogeneic organ grafts by transplant patients and for the maintenance of a state of donor‐specific low responsiveness. In order to elucidate the kinetics of the development of chimerism we have performed a follow‐up analysis in 10 pediatric patients with living‐related liver transplantation (LRLTX). Blood samples obtained during the first 6 months and at 18 months post‐transplant and skin biopsies taken at one month were analysed for the presence of donor cells by PCR using donorspecific HLA‐DRB1 primer pairs or primers for a Y chromosome‐specific sequence. Furthermore 13 long‐term patients more than 2 yr after LRLTX were studied at two different time points. In the follow‐up studies donor cells could be demonstrated in the blood of all patients immediately after transplantation. After a gradual decline all patients became chimerism‐negative for several weeks or months. At 6 months, however, in five of eight patients tested and at 18 months in six of nine patients donor cells had reappeared. This biphasic pattern in the development of chimerism is proposed to reflect the occurrence of different donor‐derived cell populations in the recipient. The population giving rise to the first wave of chimerism probably represents matured cells with a limited lifespan which are released from the graft into the circulation of the recipient during the first weeks after transplantation. The population of cells occurring with the second wave of chimerism is likely to have been generated by donor‐derived cells with stem cell potential located either in the graft or in the hematopoetic organs of the recipient after emigration from the graft. This model may be able to explain fluctuations in the incidence and degree of microchimerism described in other patient populations during the first year post‐transplant. Of the 13 long‐term patients, chimerism could be demonstrated in 11. In seven patients it was detected in both blood and skin, in three patients the results obtained for blood and skin were discordant. In one patient only blood was analysed. It is not clear whether the negative results really reflected the absence of chimerism or whether the number of donor cells was below the level of detectability.