bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion
Authors: Cantafio A.W. , Dick A.A.S. , Halldorson J.B. , Bakthavatsalam R. , Reyes J.D. , Perkins J.D. 
Published: May 2011

Cantafio AW, Dick AAS, Halldorson JB, Bakthavatsalam R, Reyes JD, Perkins JD. Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion. Clin Transplant 2011: 25: E530–E540. © 2011 John Wiley & Sons A/S.Abstract:  There has been a dramatic increase in the utilization of kidneys from donors after cardiac death (DCD). While these organs represent an opportunity to expand the donor pool, the assessment of risk and optimal perioperative management remains unclear. Our primary aim was to identify risk factors for objective outcomes, and secondarily, we sought to determine what impact pulsatile machine perfusion (PMP) had on these outcomes. From 1993 to November 2008, 6057 DCD kidney transplants were reported to the Organ Procurement and Transplantation Network database, with complete endpoints for delayed graft function (DGF) and graft survival (GS). Risk factors were identified using a multivariable regression analysis adjusted for recipient factors. Age (50 yr) [OR 1.81, p < 0.0001] and cold ischemia time (CIT) (>30 h) [OR 3.22, p < 0.0001] were the strongest predictors of DGF. The use of PMP decreased the incidence of DGF only when donor age was >60 yr and improved long‐term graft survival when donor age was >50 yr. Donor warm ischemia time >20 min was also found to correlate with increased DGF. While the incidence of DGF in DCD kidneys is significantly higher, the only factors the transplant surgeon can control are CIT and the use of PMP. The data suggest that the use of PMP in DCD kidneys <50 yr old provides little clinical benefit and may increase CIT.
Are informed consent forms for organ transplantation and donation too difficult to read?
Authors: Gordon Elisa J. , Bergeron Ashley , McNatt Gwen , Friedewald John , Abecassis Michael M. , Wolf Michael S. 
Published: May 2011

Gordon EJ, Bergeron A, McNatt G, Friedewald J, Abecassis MM, Wolf MS. Are informed consent forms for organ transplantation and donation too difficult to read?  Clin Transplant 2011 DOI: 10.1111/j.1399‐0012.2011.01480.x.  © 2011 John Wiley & Sons A/S.Abstract:  Informed consent for organ transplantation and donation is an ethical obligation, legally required, and considered as part of the Patient’s Rights Condition of Medicare Participation for hospitals. National policy‐makers recommend that informed consent forms and patient education materials be written at a low reading level (5th–8th grade level) to facilitate patient comprehension. We assessed reading levels of informed consent forms (CFs) for adult organ transplant recipients and living organ donors across US transplant centers. CFs were analyzed using three measures of reading level: Lexile Measure, Flesch–Kincaid Grade Level, and the Gunning Fog Index. Of active transplant centers contacted (N = 209), 75 (36%) sent a total of 332 CFs. CFs were written, on average, at the college level, which is a considerably higher reading level than the standards set by policy‐makers. CF reading levels were negatively correlated with transplant center volume (r = −0.119; p < 0.03). CFs for intestine transplantation and for evaluation/listing were the easiest to read, while consent forms for liver transplantation/donation and pre‐transplant agreements were the most difficult to read. Reducing CFs’ reading level may help to increase patient comprehension for adequate informed consent.
Lung transplantation after hematopoietic stem cell transplantation
Authors: Whitson Bryan A. , Shelstad Ryan C. , Hertz Marshall I. , Kelly Rosemary F. , D’Cunha Jonathan , Shumway Sara J. 
Published: May 2011

Whitson BA, Shelstad RC, Hertz MI, Kelly RF, D’Cunha J, Shumway SJ. Lung transplantation after hematopoietic stem cell transplantation.  Clin Transplant 2011 DOI: 10.1111/j.1399‐0012.2011.01482.x.  © 2011 John Wiley & Sons A/S.Abstract:  Introduction:  Pulmonary insufficiency following bone marrow transplant (BMT) is common and has significant associated mortality. Lung transplantation (LTX) is the only viable treatment for patients with end‐stage pulmonary disease, but LTX after BMT is an uncommon event given the medical candidacy of the potential recipients. We sought to evaluate the short‐ and long‐term outcomes of LTX in BMT recipients.Methods:  We performed a retrospective evaluation of our institution’s longitudinal LTX and BMT databases. Demographic and outcomes variables were collected.Results:  We identified 639 LTX from January 1, 1988, through December 31, 2009, and 5525 BMT from program inception, March 21, 1974, through December 31, 2009. From the cross‐referenced cohort, we identified four patients who had BMT followed by LTX. Our series was composed of two men and two women, with a mean age of 32.3 yr (range, 20–59 yr). Single LTX were performed in two recipients (50%). All patients had significant and expected morbidities related to their transplant immunosuppression. Three patients (75%) required cardiopulmonary bypass at the time of LTX. The two recipients who underwent bilateral LTX required open chest management and subsequent tracheostomy. All patients are still alive at follow‐up (range, 19–119 months, median 39.5).Conclusion:  Our study demonstrates that LTX in the setting of BMT is a high‐risk operation with the potential for a tumultuous perioperative course. Despite this, good outcomes and survival are obtainable in carefully selected patients. Selection factors include clinically stable patients without active sepsis and preoperative optimization of nutrition in anticipation of a prolonged recovery. An experienced multidisciplinary team approach and a protocol‐driven management plan are paramount for successful outcomes in this challenging population.
LabMELD‐based organ allocation increases total costs of liver transplantation: a single‐center experience
Authors: Bruns Helge , Hillebrand Norbert , Schneider Tobias , Hinz Ulf , Fischer Lars , Schmidt Jan , Goldschmidt Andreas J.W. , Schemmer Peter 
Published: May 2011

Bruns H, Hillebrand N, Schneider T, Hinz U, Fischer L, Schmidt J, Goldschmidt AJW, Schemmer P. LabMELD‐based organ allocation increases total costs of liver transplantation: a single‐center experience. Clin Transplant 2011: 25: E558–E565. © 2011 John Wiley & Sons A/S.Abstract:  Introduction:  In 2006, model for end‐stage liver disease (MELD)‐based allocation was implemented in the Eurotransplant (ET) region. Sick patients, who in general require more resources, are prioritized. In this analysis, the effect of MELD on costs for liver transplantation (LTx) was assessed.Methods:  Total costs for LTx before and after implementation of MELD were identified in 256 patients from January 2005–December 2007. Forty‐nine patients (Re‐LTx, HU listings, and 30‐d mortality) were excluded from further analysis. The costs of LTx in 207 patients have been correlated with their corresponding labMELD; 84 and 123 LTx before and after implementation of MELD were compared, and patient survival was monitored.Results:  A positive correlation exists between labMELD and costs (r2 = 0.28; p < 0.05). Only nominal correlation existed between the Child–Pugh classification and costs. The labMELD scores can be stratified into four groups (I: 6–10, II: 11–18, III: 19–24, and IV: >24), with an increase of €15.672 ± 2.233 between each group (p < 0.05). Recipients’ labMELD at the time of LTx increased significantly in the MELD‐based allocation system. Costs increased by €11.650/patient (p < 0.05), while median survival decreased from 1219 to 869 d (p < 0.05).Conclusion:  LabMELD‐based allocation increased total costs of LTx. In accordance with other studies, the sickest patients need the most resources.
Pharmacokinetics, pharmacodynamics, safety, and tolerability of single‐dose fingolimod (FTY720) in adolescents with stable renal transplants
Authors: Ettenger R. , Schmouder R. , Kovarik J. M. , Bastien M. C. , Hoyer P. F. 
Published: May 2011

Ettenger R, Schmouder R, Kovarik JM, Bastien MC, Hoyer PF. Pharmacokinetics, pharmacodynamics, safety, and tolerability of single‐dose fingolimod (FTY720) in adolescents with stable renal transplants. Pediatr Transplantation 2011: 15: 406–413. © 2011 John Wiley & Sons A/S.Abstract:  Oral fingolimod signals the sphingosine 1‐phosphate receptor and this in turn mediates immunomodulatory activity. No data of fingolimod in any pediatric population existed before this study. We put our study results in perspective against data from adult renal transplant patients. We investigated pharmacokinetics and pharmacodynamics of single‐dose fingolimod (0.07 mg/kg) and its effects on lymphocytes and heart rate in seven adolescents (14.1 ± 1.6 yr) with stable renal transplants. Blood samples for pharmacokinetics and lymphocytes were collected at screening, baseline, and up to 28 days post‐dosing. Cardiac monitoring included 12‐lead ECG, 24‐h Holter monitoring, and echocardiography. A fingolimod dose of 0.07 mg/kg resulted in mean AUC of 731 ± 240 ng·h/mL and Cmax of 3.6 ± 0.6 ng/mL. Drug exposure was nearly identical to adults receiving the same dose. Absolute lymphocyte count decreased 85% from baseline; average nadir occurred by six h post‐dose. Heart rate decreased from 74 bpm (predose mean) to 53 bpm (nadir) three h post‐dose. Mean heart rates recovered by Day 14 (75 bpm). Weight‐adjusted doses of fingolimod in adolescents resulted in drug exposure similar to adults. Adolescents and adults shared comparable negative chronotropic effects and decreased lymphocyte count. Recovery trajectories of these parameters back to baseline were similar between age groups.
Long‐term follow‐up in adult living donors for combined liver/bowel transplant in pediatric recipients: A single center experience
Authors: Ghafari Jamie L. , Bhati Chandra , John Eunice , Tzvetanov Ivo G. , Testa Giuliano , Jeon Hoonbae , Oberholzer Jose , Benedetti Enrico 
Published: May 2011

Ghafari JL, Bhati C, John E, Tzvetanov IG, Testa G, Jeon H, Oberholzer J, Benedetti E. Long‐term follow‐up in adult living donors for combined liver/bowel transplant in pediatric recipients: A single center experience. Pediatr Transplantation 2011: 15: 425–429. © 2011 John Wiley & Sons A/S.Abstract:  Pediatric candidates for combined liver/bowel transplant (LBTx) experience a very high mortality on the cadaver waiting list. Our transplant center has successfully used adult living donors to treat pediatric candidates for LBTx. We report the long‐term follow‐up of this unique cohort of organ donors. The charts of six adult donors for LBTx performed between 2004 and 2007 were reviewed. All the pertinent clinical data were carefully reviewed and integrated with phone interviews of all donors. A total of six children (average age 13.5 months) received living donor LBTx. Average follow‐up for the donors was 42 months (range 29–51). The donors’ median age was 25 yr (19–32); five women and one man. The average median hospital stay was nine days. There were no peri‐operative complications. At present all donors remain in good health. Three of the five mothers became pregnant after donation. Five of the six children are currently alive and well whereas one died with functioning grafts six months post‐transplant due to plasmoblastic lymphoma. Living donor LBTx is an effective therapy for combined hepatic and intestinal failure in children less than five yr. The donor operation can be performed with minimal morbidity.
Laparoendoscopic single‐site (LESS) bilateral nephrectomy in the pretransplant pediatric population
Authors: Marietti Sarah , Holmes Nicholas , Chiang George 
Published: May 2011

Marietti S, Holmes N, Chiang G. Laparoendoscopic single‐site (LESS) bilateral nephrectomy in the pretransplant pediatric population. Pediatr Transplantation 2011: 15: 396–399. © 2011 John Wiley & Sons A/S.Abstract:  End‐stage renal failure management in children may require bilateral kidney removal prior to transplantation secondary to recurrent urinary tract infections, renin‐dependent hypertension, vesicoureteral reflux, proteinuria, risk of malignancy (Denys‐Drash), or high output renal failure. Conventional laparoscopy or open nephrectomy has been employed to date. However, we present our method of bilateral nephrectomy in four patients via the SILS Covidien © system. Patient age ranged from 18 months to 18 years. Operative time ranged from 308 to 370 minutes. Estimated blood loss was minimal, all cases were completed via the single incision and no cases were converted to open. Laparoendoscopic single‐site bilateral nephrectomy is safe and feasible in children and well‐suited for the pre‐transplant population.
Non‐genetic heterogeneity and cell fate choice in Dictyostelium discoideum
Authors: Chattwood Alex , Thompson Christopher R. L. 
Published: May 2011

From microbes to metazoans, it is now clear that fluctuations in the abundance of mRNA transcripts and protein molecules enable genetically identical cells to oscillate between several distinct states (Kaern et al. 2005). Since this cell–cell variability does not derive from physical differences in the genetic code it is termed non‐genetic heterogeneity. Non‐genetic heterogeneity endows cell populations with useful capabilities they could never achieve if each cell were the same as its neighbors (Raj & van Oudenaarden 2008; Eldar & Elowitz 2010). One such example is seen during multicellular development and “salt and pepper” cell type differentiation. In this review, we will first examine the importance of non‐genetic heterogeneity in initiating “salt and pepper” pattern formation during Dictyostelium discoideum development. Second, we will discuss the various ways in which non‐genetic heterogeneity might be generated, as well as recent advances in understanding the molecular basis of heterogeneity in this system.
Management of cancer risk in Barrett's esophagus
Authors: Tan Alyisha , Macrae Finlay 
Published: May 2011

AbstractThe importance of Barrett's esophagus (BE) lies in its potential to give rise to esophageal adenocarcinoma (EAC), postulated to be through a series of progressive degrees of dysplasia; from intestinal metaplasia to low‐grade dysplasia, high‐grade dysplasia, and subsequently, to cancer. The management strategies for the detection and treatment of dysplasia and early esophageal cancer on a background of BE have changed significantly in the last few decades, with the emergence of newer and less invasive non‐operative alternatives. This review aims to outline BE and its relation to EAC, the rationale and cost‐effectiveness of both screening and surveillance programs, methods of diagnosing and identifying dysplasia and early cancer in Barrett's, and approaches to individualizing their endoscopic and surgical management based on best‐available staging techniques.
Dihydrolipoyl histidinate zinc complex, a new antioxidant, attenuates hepatic ischemia‐reperfusion injury in rats
Authors: Masuda Takashi , Iwashita Yukio , Hagiwara Satoshi , Ohta Masayuki , Inomata Masafumi , Noguchi Takayuki , Kitano Seigo 
Published: May 2011

AbstractBackground and Aims:  Ischemia/reperfusion (I/R) injury is characterized by significant oxidative stress, which induces characteristic changes in the antioxidant system and organ injury leading to significant morbidity and mortality. The aim of this study was to evaluate the protective effect of dihydrolipoyl histidinate zinc complex (DHLHZn) on oxidative damage after severe hepatic I/R injury.Methods:  Thirty male Wistar rats were subjected to 45 min of hepatic ischemia by clamping of the hepatic artery and portal vein, followed by a 6‐h reperfusion period. DHLHZn (10 mg/kg) (I/R + DHLHZn group) or saline (I/R group) was administered intraperitoneally twice, 30 min before ischemia and at the beginning of the reperfusion. Sham‐operated animals (sham group) received equal amounts of saline. The rats were killed at the end of the reperfusion period. Serum levels of aspartate aminotransferase and alanine aminotransferase were determined, and histological examination and oxidative stress were evaluated in liver tissues. In addition, antimycin A‐stimulated RAW264.7 cells (murine macrophage‐like cells) were treated with DHLHZn to estimate its antioxidant effect.Results:  Serum aspartate aminotransferase and alanine aminotransferase levels were increased in the I/R group, but these increases were significantly inhibited in the I/R + DHLHZn group. Similarly, liver tissue damage observed in the I/R group was attenuated in the I/R + DHLHZn group. Cells treated in vitro with both DHLHZn and antimycin A showed reduced reactive oxygen species activity compared to cells treated with antimycin A alone.Conclusion:  The new antioxidant DHLHZn may have potential for therapeutic application in liver I/R injury, although this is a limited animal study.
Complex non‐invasive fibrosis models are more accurate than simple models in non‐alcoholic fatty liver disease
Authors: Adams Leon A , George Jacob , Bugianesi Elisabetta , Rossi Enrico , De Boer W Bastiaan , van der Poorten David , Ching Helena L I , Bulsara Max , Jeffrey Gary P 
Published: May 2011

AbstractBackground and Aim:  Significant hepatic fibrosis is prognostic of liver morbidity and mortality in non‐alcoholic fatty liver disease (NAFLD); however, it remains unclear whether non‐invasive fibrosis models can determine this end‐point. We therefore compared the accuracy of simple bedside versus complex fibrosis models across a range of fibrosis in a multi‐centre NAFLD cohort.Methods:  Simple (APRI, BARD) and complex (Hepascore, Fibrotest, FIB4) fibrosis models were calculated in 242 NAFLD subjects undergoing liver biopsy. Significant (F2‐4) and advanced fibrosis (F3,4) were defined using Kleiner criteria. Models were compared using area under the receiver operator characteristic curves (AUC). Cut‐offs were determined by Youden Index or 90% predictive values.Results:  For significant fibrosis, non‐invasive fibrosis models had modest accuracy (AUC 0.707–0.743) with BARD being least accurate (AUC 0.609, P < 0.05 vs others). Using single cut‐offs, sensitivities and predictive values were < 80%; using two cut‐offs, > 75% of subjects fell within indeterminate ranges. Simple models had significantly more subjects within indeterminate ranges than complex models (99.1–100% vs 82.1–84.4% respectively, P < 0.05 for all). For advanced fibrosis, complex models were more accurate than BARD (AUC 0.802–0.858 vs 0.701, P < 0.05). Using two cut‐offs, complex models had fewer individuals within indeterminate ranges than BARD (11.1–32.3% vs 70.7%, P < 0.01 for all). For cirrhosis, complex models had higher AUC values than simple models.Conclusions:  In NAFLD subjects, non‐invasive models have modest accuracy for determining significant fibrosis and have predictive values less than 90% in the majority of subjects. Complex models are more accurate than simple bedside models across a range of fibrosis.
Outcomes after curative treatment for cryptogenic cirrhosis‐associated hepatocellular carcinoma satisfying the Milan criteria
Authors: Takuma Yoshitaka , Nouso Kazuhiro , Makino Yasuhiro , Gotoh Tomoyuki , Toshikuni Nobuyuki , Morimoto Youichi , Shimomura Hiroyuki , Yamamoto Hiroshi 
Published: May 2011

AbstractBackground and Aim:  The prognosis of cryptogenic cirrhosis‐associated hepatocellular carcinoma (CC‐HCC) was reported to be poor because many of them were discovered at the advanced stage. The aim of this study is to reveal the clinical features of early CC‐HCC.Methods:  Consecutive 36 curatively treated CC‐HCC patients satisfying the Milan Criteria were compared with corresponding 211 HCV‐associated HCC (HCV‐HCC) patients. The clinical background, tumor recurrence rate, overall survival rate, and prognostic values of the patients were assessed.Results:  The size of CC‐HCCs was larger than that of HCV‐HCCs (P = 0.01). The respective tumor recurrence rates at 1, 3, and 5 years were 11%, 32%, and 46% in the CC‐HCC, and 21%, 59%, and 81% in the HCV‐HCC. The respective overall survival rates at 1, 3, and 5 years were 94%, 85%, and 80% in the CC‐HCC, and 98%, 81%, and 61% in the HCV‐HCC. CC‐HCC patients had a lower tumor recurrence rate and a higher survival rate compared to the HCV‐HCC patients (P = 0.001 and P = 0.02, respectively). Via multivariate analysis, significant factors for high recurrence rate were number of HCCs (P = 0.02) and serum alpha fetoprotein levels (P = 0.03) in CC‐HCC, whereas multiple tumors (P < 0.001), large tumor size (P = 0.01), and high alanine aminotransferase (P = 0.04) in HCV‐HCC. The factor for survival was albumin in both groups.Conclusion:  The size of CC‐HCC was larger than that of HCV‐HCC even in patients who received curative treatment; however, the risk for recurrence and the mortality of the patients with CC‐HCC was lower than those with HCV‐HCC.
Suppressive effects of entecavir on hepatitis B virus and hepatocellular carcinoma
Authors: Jin Young‐Joo , Shim Ju Hyun , Lee Han Chu , Yoo Dong‐Jun , Kim Kang Mo , Lim Young‐Suk , Suh Dong Jin 
Published: May 2011

AbstractBackground and Aim:  We investigated the efficacy and effectiveness of entecavir in hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC) patients.Methods:  We enrolled 231 nucleoside‐naïve chronic hepatitis B (CHB) patients primarily treated with entecavir 0.5 mg/day for at least 6 months in our institution. Of these, 71 patients had HCC at the start of entecavir treatment (HCC group) and 160 did not (non‐HCC group). We compared antiviral responses to entecavir in the two groups, and evaluated the effects of entecavir on the clinical outcomes of curatively‐treated HCC patients.Results:  The HCC and non‐HCC groups had similar cumulative rates of HBV‐DNA negativity, alanine aminotransferase normalization, and hepatitis e antigen loss in year 2 (100% vs 95.4%, 94.7% vs 97.3%, and 40.8% vs 41.8%, respectively; P > 0.05). Entecavir treatment for 12 months decreased mean Model for End‐Stage Liver Disease scores in patients with cirrhosis and HCC (7.2 vs 5.6, P < 0.001). Of the 71 HCC patients, 16 underwent curative therapies concurrently with entecavir; hepatectomy in six and radiofrequency ablation in 10, and the 55 remaining patients received transarterial chemoembolization or conservative treatment. In a subgroup of 16 HCC patients receiving curative treatments, patients who became serum HBV DNA negative by week 24 had better overall survival (P = 0.039), but not recurrence‐free survival (P = 0.961), than those who did not.Conclusions:  First‐line entecavir monotherapy is comparably effective in CHB patients with and without HCC, and improves hepatic function in HBV‐related HCC patients. An early virological response to entecavir is prognostic of improved survival following curative therapy against HBV‐related HCC.