bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
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.
A search for cyclophilin‐A gene variants in cyclosporine A‐treated renal transplanted patients
Authors: Moscoso‐Solorzano Grace Tamara , Ortega Francisco , Rodríguez Isabel , García‐Castro Mónica , Gómez Ernesto , Díaz‐Corte Carmen , Baltar José M. , Alvarez Victoria , Ortiz Alberto , Coto Eliecer 
Published: August 2010

Abstract: Background:  The cyclophilin A (CypA) ‐ cyclosporine (CsA) complex promotes immune response. The variation at the CypA gene could explain CsA‐pharmacokinetics and clinical outcomes among CsA‐treated patients.Methods:  The study included 290 kidney transplanted patients (65% male; mean age 51 ± 15 yr), treated with CsA. The five CypA‐ exons and the promoter region were analysed through single‐strand conformation analysis, denaturing high performance liquid chromatography, and direct sequencing. The effect of a promoter polymorphism (−11 G/C) on gene expression was analysed in cell‐cultures.Results:  We found two polymorphisms in the promoter (−11 G/C) and exon 1 (+36 G/A). Genotype frequencies did not differ between patients according to their pharmacokinetics status. In vitro studies showed that −11 G/C affected gene expression. The −11 G allele was significantly associated with clinical nephrotoxicity (p = 0.006). The strongest predictors for nephrotoxicity were a donor age ≥55 yr, and the promoter GG + GC genotypes.Conclusions:  Our work suggests that a CypA‐promoter polymorphism (−11 G/C) could be associated with clinical nephrotoxicity. Replication of this study in other populations is necessary to define the role of CypA‐variants in the main clinical outcomes among CsA‐treated kidney‐transplanted patients.
CD30, a marker to detect the high‐risk kidney transplant recipients
Authors: Spiridon Camelia , Nikaein Afzal , Lerman Mark , Hunt Judson , Dickerman Richard , Mack Michael 
Published: August 2010

Abstract: Background:  Sensitization of potential renal transplant recipients may impact the selection of donors and the outcome of transplant. Another element of the potential kidney transplant recipient immune system that provides useful information regarding the transplant outcome is the immunologic CD30 molecule.Methods and results:  This study shows a significant correlation between the pre‐transplant high level of soluble CD30 and increased incidence of post‐transplant infection. Only 7/34 (20.6%) of the patients who had a low level of sCD30 (<90 U/mL) developed infection as compared with the 25/58 (43.1%) of the patients who had a high level (>90 U/mL) of sCD30 (p < 0.04). Higher level of sCD30 pre‐transplant was also correlated with the increased level of serum creatinine (p < 0.05) and pre‐transplant malignancy (p < 0.04). A significant higher level of sCD30 was also noted among females (74%), as compared with males (50%) with p < 0.03. In addition, significant effect of 3–6 human leukocyte antigen (HLA) mismatches on rejection was seen.Conclusions:  These results show that higher pre‐transplant immunologic reactivity measured by sCD30 level was associated with post‐transplant outcome. The high level of sCD30 among females may indicate an active immunologic status, perhaps because of previous pregnancies.
Tuberculosis in southern Chinese renal‐transplant recipients
Authors: Chen Si‐yang , Wang Chang‐xi , Chen Li‐zhong , Fei Ji‐guang , Deng Su‐xiong , Qiu Jiang , Li Jun , Chen Gu‐odong , Fu Hong‐mei , Xie Can‐mao 
Published: August 2010

Abstract: Objectives:  To analyze the characteristics of tuberculosis (TB) in Southern Chinese renal transplant recipients, and summarize the corresponding experiences in diagnosis and management.Method:  Retrospectively study 41 documented post‐transplant TB cases out of the 2333 patients who received kidney transplantation in the First Affiliated Hospital of Sun Yat‐sen University between Jan. 1991 and Apr. 2007.Results:  TB in the post‐renal‐transplant population in Southern China displayed the following characteristics: (i) high incidence within a short time after transplantation, the median interval between renal transplantation and diagnosis of TB was 8 months (range: 1‐156 months) and 56.1% were diagnosed within the first year post‐transplant; (ii) high prevalence (51.2%) of extra‐pulmonary tuberculosis; (iii) high co‐infection rate (19.5%), pathogens included candida albicans, pseudomonas aeruginosa, staphylococcus aureus, Acinetobacter haemolyticus and cytomegalovirus; (iv) fever (82.9%), cough (56.1%) and sputum (39.0%) are the most common clinical manifestations; (v) purified protein derivative of tuberculin (PPD) skin test had little diagnostic value in this group with a negative result in all 41 cases; (vi) acute rejection (29.3%) and liver function damage (17.1%) were the main adverse effects of anti‐tuberculosis chemotherapy; (vii) mortality of patients with post‐transplant tuberculosis reached up to 22.0%.Conclusions:  Chinese renal transplant recipients face a high risk of TB because of their immuno‐compromised state and epidemiological prevalence of the disease. Therefore, attention should be given to this differential diagnosis in clinical practice. Balancing the benefits and disadvantages of anti‐tuberculosis chemotherapy is of importance for this specific population.
Coronary flow reserve dysfunction in hemodialysis and kidney transplant patients
Authors: Caliskan Yasar , Oflaz Huseyin , Demirturk Mustafa , Yazici Halil , Turkmen Aydin , Çimen Arif , Elitok Ali , Yildiz Alaattin 
Published: August 2010

Abstract: Background:  The assessment of coronary flow reserve (CFR) by trans‐thoracic echocardiography has recently been introduced into clinical studies. Impairment of coronary microvascular functions and decreased CFR detected by trans‐thoracic Doppler harmonic echocardiography (TTDE) has recently been reported in hemodialysis (HD) patients, but there is no comparative study between HD patients and renal transplant recipients.Methods:  The aim of our study was to evaluate coronary microvascular circulation in chronic HD patients and renal transplant recipients. Forty‐eight chronic HD patients, 27 renal transplant patients and 39 normotensive healthy controls were studied for the assessment of CFR by TTDE. The carotid artery intima media thickness (IMT) and areas of focal plaque formation were also evaluated in all subjects.Results:  CFR values were significantly lower in both the HD and renal transplant groups than in the control group (p = 0.00). CFR values (1.57 ± 0.32 vs. 1.89 ± 0.50, p = 0.01) were also significantly lower in the HD group than in the renal transplant group. In 43 of 48 (89.6%) HD patients, CFR was <2.0; however, in 16 of 27 (59.3%) renal transplant recipients it was <2.0 (p = 0.00). When the HD and renal transplant groups were divided into two subgroups, according to CFR measurements (CFR < 2 and ≥2), no significant differences were found with respect to coronary risk factors and left ventricular echocardiographic measurements. The IMT of the control group (0.586 ± 0.163 mm) was significantly lower than the HD (0.799 ± 0.218 mm) and renal transplant groups (0.681 ± 0.148 mm; p = 0.00). The IMT of the HD patients (0.799 ± 0.218 mm) was significantly higher than the renal transplant recipients (0.681 ± 0.148 mm; p = 0.01).Conclusions:  Renal transplant and HD patients had lower CFR values detected by TTDE, which may be regarded as an early finding of an affected cardiovascular system. CFR is more impaired in HD patients than renal transplant recipients. Uremia‐associated microvascular disease may be responsible for CFR impairment in HD patients.
THE NEEDS OF CANCER PATIENTS AND THEIR FAMILIES FROM RURAL AND REMOTE AREAS OF QUEENSLAND
Authors: Clavarino Alexandra M. , Lowe John B. , Carmont Sue‐Ann , Balanda Kevin 
Published: August 2010

ABSTRACT: This study examines the impact of travelling for treatment on cancer patients and their families. Twenty‐eight consecutive cancer patients, who were receiving radiation therapy treatment and 19 family carers, completed a structured needs assessment questionnaire and an in‐depth interview.Both patients and carers reported moderate to high levels of unmet psychological need. Carers were found to have higher levels of anxiety than patients, although both groups had higher anxiety levels than the general population. Taking more responsibility for household tasks and organising new living arrangements for the family were the most frequently identified demands of a dual burden of caring. Nearly 40% of carers reported some disruption to their schedule and half reported experiencing financial difficulties. The qualitative interviews highlight the disruption that parents and children experience under the present system, particularly in relation to the demands of family life and the need to maintain some level of continuity and security for children.