bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interstitial expression of heat‐shock protein 47 correlates with capillary deposition of complement split product C4d in chronic allograft nephropathy
Authors: Ohba Kojiro , Miyata Yasuyoshi , Koga Shigehiko , Nishikido Masaharu , Kanetake Hiroshi , Nazneen Arifa , Razzaque Mohammed S , Taguchi Takashi 
Published: August 2010

Abstract:  Background:  Chronic allograft nephropathy (CAN), associated with late‐allograft dysfunction is caused by alloantigen‐dependent and ‐independent mechanisms, and eventually leads to interstitial fibrosis (ci). Activation of complement cascade is considered to be a poor prognostic marker of graft survival. This study was designed to examine the relationship between the expression of C4d and heat‐shock protein 47 (HSP47, a collagen‐specific chaperone) in the development of interstitial fibroproliferative lesions in CAN.Methods:  Sixty‐three renal allograft biopsy specimens, obtained from 48 patients, were examined for the expression of C4d, HSP47, CD68 and α‐smooth muscle actin (α‐SMA) by immunohistochemistry. Double‐staining was performed to determine the colocalization of C4d and HSP47. The relationship of between the expression of C4d, HSP47, CD68 and α‐SMA and the clinical and histopathological parameters were statistically analysed.Results:  No expression of C4d was noted in the tubulointerstitium including peritubular capillary (PTC) of the control kidney. C4d was expressed in PTC in one‐third of allograft renal tissues with morphological evidences of CAN. The interstitial cells around the fibrotic areas of the PTC of CAN were positive for the expression of HSP47. The deposition of C4d in PTC correlated with interstitial expression of HSP47 around the PTC. Most HSP47 expressing cells were phenotypically altered myofibroblasts, as determined by the dual staining of α‐SMA.Conclusions:  The increased expression of HSP47 positively correlated with the expression of C4d in PTC, and might contribute to the progression of interstitial ci in CAN.
Anemia in kidney transplanted patients
Authors: Molnar Miklos Zs , Novak Marta , Ambrus Csaba , Kovacs Agnes , Pap Judit , Remport Adam , Szeifert Lilla , Mucsi Istvan 
Published: August 2010

Abstract: Background: Although a known cardiovascular risk factor, anemia in the renal transplant recipients has only recently been receiving an increasing attention.Methods: In a cross‐sectional study, data was obtained from 959 patients followed at a single outpatient transplant clinic. Based on the guideline of the American Society of Transplantation, anemia was defined as hemoglobin (Hb) 130 g/L in males and 120 g/L in females.Results: About one‐third (34%) of the patients were anemic. The prevalence of anemia was comparable in males and females. Serum Hb concentration was significantly correlated with the estimated glomerular filtration rate (eGFR) (abbreviated modification of diet in renal disease formula) (r = 0.266, p < 0.001), serum transferrin (r = 0.268, p < 0.001) and serum albumin (r = 0.196, p < 0.001). None of the immunosuppressive medications or the use of angiotensin converting enzyme inhibitors was associated with a higher likelihood of anemia. In multivariate analysis the eGFR, serum albumin and serum transferrin, potential markers of nutritional status and/or chronic inflammation, and also iron deficiency were independently and significantly associated with anemia. Erythropoietin was administered only to 63 (19%) anemic patients.Conclusions: Post‐transplant anemia is a prevalent and under‐treated condition. Based on our results we suggest that, besides other factors, protein/energy malnutrition and/or chronic inflammation may be independently associated with anemia. Further studies are needed to determine whether the presence of anemia and its treatment will have an impact on long‐term outcomes of this population.
Age and heart transplantation: results from a heart failure management unit
Authors: Grigioni Francesco , Potena Luciano , Barbieri Andrea , Bianchi Giorgio , Reggianini Letizia , Russo Antonio , Fallani Francesco , Magnani Gaia , Coccolo Fabio , Arpesella Giorgio , Rapezzi Claudio , Modena Maria Grazia , Branzi Angelo 
Published: August 2010

Abstract:  Background:  More evidence is needed to assess the pros and cons of maintaining age‐limit policies in heart transplantation (HT).Methods:  We analyzed clinical data from a heart failure management unit to investigate the impact of age on prognosis of two distinct cohorts: (i) 309 patients (median age, 57 yr; 62% male) with severe chronic heart failure (CHF) consecutively screened for HT; (ii) 336 HT recipients (median age 56 yr, 82% male).Results:  In CHF patients (screened for HT), prognosis was conditioned by the underlying severity of cardiac disease (i.e., New York Heart Association class III–IV, decreasing blood pressure, presence of atrial fibrillation and severe mitral regurgitation), whereas increasing age showed no sign of predicting all‐cause or cardiovascular mortality (both p ≥ 0.4). In HT recipients, age did not retain significance at multivariate analysis as an independent predictor (p ≥ 0.14 for both all‐cause and cardiovascular death), whereas ischemic etiology of pre‐existing CHF did (p ≤ 0.02).Conclusions:  Age did not appear to be a primary determinant of all‐cause or cardiovascular mortality among potential HT candidates or eventual recipients (ischemic etiology of CHF turned out to be the major determinant of post‐transplant outcome). These results support the concept that HT may be considered a treatment option in patients with more advanced age strata, particularly when affected by non‐ischemic cardiomyopathy.
Arteriovenous fistula reconstruction in patients with kidney allograft failure
Authors: Weyde Wacław , Letachowicz Waldemar , Krajewska Magdalena , Gołębiowski Tomasz , Letachowicz Krzysztof , Kusztal Mariusz , Porażko Tomasz , Wątorek Ewa , Madziarska Katarzyna , Klinger Marian 
Published: August 2010

Abstract: Background:  Kidney recipients with failing allograft function face the vascular access problem again before returning to hemodialysis. An autologous arteriovenous fistula (AVF), according to the recent Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, is the optimal vascular access and the use of prosthetic grafts and catheters should be limited. The objective of this study was to assess the feasibility of AVF reconstruction in patients reentering hemodialysis after kidney allograft failure.Materials and methods:  Two hundred and forty‐one transplant recipients reentered hemodialysis between 1990 and 2005. Before kidney transplantation, 221 patients had a functioning AVF on the forearm. Fistula reconstruction was attempted in 112 (51%) patients because of AVF thrombosis. Three strategies were applied according to forearm vein patency: a new radial‐cephalic fistula, a radial‐perforating vein fistula, or a radial‐basilic forearm transposition was created.Results:  Forearm AVFs were successfully reconstructed in 85 of the 112 patients (73%). The primary patency of the reconstructed AVFs was 57.6% and 44% at 12 and 24 months. Secondary patency was 64.9% and 54.9% at 12 and 24 months, respectively.Conclusions:  The reconstruction of an old, thrombosed AVF is possible in kidney recipients returning to dialysis, even if the time from thrombosis to fistula repair is a few years.
Cardiovascular risk, cardiovascular events, and metabolic syndrome in renal transplantation: comparison of early steroid withdrawal and chronic steroids
Authors: Rike Adele H. , Mogilishetty Gautham , Alloway Rita R. , Succop Paul , Roy‐Chaudhury Prabir , Cardi Michael , Kaiser Tiffany E. , Thomas Mark , Woodle E. Steve 
Published: August 2010

Abstract: Background:  Cardiovascular disease (CVD) is the leading cause of death with a functioning graft in renal transplant recipients. The purpose of this study was to compare Framingham Risk Score (FRS), metabolic syndrome (MS), and cardiovascular events (CVE) in patients receiving early corticosteroid withdrawal (ECSWD), or chronic corticosteroid therapy (CCS).Methods:  In all, 251 ECSWD and 146 CCS patients were evaluated. FRS and MS were identified at baseline, six, 12, and 24 months post‐transplant. A total of 124 patients with diabetes mellitus prior to transplantation were excluded from MS analysis. CVE were defined as sudden‐death, MI, angina, or CVA/TIA. Repeat‐measure logistic regression was used for statistical analysis.Results:  Fifty‐four patients experienced 72 CVE. Mean follow‐up was 755 ± 312 d and time to CVE was 14.8 ± 8.3 months. Demographics were similar between groups. FRS was not different between groups. CVE were significantly greater in CCS patients then ECSWD (20% vs. 10%, p = 0.024). New‐onset MS occurred more frequently in patients receiving CCS then ECSWD (45% vs. 22%, p < 0.001) and was associated with more CVE (p < 0.015).Conclusions:  Patients receiving ECSWD regimens have significantly decreased CVE and new onset MS compared with CCS. MS is associated with increased CV risk and CVE.
Clinical factors associated with graft fibrosis in kidney‐transplant recipients on steroid‐avoidance immunosuppression
Authors: Heilman Raymond L. , Chakkera Harini A , Reddy Kunam S , Colby Thomas V , Moss Adyr A , Williams James W , Mazur Marek J , Petrides Savas , Mulligan David C 
Published: August 2010

Abstract:  Background:  Recent studies have documented good patient and graft outcomes and a low risk of acute rejection with steroid‐avoidance immunosuppression in kidney‐transplant recipients, but the risk of progressive graft fibrosis is not well studied.Methods:  All adult primary kidney transplant or combined kidney and pancreas transplant recipients on steroid avoidance immunosuppression were eligible for study. All recipients received induction with antithymocyte globulin or basiliximab. Corticosteroids were stopped after day 4 post‐transplantation. Patients were maintained with tacrolimus and mycophenolate mofetil. Protocol biopsies were done at reperfusion and at one, four, and 12 months after transplantation.Results:  Eighty one‐yr protocol biopsies with adequate specimens were obtained from 132 kidney or kidney–pancreas transplant recipients. Fifteen (19%) of the biopsies showed moderate to severe graft interstitial fibrosis (GIF) (Banff ci score ≥2). Recipients with GIF were older, had lower body mass index, greater human lymphocyte antigen (HLA) mismatch, older donors, serum creatinine ≥1.6 mg/dL at one month, a Banff ci score >0 on one‐month biopsy, BK nephropathy, and interstitial cellular infiltrates on the one‐yr biopsy. In the unadjusted logistic regression analysis, BK nephropathy, serum creatinine ≥1.6 mg/dL at one month, recipient age, Banff ci score >0 on one‐month biopsy, and donor age were the only variables associated with a higher risk of GIF on the one‐year biopsy. In the multivariate logistic regression model adjusted for these variables, BK nephropathy, serum creatinine ≥1.6 mg/dL at one month after transplantation, and recipient age were independently associated with the risk of GIF on the one‐year biopsy.Conclusion:  In this small study of primary kidney or combined kidney–pancreas transplant recipients on steroid‐avoidance immunosuppression, we found that 19% had GIF on a one‐year protocol biopsy. BK nephropathy, serum creatinine ≥1.6 mg/dL one month after transplantation, and recipient age correlated with an increased risk for GIF on the one‐yr biopsy.
Exploring the psychological effects of deceased organ donation on the families of the organ donors
Authors: Merchant Shaila J , Yoshida Eric M , Lee Tim K , Richardson Penny , Karlsbjerg Kari M , Cheung Elsie 
Published: August 2010

Abstract:  Background:  Our specific aim was to investigate whether the donation process hindered or ameliorated the bereavement process for organ donor families, specifically with regard to depression, post‐traumatic stress and grief.Methods:  Using the British Columbia Transplant Society (BCTS) database, we mailed packages to donor families who consented to and successfully proceeded to donate. Each package contained three standardized, validated questionnaires that included scales of depression, post‐traumatic stress, and bereavement. We also included a newly designed questionnaire specific to the BCTS Donation Experience. Seventy‐three completed packages were received and analyzed using multiple regression models. Our overall response rate was 46%.Results:  The younger the deceased and the shorter the time elapsed since donation, the greater the strength of bereaved feelings reported by the donor families. If donor families felt there were negative aspects about the donation process, the more likely they were bothered by symptoms of post‐traumatic stress. The more comforted donor families felt about donation, the less likely they were bothered by feelings of depression.Conclusions:  Our data suggest that donation has a beneficial effect on the bereavement process.
Clinical course of kidney transplant patients with acute rejection and BK virus replication following Campath therapy
Authors: Kayler Liise K. , Mohanka Ravi , Morgan Claire , Basu Amit , Shapiro Ron , Randhawa Parmjeet S. 
Published: August 2010

Abstract:  Background:  Kidney transplant recipients with active BK virus (BKV) replication are generally treated with reduction in immunosuppression to allow a successful immune response against the virus.Methods:  We inadvertently administered Campath to two patients with BKV viruria, and one patient with BKV nephropathy, since allograft biopsies showed severe tubulitis or intimal arteritis, and results of PCR and in situ hybridization were not available at the time of therapeutic intervention.Results:  Increased viral replication was observed, but not uniformly in all cases, and follow‐up biopsies showed nephropathy in one additional case. Extra‐renal dissemination did not occur. With subsequent reduction of immunosuppression or antiviral therapy, it was still possible to obtain clearance of viremia in all cases. Serum creatinine fell transiently after Campath in one patient; however, at one yr post‐treatment all had increased levels over baseline. One graft was lost to persistent acute rejection that led to interstitial fibrosis and tubular atrophy.Conclusion:  These cases suggest that Campath treatment does not (i) irreversibly deplete cells believed to be important in mounting an immune response against BKV, or (ii) preclude subsequent eradication of viral DNA from the blood.
The impact of employment status on recipient and renal allograft survival
Authors: Petersen Emily , Baird Bradley C. , Barenbaum Lev L. , Leviatov Alexander , Koford James K. , Shihab Fuad , Goldfarb‐Rumyantzev Alexander S. 
Published: August 2010

Abstract: Background:  With the improved median survival of kidney transplant recipients, there has been an increased focus on quality of life after transplantation. Employment is a widely recognized component of quality of life. To date, no study has demonstrated a link between post‐transplant employment status and recipient and allograft survival after transplant.Methods:  The records from the United States Renal Data System (USRDS) and the United Network for Organ Sharing (UNOS) from January 1, 1995, through December 31, 2002, were examined in this retrospective study. Two outcomes, allograft survival time (time between the transplantation and allograft failure or censor) and recipient survival time (time between the transplantation and recipient death or censor), were analyzed using Cox models adjusted for potential confounding factors.Results:  Compared to patients working full time at the time of transplantation, those not working by choice have a greater risk to graft [hazard ratio (HR) 1.27, p < 0.001] but not to recipient survival. A similar trend was observed in patients not working at 12 months post‐transplant (HR 1.30, p < 0.001 for graft survival but not for recipient survival). However, at five‐yr post‐transplant not working by choice was protective to the graft (HR 0.47, p < 0.01) as compared to working full time. Results of the analysis in the patient subgroups based on the comorbidities and the overall health status were similar.Conclusion:  Employment status at the time of transplantation and in post‐transplant period has a strong and independent association with the graft and recipient survival. Full time employment at the time of transplant and at one‐yr post‐transplant is associated with lower risk for graft failure and recipient mortality. However, working beyond the time covered by Medicare might be associated with potential risk for graft survival.
Determinants of bone mass in end‐stage renal failure patients at the time of kidney transplantation
Authors: Dolgos Szilveszter , Hartmann Anders , Bønsnes Stine , Ueland Thor , Isaksen Gunhild Aker , Godang Kristin , Pfeffer Per , Bollerslev Jens 
Published: August 2010

Abstract: Background:  Patients with chronic renal failure (CRF) are at high risk of renal osteodystrophy. Our study aimed to identify predictors of bone mass and cumulative fracture rate at the time of renal transplantation (RTx). This is important since the patients experience further substantial bone loss the first month post‐transplant.Material and methods:  Altogether 133 renal transplant patients were examined for bone mineral density (BMD) using dual‐energy X‐ray absorptiometry shortly after RTx.Results:  The patients’Z‐scores were significantly lower at the time of RTx compared to the reference population (p < 0.05), 32% were osteopenic and 11% had osteoporosis. Independent predictors of low bone mass were age (p < 0.001), female sex (p < 0.001), intact parathyroid hormone (iPTH) level (p < 0.001), former transplantation (p = 0.001) and time on hemodialysis (HD) (p = 0.005). Body mass index (BMI) (p < 0.001) and physical activity (p = 0.027) were associated with high BMD. Cumulative fracture rate (29%) was associated with physical inactivity (p = 0.003), BMI (p = 0.036) and osteopenia (p < 0.001) at the time of RTx.Conclusion:  In a representative CRF population, BMD was reduced. Independent predictors of BMD were as for the general population, and uremia associated predictors were time on HD, previous transplantation and serum iPTH level. Fracture rate was high, and physical inactivity had the strongest association with fractures.
Liver transplantation for sinusoidal obstructive syndrome (veno‐occlusive disease): case report with review of the literature and the UNOS database
Authors: Membreno Fernando E. , Ortiz Jorge , Foster Preston F. , Wright Francis , Ostrower Victor S. , Metter John D. , Palma‐Vargas Juan , LeMaistre Charles F. 
Published: August 2010

Abstract: Background:  Severe sinusoidal obstructive syndrome (SOS) is a life‐threatening complication of stem cell transplantation. We report the case of a young man transplanted for SOS.Method:  A single chart review with query of the United Network of Organ Sharing database and review of the medical literature.Case:  A 23‐yr‐old male diagnosed with chronic myeloid leukemia underwent a matched unrelated stem cell transplant. The conditioning regimen included high‐dose cyclophosphamide and busulfan. Within one month, he developed painful hepatomegaly, jaundice, ascites, and weight gain, and was diagnosed with biopsy‐proven SOS. Despite therapy with defibrotide, he continued to deteriorate with the development of progressive renal failure and encephalopathy. The patient underwent orthotopic liver transplantation. After surgery, he developed cytomegalovirus infection and six wk later presented with a bile leak, hepatic artery thrombosis, and a liver abscess. A repeat bone marrow biopsy showed no evidence of recurrent disease. Although the patient was listed for re‐transplantation, he succumbed prior to an organ becoming available.Conclusion:  Severe SOS in the setting of bone marrow transplantation portends a poor prognosis. Careful patient selection, timing, and perhaps less immunosuppression should be considered when performing a liver transplantation in the setting of severe SOS.
CD25, CD28 and CD38 expression in peripheral blood lymphocytes as a tool to predict acute rejection after liver transplantation
Authors: Boleslawski Emmanuel , BenOthman Samia , Grabar Sophie , Correia Leonor , Podevin Philippe , Chouzenoux Sandrine , Soubrane Olivier , Calmus Yvon , Conti Filomena 
Published: August 2010

Abstract:  Background/Aim:  The aim of this study was to determine whether the expression of CD25, CD28 and CD38 (which reflects the degree of T‐cell activation) by peripheral blood mononuclear cells constitutes a useful means of measuring the immune status of liver transplant recipients.Methods:  Fifty‐two patients enrolled in a prospective randomized study comparing cyclosporine and tacrolimus as the principal immunosuppressive drugs were monitored prospectively. The expression of CD25, CD28 and CD38 was analyzed on CD3‐, CD4‐ and CD8‐positive cells from whole blood using flow cytometry. The prognostic value of baseline and day 14 measurements regarding acute rejection was examined using Kaplan–Meier estimates for univariate analyses and the Cox model for multivariate analyses.Results:  The mean frequencies of CD28 and CD38‐expressing T cells were significantly higher in patients with acute rejection (p = 0.01 and p = 0.001, respectively), whereas the frequency CD25‐expressing T cells did not differ significantly. Under univariate analysis, baseline CD25 levels, the type of calcineurin inhibitor, as well as the CD28 and CD38 frequencies obtained at day 14 were associated with the subsequent development of acute rejection. Under multivariate analysis, only CD28 and CD38 frequencies obtained at day 14 were independently associated with acute rejection.Conclusions:  The evaluation of CD28 and CD38 expression in peripheral blood lymphocytes is a simple marker that could be used routinely in clinical practice to assess the level of immunosuppression.
Herpes zoster infection after liver transplantation in patients receiving induction therapy with alemtuzumab
Authors: Alcaide Maria L , Abbo Lilian , Pano Jose R , Gaynor Jeffrey J , Tryphonopoulos Panagiotis , Weppler Debbie , Moon Jang I , Tzakis Andreas G , Morris Michele I 
Published: August 2010

Abstract: Background: The incidence of herpes zoster (HZ) infection in liver transplant recipients prior to the use of induction therapy with monoclonal antibodies has been reported as being 1.2–18%. We studied the occurrence of HZ in liver transplant recipients that received induction therapy with alemtuzumab (Campath 1H®).Material and methods: This was a retrospective review of primary liver transplant recipients who received alemtuzumab as induction therapy at our center. HZ infection was diagnosed clinically as the presence of a characteristic vesicular rash in a dermatomal distribution without any further virological confirmation.Results: A total of 118 liver transplant recipients were treated with alemtuzumab between August 2002 and August 2005. Twelve patients developed HZ infection, and the cumulative probability of a patient developing HZ infection by 36 months post‐transplant ±1 SE was estimated as 16.5 ± 5.0%. The median time for onset of the infection was 10.2 months (range 4.7–30.7) after the transplant. All patients had only one dermatomal distribution, and none developed systemic infection or complications such as postherpetic neuropathy. All patients except one were treated with systemic intravenous acyclovir. One patient received famciclovir. All of the patients had received ganciclovir during the post‐transplant period but were not receiving any other antiviral medication at the time of the infection.Conclusion: Herpes zoster infection has previously been reported as a frequent complication of liver transplantation. Our study suggests that it occurs in approximately 16% of patients receiving induction therapy with alemtuzumab. Although alemtuzumab is a powerful immunosuppressive agent and there is still little information regarding its long‐term safety when used in liver transplantation, our data do not suggest any increase in the occurrence and complications of HZ.