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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The advent of small bowel transplantation has provided selected patients with chronic intestinal irreversible failure with a physiologic alternative to total parenteral nutrition. Recently a standardized technique for living related small bowel transplantation (LR-SBTx) has been developed. Three patients with short bowel syndrome underwent LR-SBTx at our institution. All donors were ABO compatible with a good human leukocyte antigen match. A segment of 180 to 200 cm of ileum was harvested and transplanted with its vascular pedicle constituted by the ileocolic artery and vein. The grafts were transplanted with a short cold and warm ischemia time. The immunosuppression regimen consisted of oral FK-506, prednisone, and intravenous induction with atgam. Serial biopsies of the intestinal grafts were performed to evaluate rejection or viral infections. The postoperative course was uneventful for all donors. All of the recipients are currently alive and well. Two of three patients are off total parenteral nutrition and tolerating an oral diet with no limitations on daily activity. In the third patient, the graft was removed 6 weeks after transplantation. At the time of enterectomy, no technical or immunologic complications were documented. Absorption tests for D-xylose and fecal fat studies were performed showing functional adaptation of the segmental graft. All biopsies were negative for acute rejection. A well-matched segmental ileal graft from a living donor can provide complete rehabilitation for patients with short bowel syndrome. Our initial experience suggests that the risk of acute rejection and infection is greatly reduced compared to cadaveric bowel transplantation. Further clinical application of this procedure is warranted.
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PMID:Segmental living related small bowel transplantation in adults. 1133 80

Based on data reported to the United Network for Organ Sharing through December 2001: 1. The number of heart transplant procedures performed in the United States increased slightly (< 1%) during each of the last 2 complete years from 2,187 transplants during 1999 to 2,197 transplants during 2000, followed by an additional increase in 2001 to 2,202 transplants. A more substantial increase was seen in the number of lung transplants performed: from 890 transplants in 1999 to 956 in 2000 (+7%) and an additional increase to 1,053 transplants in 2001 (+10%). Fewer than 30 heart-lung transplants were performed in 2001. Living-donor lung transplants comprised 2-3% of lung transplants performed between 1995-2001. 2. Pediatric recipients were more frequently on life support in the ICU; more likely to have an ischemia time of at least 4 hours; more often gender mismatched; and more often ABO-compatible rather than ABO-identical with the donor than adult recipients for all thoracic organ types. 3. The most common indication for transplant since 1996 in adult heart recipients was coronary artery disease (50%), followed closely by cardiomyopathy (42%). Among pediatric heart recipients, the 2 most common indications: cardiomyopathy (46%) and congenital heart disease (43%) accounted for approximately 90% of the transplants. The indications for lung transplants were more disparate. In adult lung recipients, the 4 most common diagnoses (COPD - 42%, IPF - 17%, CF - 15% and A1A - 9%) encompassed more than 80% of the transplants. More than half of the pediatric lung transplants were performed in recipients with CF. The 3 most frequently cited indications for adult heart-lung transplant recipients (Eisenmenger's Syndrome, other congenital heart diagnoses and PPH) accounted for greater than 75% of the transplants. 4. Approximately 30-35% of adult heart transplants since 1999 have been performed in patients who were Status 1A. For pediatric transplant recipients, Status 1A comprised 60-70% of the transplants. 5. The one-year survival rate for transplants performed during the first three-quarters of 2001 was 85% for both adult and pediatric heart transplant recipients and 77% for both adult and pediatric recipients of lung transplants. For adult heart-lung transplants performed during 2000, the one-year survival rate was 69%. 6. The long-term patient survival rates were: 39% for adult heart recipients and 50% for pediatric heart recipients at 12 years; 18% at 11 years for adult lung recipients and 31% at 9 years for pediatric lung recipients; and 24% at 11 years for adult heart-lung recipients and 21% at 8 years for pediatric heart-lung recipients. 7. Drug-treated rejection and drug-treated infection were reported to occur before discharge in approximately 20-40% of transplant recipients, with the exception of pediatric lung and heart-lung recipients, with rates varying by organ and age group. Drug-treated infections were reported before discharge in more than 60% of pediatric lung recipients and approximately half of pediatric heart-lung recipients. 8. Approximately 60% of adult heart recipients and 70% of pediatric heart recipients were hospitalized at least once during the first 3 years following their transplant.
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PMID:Thoracic organ transplantation in the US. 1297 35

Transplantation is the best treatment for end-stage renal diseases. For transplantologists, it is most important to know the factors that worsen graft survival prognosis. The aim of the study was to investigate factors predictive of graft loss and shortened graft survival. We retrospectively reviewed 442 renal transplant patients between 1990 and 1995 in two Szczecin units, all of whom received a triple-drug immunosuppressive regimen. One hundred thirty patients showed graft disorders such as delayed graft function or primary nonfunction. The occurrence of these disorders was examined as a function of donor and recipient age and sex, cause of ESRD, HLA compatibility, ABO and Rh compatibility, cold ischemia time, warm ischemia time, antileukocyte antibody level (PRA), and period of dialysis therapy before transplantation. The study showed that a high maximal PRA level, incompatibility for ABO group, and a longer warm ischemia time increase the probability of early graft function disorders.
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PMID:Impact of selected factors on early graft function in patients after renal transplantation. 1452 77

The course and outcome of patients after liver transplantation (LT) for primary sclerosing cholangitis (PSC) are still debated. Our purpose is to define retrospectively, the post-LT clinicopathologic findings seen in 51 PSC patients with a follow-up of 2 to 14 years. Of the total 51 patients, 16 with native liver hilar xanthogranulomatous cholangiopathy (XGC) had median graft and patient survival of 573 and 835 days, respectively compared with 2489 and 2794 days, respectively, in 35 patients without XGC. Perioperative complications resulted in 9 early deaths (day 0 to 52). Of the remaining 42 patients, 6 had recurrent PSC (R-PSC) with typical histologic and cholangiographic findings, 12 had autoimmune liver disease-not otherwise specified with histology of autoimmune hepatitis/overlap syndrome, 3 had chronic rejection, 4 had ischemic cholangiopathy, and 17 had no recurrence. The presence of inflammatory bowel disease, total ischemia time of > or =11 hours, recipient-donor ABO and HLA Class I and II matches, and the type of immunosuppression did not affect the post-LT outcome. Recipient-donor gender mismatch was more common in R-PSC than in the nonrecurrent group (P=0.045). Post-LT malignancies were significantly more common in the nonrecurrent cases compared with all others combined (P=0.031) and caused deaths in 4. The majority of deaths (11/13) in other groups were due to sepsis complicating graft dysfunction. In conclusion, allograft autoimmune liver disease was seen in 18 (43%) of 42 long-term post-LT PSC patients, with progression in 5 of 18 patients. Features of PSC were seen in 6 (33%) of 18. Native liver XGC negatively impacted post-LT graft and patient survival. Increased incidence of malignancies in the nonrecurrent group may reflect overimmunosuppression in those patients.
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PMID:Liver transplantation for primary sclerosing cholangitis: a long-term clinicopathologic study. 1465 14

Humoral rejection caused by antidonor blood group A/B antibodies is one of the most important obstacles for successful ABO-incompatible liver transplantation. However, no specific morphologic features of liver biopsies to distinguish humoral rejection from other conditions such as ischemia or sepsis have been satisfactorily documented. To histologically clarify the early changes in humoral rejection, we studied 41 cases of living donor ABO-incompatible liver transplantation whose allograft biopsies during the first episode of suspected acute rejection were available within the first postoperative month. Postoperative isohemagglutinin IgM titers were x64 or more in 21 patients (51%; high-titer group) and less than x64 in 20 cases (49%; low-titer group). In the high-titer group, elevation of postoperative titers x64 or more occurred within postoperative days 5.7 +/- 4.1 (range: 1-17). An increase in the incidence of cholangitis was observed in the high-titer group (90% vs. 30%, P <.0001), as well as poorer overall graft survival than in the low-titer group (38% vs. 70%, P <.05). Seven biopsies obtained from the high-titer group within 3 days after the onset of elevation of the antibody titers and one biopsy obtained at the peak of the antibody titers demonstrated periportal edema and necrosis, neither of which was found in the low-titer group. All grafts of these patients caused massive hepatocyte necrosis or severe biliary complications. In conclusion, a high morbidity rate of ABO-incompatible liver transplantation is associated with high postoperative levels of antibody titers. Periportal edema and necrosis observed during elevation of antibody titers can be regarded as histological indications of early changes in severe humoral rejection.
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PMID:Periportal edema and necrosis as diagnostic histological features of early humoral rejection in ABO-incompatible liver transplantation. 1475 73

Nonocclusive mesenteric ischemia (NOMI) is an infrequent and fatal disorder. We describe a 54-year-old man who developed NOMI during the peritransplant period following ABO-incompatible living-donor kidney transplantation, but who was successfully treated with his renal graft function unimpaired. Abdominal pain appeared on the sixth postoperative day (POD), and emergency surgery was performed on POD 8. Discontinuous segmental necrosis extended throughout the small intestine, and the necrotic segments were entirely removed. He thereafter had ischemia of the ascending colon, which was treated with colectomy, and prostaglandin E1 delivered through the related artery prevented advanced necrosis. Temporary colostomy was closed 20 months after surgery. He maintains excellent graft function at present without secondary disorder. There has been no ABO-incompatible kidney transplant recipient complicated with NOMI. However, patients with end-stage renal disease are at the highest risk for this lethal condition, and physicians and urologists should correctly recognize its diagnostics and therapeutics.
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PMID:Successful treatment of nonocclusive mesenteric ischemia that developed during the peritransplant period following ABO-incompatible kidney transplantation. 1983 26

Liver transplantation is known as a highly complex procedure. Several variables can affect the outcome. The present study is a retrospective multivariate analysis of the outcomes of primary liver transplant recipients from deceased donors. From November 2006 through January 2009, 155 patients received first liver transplants from deceased donors. The data included the following: age of the recipient, gender of the recipient, ABO type, indication for the transplantation, model for end-stage liver disease (MELD) score, operative time, donor age, gender of the donor, cold ischemia time, and quantity of transfused blood products-red blood cells (PRBC), red blood cells recovered during the operation (cell saver), platelets, and fresh frozen plasma. Statistical analysis was done using SPSS 17 software. Cox regression analysis was performed to identify significant variables. ROC (receiver operating characteristic) curve was applied for those significant factors. Among all variables, only PRBC transfusion and MELD score showed statistical significance. For PRBC the increment of death risk was 17.08%, and for MELD score it was 3.83%. Patients that had to use PRBC and higher MELD scores had worse survivals. We concluded that the requirement for red blood cell transfusions and MELD showed the most significant influences on the outcomes of adult liver transplantations from deceased donors.
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PMID:Analysis of survival after primary liver transplantation: multivariate analysis of 155 cases in a single center. 2030 80

Critical limb ischemia in patients with diabetes at the organ complication stage represents a considerable challenge in vascular medicine. Because of the complexity of the disease and the often symmetric involvement of both lower limbs, a discrepancy between suitable vascular conduit availability and the actual requirement can occur: notably, the prevalence of multilevel and diffuse arterial disease often limits the possibilities of endovascular treatment, and, in surgical cases, frequently prohibits the effective use of prosthetic material. In our patient with bilateral critical limb ischemia and previous coronary artery bypass graft followed by cardiac transplantation, only one great saphenous vein remained available. That was used in its entirety to salvage one limb as a sequential femorocrural bypass. A similar surgical procedure with a fresh arterial allograft retrieved from a deceased donor was performed on the other extremity . ABO compatibility as well as the chronic immunosuppressive therapy in a heart transplant recipient may have contributed to the favorable long-term clinical outcome of the allogeneic arterial reconstruction.
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PMID:The seven-year' secondary patency of a fresh arterial allograft in the femorocrural position in a heart transplant recipient. 2059 50

Diagnosis of liver allograft antibody-mediated rejection (AMR) is difficult and requires a constellation of clinical, laboratory and histologic features that support the disease and exclude other causes. Histologic features of AMR may intermix with those of biliary obstruction, preservation/reperfusion injury, and graft ischemia. Tissue examination for complement degradation product 4d (C4d) has been proved to support this diagnosis in other allografts. For this reason, we conducted a retrospective review of all ABO compatible/identical re-transplanted liver patients with primary focus on identifying AMR as a possible cause of graft failure and to investigate the utility of C4d in liver allograft specimens. We reviewed 193 liver samples obtained from 53 consecutive ABO-compatible re-transplant patients. 142 specimens were stained with C4d. Anti-donor antibody screening and identification was determined by Luminex100 flow cytometry. For the study analysis, patients were stratified into 3 groups according to time to graft failure: group A, patients with graft failure within 0-7 days (n=7), group B within 8-90 days (n=13) and C >90 days (n=33). Two patients (3.7%) met the diagnostic criteria of acute AMR. Both patients experienced rapid decline of graft function with presence of donor specific antibodies (DSA), morphologic evidence of humoral rejection and C4d deposition in liver specimens. C4d-positive staining was identified in different medical liver conditions i.e., acute cellular rejection (52%), chronic ductopenic rejection (50%), recurrent liver disease (48%), preservation injury (18%), and hepatic necrosis (54%). Univariate analysis showed no significant difference of C4d-positive staining among the 3 patients groups, or patients with DSA (P>.05). In conclusion, AMR after ABO-compatible liver transplantation is an uncommon cause of graft failure. Unlike other solid organ allografts, C4d-positive staining is not a rugged indicator of humoral rejection, thus, interpretation should be done with caution to avoid diagnostic dilemmas.
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PMID:Significance of complement split product C4d in ABO-compatible liver allograft: diagnosing utility in acute antibody mediated rejection. 2190 4

Despite improvement in early outcome, rejection particularly chronic allograft enteropathy continues to be a major barrier to long-term visceral engraftment. The potential role of donor specific antibodies (DSA) was examined in 194 primary adult recipients. All underwent complement-dependent lymphocytotoxic crossmatch (CDC-XM) with pre- and posttransplant solid phase HLA-DSA assay in 156 (80%). Grafts were ABO-identical with random HLA-match. Liver was included in 71 (37%) allografts. Immunosuppression was tacrolimus-based with antilymphocyte recipient pretreatment in 150 (77%). CDC-XM was positive in 55 (28%). HLA-DSA was detectable before transplant in 49 (31%) recipients with 19 continuing to have circulating antibodies. Another 19 (18%) developed de novo DSA. Ninety percent of patients with preformed DSA harbored HLA Class-I whereas 74% of recipients with de novo antibodies had Class-II. Gender, age, ABO blood-type, cold ischemia, splenectomy and allograft type were significant DSA predictors. Preformed DSA significantly (p < 0.05) increased risk of acute rejection. Persistent and de novo HLA-DSA significantly (p < 0.001) increased risk of chronic rejection and associated graft loss. Inclusion of the liver was a significant predictor of better outcome (p = 0.004, HR = 0.347) with significant clearance of preformed antibodies (p = 0.04, OR = 56) and lower induction of de novo DSA (p = 0.07, OR = 24). Innovative multifaceted anti-DSA strategies are required to further improve long-term survival particularly of liver-free allografts.
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PMID:Preformed and de novo donor specific antibodies in visceral transplantation: long-term outcome with special reference to the liver. 2294 59


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