移植技术与研究

Introduction

Recognizing factors influencing kidney transplantation results may significantly affect therapeutic decisions made before, during and post transplantation.

Aim of the study

The aim of the study was to analyse factors influencing kidney graft function.

Material and methods

The group of 993 patients who received kidney graft from deceased and living donors, at Department of General and Transplantation Surgery, Baby Jesus Clinical Hospital in Warsaw, between January 1996 and August 2010 was analysed regarding factors that may have an influence on kidney transplantation results. Factors contingent from donor, recipient and time of kidney preservation were analysed.

Results

A multivariate analysis exhibited that time of dialyses prior transplantation is statistically significant factor influencing recipient’s survival (p=0.017). We proved that donor age is a variable that affects both recipient and graft survival. The higher number of mismatches HLA, the lower graft survival (p=0,0028). Cold ischaemia time (CIT) (OR=1.182), HBV infection (OR=1.58) as well as number of mismatch HLA (OR=1.1496), are the factors that influenced on frequency of delayed graft function (DGF) episodes. Moreover, we evidenced that the cause of graft failure affects graft survival. Patients, who suffer from IgA nephropathy, as well as hypertensive nephropathy, have the worst survival ratio after kidney transplantation. Patients who had had received a kidney graft from cadaveric donor with intracranial bleeding had higher creatinine serum concentration up to 5 years post transplantation in comparison with recipients whose kidney had come from donor with cranial trauma (p<0.005).

Conclusions

Factors that significantly influence on kidney graft function are: time of dialyses prior transplantation, number of mismatch HLA, cause of renal failure, HBV infection and CIT.

Objective: To provide review of our experience in vascular anastomosis technique for kidney transplantation patients.

Material and Methods: 100 chronic kidney disease patients 89 males and 11females with mean age 23.5 ± 3 years have been operated for kidney transplantation from January 2011 through April 2015. Vascular part of operation was done using parachute suture technique and arteriotomy by aortic punch. Recipients were prospectively entered into a database and retrospectively reviewed. Data collected included the warm and cold ischemic time, arterial and venous anastomotic time, color Doppler ultrasonography examination of the anastomosis site on 1, 7 postoperative days, mean serum creatinine level on 3, 14 days after the operation and any early or late postoperative complications.

Results: Mean kidney warm and cold ischemia time was 7.5 ± 4minutes and 21.5 ± 7minutes respectively. Mean arterial and venous anastomotic time was 7.2 ± 9 minutes and 8 ± 4 minutes respectively. All allografts had single artery. Renal arteries were anastomosed to (53%) common iliac arteries, (40%) external iliac arteries, (6%) internal iliac arteries and just (1%) to lower aorta in recipients; however, allograft renal veins were anastomosed to (95%) common iliac vein and (5%) inferior vena cava recipients.

No vascular complications were detected in the early postoperative period by Doppler ultrasonography examination. The mean serum creatinine level on the 3the and 14the days after the operation was 0.9 (range, 0.5-4 mg/dl) and 0.6(range 0.5-1.2 mg/dl) respectively. Slow graft function was diagnosed in 2patients, with a good perfusion of the allografts showed by renal scan. During a mean follow-up of 4 years, we did not encounter any case of renal artery or venous thrombosis or any suspected arterial stenosis.

Conclusions: The parachute suture technique is safe and straightforward method for arterial and venous anastomosis in renal transplantation with low complication rates. Using aortic punch for arteriotomy facilitates the arterial anastomosis, which may results in excellent kidney function without stenosis of the renal artery.

Background: We report a rare case of incidental allograft liver schistosomiasis within the United States.

Methods: A 52-year-old Filipino female received a liver transplant for decompensated cirrhosis and hepatocellular carcinoma secondary to hepatitis B viral infection and alcoholic liver disease.

Results: Her posttransplant course was unremarkable. However, a protocol liver allograft biopsy revealed multiple dead and calcified Schistosoma eggs. The patient’s explant liver showed cirrhosis but no signs of Schistosoma. This finding of incidental hepatic schistosomiasis prompted a retrospective review of the donor’s profile. The donor had no history of liver disease, schistosomiasis, or any signs to suggest an active parasitic infection. It was elected to follow this patient without any empirical treatment. The patient was discharged on standard posttransplant immunosuppression. Currently after four months of followup she remains disease free.

Conclusions: With many immigrants migrating into the United States, plausible guidelines are necessary at large liver transplant centers in regard as screening donor livers and management for Schistosoma

Existing experimental models of cardiac lesion do not allow precise reproducible dimensions of injury with complete safeness of surrounding tissues and cannot answer the tremendous question for heart cell therapy: are the implanted cells unable to influence the heart healing process or do the conditions in the injured heart prevent their complete development and integration?
60 rats were used for elaborating an alternative technique of cardiac lesion.
The anterior apical area of the heart was cauterized with a «Cautery high temperature fine tip» to create an injury of controllable, precise and reproducible dimensions (8×8 mm² surface, 1 mm depth).
To evaluate functional and morphological characteristics of the lesion, electrocardiography, pulse oximetry, echocardiography and optic microscopy were performed at different times (from day 0 to 230) after the operation.
After technical adjustment a 100% survival of the last 15 operated animals was obtained. A sub epicardium “infarction” was documented: ECG mirror ST-modifications in 2 leads, stable ejection fraction significant decrease, necrotic alterations and fibrosis of the lesion area, with surrounding myocardium preserved.
The survival and the injury evolution suggest that the proposed technique could be used for studies concerning cardiac tissue repair.

Liver transplant is considered is the only treatment for liver cirrhosis. Despite the success of organ transplantation, the treatment requires lifelong immunosuppression and major limitation is the availability of donor liver. Hepatic progenitor cell transplantation (HSCT) offers novel but challenging alternatives therapy to liver transplantation for management of liver cirrhosis. In this study, we investigated the cellular immune response by monitoring T-cell, NK-cell and cytokines which play major role in cellular rejection. A total of 5 patients with decompensated liver cirrhosis were enrolled in the study. T-cell (CD3, CD4 and CD8), NK-cells (CD16) was monitored before (Day-1) and after transplantation (Day 1, 7, 15, 30) of human fetal liver-derived EPCAM+Ve cell by flowcytometry. Before and after transplantation, Cytokinelevels (IL2, TNFβ, IFNα, IFNγ and INFβ) were also measured by ELISA. Study has demonstrated that after HSCT patient showed marked clinical recovery and decline in the MELD score and there was no significant increase found in cell mediated response and cytokine levels between pre and post transplantation. Hence this preliminary study demonstrated human fetal liver- derived EPCAM+Ve stem cell transplantation is safety for end stage liver cirrhosis.

Objective: There is still a lack of organs for transplantation purposes. In the field of kidney and liver transplantation one of available solutions is the use of organs from so-called marginal donors. These donors can be e.g. non-heartbeating donors (NHBD). In these cases perfusion and preservation of organs intended for transplantation is generally more difficult. Retrograde oxygen persufflation (ROP) may be one of the possible solutions of this issue. This method is based on retrograde perfusion by oxygen through the renal vein thus reconditioning the organ.
Materials and methods: We have operated on 10 animals (porcine models). In all animals was simulated ischemic injury of right kidney. In Group A (N=5) were kidneys after explantation perfused with retrograde oxygen persufflation. In group B (N=5) were kidneys perfused intrarterialy like usually in clinical practice. After perfusion were all kidneys again transplanted to the same animal. Quality of graft restitution was evaluated by urea level taken from renal vein and by histopathological analysis after explantation.
Results: We have found no statistically significant differences between the groups A and B in urea levels after transplantation as wel as we have found no significant differences in quality of kidney parenchyma restoration in both groups.
Conclusions: Retrograde oxygen persufflation is able to protect and restore kidney parenchyma.