Postoperative biliary complications remain a substantial challenge after living donor liver transplantation,especially due to its heterogeneous clinical presentation.
Objective To summarize preservation measures of donor’s heart and lung,and postoperative imrnunotherapy,as well as clinical experience of discrimination and management for graft rejection. Methods Clinical data of 2 ...Objective To summarize preservation measures of donor’s heart and lung,and postoperative imrnunotherapy,as well as clinical experience of discrimination and management for graft rejection. Methods Clinical data of 2 cases of heart - lung transplantation in our depart-展开更多
Liver transplantation(LT)represents a life-saving surgical procedure and is considered the current standard of care for the majority of patients having end-stage liver disease.As known,significant progress in organ pr...Liver transplantation(LT)represents a life-saving surgical procedure and is considered the current standard of care for the majority of patients having end-stage liver disease.As known,significant progress in organ preservation techniques,perioperative care,and strict immunosuppression protocols are associated with favorable patient/graft survival post-LT.Hence,proper evaluation of liver allograft-related complications among survivors has paid great attention,particularly the rejection sequel after LT.It is a seriously underestimated cause of allograft injury,which pushes researchers for understanding the exact pathogenesis of different types and proper time diagnosis for better management of such complications.However,it still represents a challenge because of the complexities related to diagnosis and histopathology.Hence,increasing clinical awareness with earlier diagnosis of post-LT rejection is essential through stimulating further studies.Therefore,our review will focus on the clinicopathological debates regarding liver allograft loss after transplantation.展开更多
Organ transplantation is an effective therapeutic tool for treating many terminal diseases.However,one of the biggest challenges of transplantation is determining how to achieve the long-term survival of the allogenei...Organ transplantation is an effective therapeutic tool for treating many terminal diseases.However,one of the biggest challenges of transplantation is determining how to achieve the long-term survival of the allogeneic or xenogeneic transplant by,for example,preventing transplant rejection.In the current study,CD26 gene-knockout mice were used to investigate the potential role of CD26/dipeptidyl peptidase-4(DPPIV)in allogeneic skin graft rejection by tail-skin transplantation.Compared with wild-type(CD26^(+/+))counterparts,CD26^(-/-)mice showed reduced necrosis of grafts and delayed graft rejection after skin transplantation.Concentrations of serum IgG,including its subclasses IgG1 and IgG2a,were significantly reduced in CD26^(-/-)mice during graft rejection.Moreover,after allogeneic skin transplantation,the secretion levels of the cytokines IFN-γ,IL-2,IL-6,IL-4,and IL-13 were significantly reduced,whereas the level of the cytokine IL-10 was increased in the serum of CD26^(-/-)mice compared with that in the serum of CD26^(+/+)mice.Additionally,the concentration of IL-17 in serum and the percentage of cells secreting IL-17 in mouse peripheral blood lymphocytes(MPBLs)were both significantly lower,while the percentage of regulatory T cells(Tregs)was significantly higher in MPBLs of CD26^(-/-)mice than in those of CD26^(+/+)mice.Furthermore,a lower percentage of CD8^(+)T cells in MPBLs and fewer infiltrated macrophages and T cells in graft tissues of CD26^(-/-)mice were detected during graft rejection.These results indicate that CD26 is involved in allogeneic skin graft rejection and provides another hint that CD26 deficiency leads to less rejection due to lower activation and proliferation of host immune cells.展开更多
BACKGROUND Capecitabine(CAP)is a classic antimetabolic drug and has shown potential antirejection effects after liver transplantation(LT)in clinical studies.Our previous study showed that metronomic CAP can cause the ...BACKGROUND Capecitabine(CAP)is a classic antimetabolic drug and has shown potential antirejection effects after liver transplantation(LT)in clinical studies.Our previous study showed that metronomic CAP can cause the programmed death of T cells by inducing oxidative stress in healthy mice.Ferroptosis,a newly defined non-apoptotic cell death that occurs in response to iron overload and lethal levels of lipid peroxidation,is an important mechanism by which CAP induces cell death.Therefore,ferroptosis may also play an important role in CAP-induced T cell death and play an immunosuppressive role in acute rejection after transplantation.AIM To investigate the functions and underlying mechanisms of antirejection effects of metronomic CAP.METHODS A rat LT model of acute rejection was established,and the effect of metronomic CAP on splenic hematopoietic function and acute graft rejection was evaluated 7 d after LT.In vitro,primary CD3+T cells were sorted from rat spleens and human peripheral blood,and co-cultured with or without 5-fluorouracil(5-FU)(active agent of CAP).The levels of ferroptosis-related proteins,ferrous ion concentration,and oxidative stress-related indicators were observed.The changes in mitochondrial structure were observed using electron microscopy.RESULTS With no significant myelotoxicity,metronomic CAP alleviated graft injury(Banff score 9 vs 7.333,P<0.001),prolonged the survival time of the recipient rats(11.5 d vs 16 d,P<0.01),and reduced the infiltration rate of CD3+T cells in peripheral blood(6.859 vs 3.735,P<0.001),liver graft(7.459 vs 3.432,P<0.001),and spleen(26.92 vs 12.9,P<0.001),thereby inhibiting acute rejection after LT.In vitro,5-FU,an end product of CAP metabolism,induced the degradation of the ferritin heavy chain by upregulating nuclear receptor coactivator 4,which caused the accumulation of ferrous ions.It also inhibited nuclear erythroid 2 p45-related factor 2,heme oxygenase-1,and glutathione peroxidase 4,eventually leading to oxidative damage and ferroptosis of T cells.CONCLUSION Metronomic CAP can suppress acute allograft rejection in rats by triggering CD3+T cell ferroptosis,which makes it an effective immunosuppressive agent after LT.展开更多
Corneal transplantation is the most common surgical procedure amongst solid organ transplants with a high survival rate of 86% at 1-year post-grafting. This high success rate has been attributed to the immune privileg...Corneal transplantation is the most common surgical procedure amongst solid organ transplants with a high survival rate of 86% at 1-year post-grafting. This high success rate has been attributed to the immune privilege of the eye. However, mechanisms originally thought to promote immune privilege, such as the lack of antigen presenting cells and vessels in the cornea, are challenged by recent studies. Nevertheless, the immunological and physiological features of the cornea promoting a relatively weak alloimmune response is likely responsible for the high survival rate in "low-risk" settings. Furthermore, although corneal graft survival in "lowrisk" recipients is favourable, the prognosis in "high-risk" recipients for corneal graft is poor. In "high-risk" grafts, the process of indirect allorecognition is accelerated by the enhanced innate and adaptive immune responses due to pre-existing inflammation and neovascularization of the host bed. This leads to the irreversible rejection of the allograft and ultimately graft failure. Many therapeutic measures are being tested in pre-clinical and clinical studies to counter the immunological challenge of "high-risk" recipients. Despite the prevailing dogma, recent data suggest that tissue matching together with use of systemic immunosuppression may increase the likelihood of graft acceptance in "high-risk" recipients. However, immunosuppressive drugs are accompanied with intolerance/side effects and toxicity, and therefore, novel cell-based therapies are in development which target host immune cells and restore immune homeostasis without significant side effect of treatment. In addition, developments in regenerative medicinemay be able to solve both important short comings of allotransplantation:(1) graft rejection and ultimate graft failure; and(2) the lack of suitable donor corneas. The advances in technology and research indicate that wider therapeutic choices for patients may be available to address the worldwide problem of corneal blindness in both "low-risk" and "high-risk" hosts.展开更多
BACKGROUND In a previous paper,we reported a high prevalence of donor-specific antibody(DSA)in pediatric patients with chronic rejection and expressed the need for confirmation of these findings in a larger cohort.AIM...BACKGROUND In a previous paper,we reported a high prevalence of donor-specific antibody(DSA)in pediatric patients with chronic rejection and expressed the need for confirmation of these findings in a larger cohort.AIM To clarify the importance of DSAs on long-term graft survival in a larger cohort of pediatric patients.METHODS We performed a retrospective analysis of 123 pediatric liver transplantation(LT)recipients who participated in yearly follow-ups including Luminex testing for DSA at our center.The cohort was split into two groups according to the DSA status(DSA-positive n=54,DSA-negative n=69).Groups were compared with regard to liver function,biopsy findings,graft survival,need for re-LT and immunosuppressive medication.RESULTS DSA-positive pediatric patients showed a higher prevalence of chronic rejection(P=0.01),fibrosis(P<0.001)and re-transplantation(P=0.018)than DSA-negative patients.Class II DSAs particularly influenced graft survival.Alleles DQ2,DQ7,DQ8 and DQ9 might serve as indicators for the risk of chronic rejection and/or allograft fibrosis.Mean fluorescence intensity levels and DSA number did not impact graft survival.Previous episodes of chronic rejection might lead to DSA development.CONCLUSION DSA prevalence significantly affected long-term liver allograft performance and liver allograft survival in our cohort of pediatric LT.Screening for class II DSAs in combination with assessment of protocol liver biopsies for chronic antibodymediated rejection improved early identification of patients at risk of graft loss.展开更多
During post-transplant evolution, adolescents may present problems with adherence to treatment, becoming a high-risk group for graft loss. Here, we report a case which describes an adolescent patient who lost a graft ...During post-transplant evolution, adolescents may present problems with adherence to treatment, becoming a high-risk group for graft loss. Here, we report a case which describes an adolescent patient who lost a graft due to humoral rejection associated with lack of adherence to treatment. During chronic peritoneal dialysis therapy, the patient developed pain and increased volume in the graft area, fever, gross hematuria and leukocyturia upon urine examination. The patient was diagnosed with graft immune intolerance syndrome and transplantectomy was suggested. Finally, a graft embolization was performed. A decrease in symptoms was observed until the patient became asymptomatic.展开更多
Objective To investigate the clinical efficacy of mycophenolate mofetil(MMF) with low dose CsA for chronic rejection in primary cadaveric renal recipients. Methods A total of 8 renal recipients who were clinically d...Objective To investigate the clinical efficacy of mycophenolate mofetil(MMF) with low dose CsA for chronic rejection in primary cadaveric renal recipients. Methods A total of 8 renal recipients who were clinically diagnosed as chronic rejection were given triimmunosuppressive agents: MMF 1.5～2.0 g/d+ CsA 2 to 3 mg/kg*d-1 and pred 10 mg/d.Results Blood creatinine reduced to normal level and urine protein disappeared in five cases, blood creatinine and urine protein decreased obviously in two cases, and kidney function deteriorated in another patient 4 to 9 weeks after this strategy. No acute rejection episodes or liver damage occurred among these patients during treatment. White blood cells reduced in one case, but it improved after therapy. Conclusion MMF combined with low dose CsA can bring a considerable efficacy in reversing chronic rejection of renal recipients. This immunosuppressive strategy may be a useful routine in the treatment of chronic rejection.展开更多
Pancreatic islet transplantation is a minimally invasive procedure aiming to reverse the effects of insulin deficiency in patients with type 1 diabetes(T1D)by transplanting pancreatic beta cells.Overall,pancreatic isl...Pancreatic islet transplantation is a minimally invasive procedure aiming to reverse the effects of insulin deficiency in patients with type 1 diabetes(T1D)by transplanting pancreatic beta cells.Overall,pancreatic islet transplantation has improved to a great extent,and cellular replacement will likely become the mainstay treatment.We review pancreatic islet transplantation as a treatment for T1D and the immunological challenges faced.Published data demonstrated that the time for islet cell transfusion varied between 2 and 10 h.Approximately 54%of the patients gained insulin independence at the end of the first year,while only 20%remained insulin-free at the end of the second year.Eventually,most transplanted patients return to using some form of exogenous insulin within a few years after the transplantation,which imposed the need to improve immunological factors before transplantation.We also discuss the immunosuppressive regimens,apoptotic donor lymphocytes,anti-TIM-1 antibodies,mixed chimerism-based tolerance induction,induction of antigen-specific tolerance utilizing ethylene carbodiimide-fixed splenocytes,pretransplant infusions of donor apoptotic cells,B cell depletion,preconditioning of isolated islets,inducing local immunotolerance,cell encapsulation and immunoisolation,using of biomaterials,immunomodulatory cells,etc.展开更多
Background: Although not life-saving procedures like liver or heart transplantation, renal transplantation is the preferred treatment for many patients with end-stage renal disease because it improves patients’ quali...Background: Although not life-saving procedures like liver or heart transplantation, renal transplantation is the preferred treatment for many patients with end-stage renal disease because it improves patients’ quality of life, while other forms of renal replacement therapy (RRT) such as haemodialysis (HDX) shown to regain only 10% of the patient’s renal function [1]. Transplantation releases patients from the dietary and fluid restrictions and the physical constraints imposed by other forms of (RRT), patients become able to return to their normal activities. Patient’s 5-year survival is higher post transplant. Patients and methods: This is Descriptive, retro-prospective, cross sectional analytic and multicentre study done in Ahmed Gasim Cardiac and Renal Transplant Centre including 105 patients. After meeting the Inclusion Criteria and exclusion Criteria, then cases were selected and written in constructed questionnaire. The aim of the study was to evaluate the outcome of renal transplantation in Sudan. Results: 105 cases were used with male predominate and ratio male to female ratio 3:1, the main age of presentation between 31 - 45 years, most of the patients discharge uneventful with good outcome. During one-year follow-up following renal transplantation. Patient survival 95.2 % graft survival 82.4%. Overall morbidity shows 70.5%. Conclusion: this study showed that the one-year patient survival of 95.2%. Actuarial one-year graft survival of 92.4%. Renal transplantation complications can be reduced by meticulous preoperative workup including good cardiovascular assessment, tissue mismatch and BMI good postoperative follow up for early detection of graft rejection and long-term complications and finally patient education.展开更多
AIM:To assess the effect of human leukocyte antigen(HLA) mismatching on liver graft outcome and acute rejection from a meta-analysis of available cohort studies.METHODS:Articles in PubMed/MEDLINE,EMBASE and the Cochra...AIM:To assess the effect of human leukocyte antigen(HLA) mismatching on liver graft outcome and acute rejection from a meta-analysis of available cohort studies.METHODS:Articles in PubMed/MEDLINE,EMBASE and the Cochrane database from January 1970 to June 2009,including non-English literature identified in these databases,were searched.Only studies comparing HLA or sub-phenotype matching with mismatching were extracted.The percentage of graft survival was extracted by "Engauge Digitizer" from survival curves if the raw data were not displayed.A meta-analysis was performed when at least 3 studies provided data.RESULTS:Sixteen studies met the inclusion criteria.A lower number of HLA mismatches(0-2 vs 3-6) did reduce the incidence of acute rejection(relative risk:0.77,P = 0.03).The degree of HLA mismatching(0-2 vs 3-6) had no significant effect on 1-year [hazard ratio(HR):1.04,P = 0.68] and 5-year(HR:1.09,P = 0.38) graft survival.In sub-phenotype analysis,the degree of HLA-A,B and DR mismatching(0 vs 1-2) had no significant effect on 1-year and 5-year graft survival,either.The HRs and P-values were 0.95,0.71(HLA-A,1-year);1.06,0.60(HLA-A,5-year);0.77,0.16(HLA-B,1-year);1.07,0.56(HLA-DR,1-year);1.18,0.23(HLADR,5-year),respectively.CONCLUSION:The results of this systematic review imply that good HLA compatibility can reduce the incidence of acute rejection in spite of having no influence on graft outcomes.To obtain a short recovery time and minimize rejection post transplantation,HLA matching studies should be considered before the operation.展开更多
Background:The shortage of donor liver restricts liver transplantation(LT).Nowadays,donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver...Background:The shortage of donor liver restricts liver transplantation(LT).Nowadays,donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver.Although it is now possible to perform ABO-incompatible(ABO-I)LT,antibody-mediated rejection(AMR)has been recognized as the primary cause of desperate outcomes after ABO-I LT.Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury.Therapeutic plasma ex-change(TPE)can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity.Data sources:We searched PubMed and CNKI databases using search terms“therapeutic plasma ex-change”,“ABO-incompatible liver transplantation”,“ABO-I LT”,“liver transplantation”,“LT”,“antibody-mediated rejection”,and“AMR”.Additional publications were identified by a manual search of references from key articles.The relevant publications published before September 30,2020 were included in this review.Results:Different centers have made different attempts on whether to use TPE,when to use TPE and how often to use TPE.However,the control standard of lectin revision level is always controversial,the target titer varies significantly from center to center,and the standard target titer has not yet been estab-lished.TPE has several schemes to reduce antibody titers,but there is a lack of clinical trials that provide standardized procedures.Conclusions:TPE is essential for ABO-I LT.Hence,further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.展开更多
BACKGROUND Biliary complications(BCs)after liver transplantation(LT)remain a considerable cause of morbidity,mortality,increased cost,and graft loss.AIM To investigate the impact of BCs on chronic graft rejection,graf...BACKGROUND Biliary complications(BCs)after liver transplantation(LT)remain a considerable cause of morbidity,mortality,increased cost,and graft loss.AIM To investigate the impact of BCs on chronic graft rejection,graft failure and mortality.METHODS From 2011 to 2016,215 adult recipients underwent right-lobe living-donor liver transplantation(RT-LDLT)at our centre.We excluded 46 recipients who met the exclusion criteria,and 169 recipients were included in the final analysis.Donors’and recipients’demographic data,clinical data,operative details and postoperative course information were collected.We also reviewed the management and outcomes of BCs.Recipients were followed for at least 12 mo post-LT until December 2017 or graft or patient loss.RESULTS The overall incidence rate of BCs including biliary leakage,biliary infection and biliary stricture was 57.4%.Twenty-seven(16%)patients experienced chronic graft rejection.Graft failure developed in 20(11.8%)patients.A total of 28(16.6%)deaths occurred during follow-up.BCs were a risk factor for the occurrence of chronic graft rejection and failure;however,mortality was determined by recurrent hepatitis C virus infection.CONCLUSION Biliary complications after RT-LDLT represent an independent risk factor for chronic graft rejection and graft failure;nonetheless,effective management of these complications can improve patient and graft survival.展开更多
Lung transplantation(LT)is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease.Furthermore,as a therapeutic option for high-risk candidates,single LT(SLT)can be feasible ...Lung transplantation(LT)is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease.Furthermore,as a therapeutic option for high-risk candidates,single LT(SLT)can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single(double)LT(SSLTx).Still,the long-term overall survival is,in general,better for SSLTx.Despite the great success over the years,the early post-SLT period remains a perilous time for these patients.Patients who undergo SLT are predisposed to evolving early or late postoperative complications.This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction,native lung complications,anastomosis complications,infections,cardiovascular,gastrointestinal,renal,and metabolite complications,and their association with morbidity and mortality in these patients.Furthermore,we discuss the incidence of malignancy after SLT and their correlation with immunosuppression therapy.展开更多
AIM:To evaluate the midterm outcomes of penetrating keratoplasty(PK)following allogeneic cultivated limbal epithelial transplantation(CLET)for bilateral total limbal stem cell deficiency(LSCD).METHODS:Ten patients(10 ...AIM:To evaluate the midterm outcomes of penetrating keratoplasty(PK)following allogeneic cultivated limbal epithelial transplantation(CLET)for bilateral total limbal stem cell deficiency(LSCD).METHODS:Ten patients(10 eyes)with bilateral LSCD were enrolled in this prospective noncomparative case series study.Each participant underwent PK approximately 6 mo after a CLET.Topical tacrolimus,topical and systemic steroids,and oral ciclosporin were administered postoperatively.Best-corrected visual acuity(BCVA),intraocular pressure(IOP),ocular surface grading scores(OSS),corneal graft epithelial rehabilitation,persistent epithelial defect(PED),immunological rejection,and graft survival rate were assessed.RESULTS:The time interval between PK and allogeneic CLET was 6.90±1.29(6-10)mo.BCVA improved from 2.46±0.32 log MAR preoperatively to 0.77±0.55 log MAR post-PK(P<0.001).Kaplan-Meier analysis of mean graft survival revealed graft survival rates of 100%at 12 and 24 mo and 80.0%at 36 mo.PEDs appeared in 5 eyes at different periods post-PK,and graft rejection occurred in 4 eyes.The total OSS decreased from 12.4±4.4 before allogeneic CLET to 1.4±1.51 after PK.CONCLUSION:A sequential therapy design of PK following allogeneic CLET can maintain a stable ocular surface with improved BCVA despite the relatively high graft rejection rate.展开更多
BACKGROUND Once daily tacrolimus regimen was found to exhibits similar bioavailability,safety and efficacy properties compared to twice-daily tacrolimus in kidney transplantation patients.AIM To compare the efficacy a...BACKGROUND Once daily tacrolimus regimen was found to exhibits similar bioavailability,safety and efficacy properties compared to twice-daily tacrolimus in kidney transplantation patients.AIM To compare the efficacy and safety of once-daily prolonged release tacrolimus compared to twice-daily tacrolimus in liver transplantation patients.METHODS MEDLINE,EMBASE,CENTRAL databases were searched for clinical trials until December 2020.Efficacy outcome measured as the rate of treatment failure indicated by biopsy-proven acute rejection,Serum creatinine,graft loss,or death.Two reviewers independently selected studies,collected data and assessed risk of bias.The results are reported as risk ratio with 95%confidence interval(CI)for dichotomous data.RESULTS Seven studies included with 965 patients.All the included studies were of moderate quality according to the risk of bias assessment using Cochrane Risk of Bias tool.Biopsy-proven acute rejection was reported in four studies,and pooled analysis of those studies indicated similar rejections in both twice daily and once daily tacrolimus groups(risk ratio:1.06,95%CI:0.84-1.34,n=758,I2=0%)and also we found no significant difference between both groups for renal outcome(serum creatinine;mean difference,0.001 mg/dL,95%CI:-0.042 to 0.043,n=846,I2=18.6%).Similarly,there was similar number of adverse events such as hypertension,headache,back pain,blood related disorders,infections and nausea observed in both groups.CONCLUSION The analysis findings confirm that both once daily and twice daily tacrolimus formulations are comparable in terms of efficacy and safety outcomes.展开更多
Transplant recipients usually have increased chances of graft rejection and graft vs host disease,requiring chronic immunosuppressive therapy.Nonetheless,longterm immunosuppression risks malignancies such as skin canc...Transplant recipients usually have increased chances of graft rejection and graft vs host disease,requiring chronic immunosuppressive therapy.Nonetheless,longterm immunosuppression risks malignancies such as skin cancer,lymphoma,and Kaposi sarcoma.However,there are very few studies that included solid organ transplant recipients while studying the efficacy of immunotherapy.“Immunotherapy after liver transplantation:Where are we now?”is a study,where the authors described the mechanism of action and outcomes of immune checkpoint inhibitors specific to liver transplant recipients.The authors reported the graft rejection rates and the factors contributing to the rejection in the liver transplant recipients.展开更多
BACKGROUND Immunosuppression(IS)therapy may contribute to cancer development.Some authors have proposed to reduce immunosuppression drugs dose in case of viral infections,in immunosuppression-related diseases,and in p...BACKGROUND Immunosuppression(IS)therapy may contribute to cancer development.Some authors have proposed to reduce immunosuppression drugs dose in case of viral infections,in immunosuppression-related diseases,and in patients undergoing radiotherapy.The present analysis reports the results of a systematic review on kidney transplant recipients undergoing immunosuppression and radiotherapy.AIM To define if it is necessary reduce immunosuppression drugs during radiotherapy.METHODS The literature search was based on three electronic databases(Pubmed,Scopus,and Web of Science)using selected keywords linked through the"AND"and"OR"Boolean operators to build specific strings for each electronic search engine.Two researchers independently screened the citations,and disagreement was resolved by discussion or through the intervention of a third author.The review was conducted and reported according to the PRISMA statement.Extracted data were narratively synthesized,and,where possible,frequencies,percentages,and ranges were calculated.RESULTS The literature search resulted in 147 citations.After abstracts screening,21 records were selected for full-text evaluation.Fifteen of these were excluded,leaving six papers considered suitable for analysis.There is still no clear evidence that withdrawing antimetabolites and/or calcineurin inhibitors and/or mammalian target of rapamycin-inhibitors,as opposed to continuing maintenance IS,improves patient survival in kidney transplant recipients with cancer undergoing radiotherapy.Only few retrospective studies on small cancer patient cohorts are available in this setting,but without comparison of different immunosuppression treatments.Even where immunosuppression therapy was described,patient survival seemed to be correlated only with cancer stage and type.CONCLUSION The results of this systematic review do not support the reduction of immunosuppression dose in patients undergoing radiotherapy.展开更多
The aim of the work was to analyze and expose the donor and recipient riskfactors in pancreas transplantation. In the following paper, we exposed the 2018Spanish Consensus Document on Donor and Recipient Selection Cri...The aim of the work was to analyze and expose the donor and recipient riskfactors in pancreas transplantation. In the following paper, we exposed the 2018Spanish Consensus Document on Donor and Recipient Selection Criteria forPancreas Transplantation. An assessment of the previous Selection Criteria forDonors and Recipients of Pancreas Transplantation, published in 2005 by theSpanish Pancreas Transplant Group (GETP) and the National TransplantOrganization (ONT) was performed. A literature review was performed usingCochrane Library, PubMed and Google Scholar databases. Some of the followingterms were used for the literature search: “Diabetes Mellitus,” “PancreasTransplantation,” “Insulin-Secreting Cells,” “Pancreas Allograft Thrombosis,”“Allograft Pancreatitis,” “Donors’ Risk Factors,” “Recipients’ Risk Factors,”“Pancreas Allograft Rejection” and “Pancreas Allograft Survival.” After anextended search, different inclusion criteria were established. Articles anddocuments with abstracts of full text and in English or Spanish language wereselected. Subsequently, different scientific meetings took place during 2015 and2016 by the GETP. Finally, the updated criteria were published by the GETP andONT in 2018. Several risk factors have been described in pancreas transplantationthat can be divided into donor risk factors: Advanced age (> 50 years);high bodymass index (BMI) (> 30 kg/m2);cause of death (e.g., stroke);previoushyperglycemia;hyperamylasemia;cold ischemia time (greater than 8 or 12 h,depending on the type of donation);the use of vasopressors in the intensive careunit or cardiac arrest;and the macroscopic aspect of the pancreas allograft. Thefollowing are recipient risk factors: Advanced age (> 50 years);active smoking;high BMI (> 30 kg/m2);and peripheral artery disease or sensorimotorpolyneuropathy. Based on the aforementioned parameters, different selectioncriteria have been established for the recipients depending on the type of pancreastransplantation. Knowledge of the risk factors for pancreas transplantation allowsthe establishment of reliable selection criteria for choosing donors and recipients.展开更多
文摘Postoperative biliary complications remain a substantial challenge after living donor liver transplantation,especially due to its heterogeneous clinical presentation.
文摘Objective To summarize preservation measures of donor’s heart and lung,and postoperative imrnunotherapy,as well as clinical experience of discrimination and management for graft rejection. Methods Clinical data of 2 cases of heart - lung transplantation in our depart-
文摘Liver transplantation(LT)represents a life-saving surgical procedure and is considered the current standard of care for the majority of patients having end-stage liver disease.As known,significant progress in organ preservation techniques,perioperative care,and strict immunosuppression protocols are associated with favorable patient/graft survival post-LT.Hence,proper evaluation of liver allograft-related complications among survivors has paid great attention,particularly the rejection sequel after LT.It is a seriously underestimated cause of allograft injury,which pushes researchers for understanding the exact pathogenesis of different types and proper time diagnosis for better management of such complications.However,it still represents a challenge because of the complexities related to diagnosis and histopathology.Hence,increasing clinical awareness with earlier diagnosis of post-LT rejection is essential through stimulating further studies.Therefore,our review will focus on the clinicopathological debates regarding liver allograft loss after transplantation.
文摘Organ transplantation is an effective therapeutic tool for treating many terminal diseases.However,one of the biggest challenges of transplantation is determining how to achieve the long-term survival of the allogeneic or xenogeneic transplant by,for example,preventing transplant rejection.In the current study,CD26 gene-knockout mice were used to investigate the potential role of CD26/dipeptidyl peptidase-4(DPPIV)in allogeneic skin graft rejection by tail-skin transplantation.Compared with wild-type(CD26^(+/+))counterparts,CD26^(-/-)mice showed reduced necrosis of grafts and delayed graft rejection after skin transplantation.Concentrations of serum IgG,including its subclasses IgG1 and IgG2a,were significantly reduced in CD26^(-/-)mice during graft rejection.Moreover,after allogeneic skin transplantation,the secretion levels of the cytokines IFN-γ,IL-2,IL-6,IL-4,and IL-13 were significantly reduced,whereas the level of the cytokine IL-10 was increased in the serum of CD26^(-/-)mice compared with that in the serum of CD26^(+/+)mice.Additionally,the concentration of IL-17 in serum and the percentage of cells secreting IL-17 in mouse peripheral blood lymphocytes(MPBLs)were both significantly lower,while the percentage of regulatory T cells(Tregs)was significantly higher in MPBLs of CD26^(-/-)mice than in those of CD26^(+/+)mice.Furthermore,a lower percentage of CD8^(+)T cells in MPBLs and fewer infiltrated macrophages and T cells in graft tissues of CD26^(-/-)mice were detected during graft rejection.These results indicate that CD26 is involved in allogeneic skin graft rejection and provides another hint that CD26 deficiency leads to less rejection due to lower activation and proliferation of host immune cells.
基金Supported by National Key Research and Development Program of China,No.2020YFA0710802The Youth Science Fund of the Nature Science Foundation of Tianjin,No.20JCQNJC01370+1 种基金The Key Projects of Tianjin Science and Technology Project,No.21JCZDJC00160The Science Foundation of Tianjin Health Commission,No.ZC20065 and No.ZC20089.
文摘BACKGROUND Capecitabine(CAP)is a classic antimetabolic drug and has shown potential antirejection effects after liver transplantation(LT)in clinical studies.Our previous study showed that metronomic CAP can cause the programmed death of T cells by inducing oxidative stress in healthy mice.Ferroptosis,a newly defined non-apoptotic cell death that occurs in response to iron overload and lethal levels of lipid peroxidation,is an important mechanism by which CAP induces cell death.Therefore,ferroptosis may also play an important role in CAP-induced T cell death and play an immunosuppressive role in acute rejection after transplantation.AIM To investigate the functions and underlying mechanisms of antirejection effects of metronomic CAP.METHODS A rat LT model of acute rejection was established,and the effect of metronomic CAP on splenic hematopoietic function and acute graft rejection was evaluated 7 d after LT.In vitro,primary CD3+T cells were sorted from rat spleens and human peripheral blood,and co-cultured with or without 5-fluorouracil(5-FU)(active agent of CAP).The levels of ferroptosis-related proteins,ferrous ion concentration,and oxidative stress-related indicators were observed.The changes in mitochondrial structure were observed using electron microscopy.RESULTS With no significant myelotoxicity,metronomic CAP alleviated graft injury(Banff score 9 vs 7.333,P<0.001),prolonged the survival time of the recipient rats(11.5 d vs 16 d,P<0.01),and reduced the infiltration rate of CD3+T cells in peripheral blood(6.859 vs 3.735,P<0.001),liver graft(7.459 vs 3.432,P<0.001),and spleen(26.92 vs 12.9,P<0.001),thereby inhibiting acute rejection after LT.In vitro,5-FU,an end product of CAP metabolism,induced the degradation of the ferritin heavy chain by upregulating nuclear receptor coactivator 4,which caused the accumulation of ferrous ions.It also inhibited nuclear erythroid 2 p45-related factor 2,heme oxygenase-1,and glutathione peroxidase 4,eventually leading to oxidative damage and ferroptosis of T cells.CONCLUSION Metronomic CAP can suppress acute allograft rejection in rats by triggering CD3+T cell ferroptosis,which makes it an effective immunosuppressive agent after LT.
基金Supported by Saving Sight in Grampian,Development Trust of University of Aberdeen,United KingdomAction Medical Research United Kingdom(grant SP4328)Link?ping University,Sweden
文摘Corneal transplantation is the most common surgical procedure amongst solid organ transplants with a high survival rate of 86% at 1-year post-grafting. This high success rate has been attributed to the immune privilege of the eye. However, mechanisms originally thought to promote immune privilege, such as the lack of antigen presenting cells and vessels in the cornea, are challenged by recent studies. Nevertheless, the immunological and physiological features of the cornea promoting a relatively weak alloimmune response is likely responsible for the high survival rate in "low-risk" settings. Furthermore, although corneal graft survival in "lowrisk" recipients is favourable, the prognosis in "high-risk" recipients for corneal graft is poor. In "high-risk" grafts, the process of indirect allorecognition is accelerated by the enhanced innate and adaptive immune responses due to pre-existing inflammation and neovascularization of the host bed. This leads to the irreversible rejection of the allograft and ultimately graft failure. Many therapeutic measures are being tested in pre-clinical and clinical studies to counter the immunological challenge of "high-risk" recipients. Despite the prevailing dogma, recent data suggest that tissue matching together with use of systemic immunosuppression may increase the likelihood of graft acceptance in "high-risk" recipients. However, immunosuppressive drugs are accompanied with intolerance/side effects and toxicity, and therefore, novel cell-based therapies are in development which target host immune cells and restore immune homeostasis without significant side effect of treatment. In addition, developments in regenerative medicinemay be able to solve both important short comings of allotransplantation:(1) graft rejection and ultimate graft failure; and(2) the lack of suitable donor corneas. The advances in technology and research indicate that wider therapeutic choices for patients may be available to address the worldwide problem of corneal blindness in both "low-risk" and "high-risk" hosts.
文摘BACKGROUND In a previous paper,we reported a high prevalence of donor-specific antibody(DSA)in pediatric patients with chronic rejection and expressed the need for confirmation of these findings in a larger cohort.AIM To clarify the importance of DSAs on long-term graft survival in a larger cohort of pediatric patients.METHODS We performed a retrospective analysis of 123 pediatric liver transplantation(LT)recipients who participated in yearly follow-ups including Luminex testing for DSA at our center.The cohort was split into two groups according to the DSA status(DSA-positive n=54,DSA-negative n=69).Groups were compared with regard to liver function,biopsy findings,graft survival,need for re-LT and immunosuppressive medication.RESULTS DSA-positive pediatric patients showed a higher prevalence of chronic rejection(P=0.01),fibrosis(P<0.001)and re-transplantation(P=0.018)than DSA-negative patients.Class II DSAs particularly influenced graft survival.Alleles DQ2,DQ7,DQ8 and DQ9 might serve as indicators for the risk of chronic rejection and/or allograft fibrosis.Mean fluorescence intensity levels and DSA number did not impact graft survival.Previous episodes of chronic rejection might lead to DSA development.CONCLUSION DSA prevalence significantly affected long-term liver allograft performance and liver allograft survival in our cohort of pediatric LT.Screening for class II DSAs in combination with assessment of protocol liver biopsies for chronic antibodymediated rejection improved early identification of patients at risk of graft loss.
文摘During post-transplant evolution, adolescents may present problems with adherence to treatment, becoming a high-risk group for graft loss. Here, we report a case which describes an adolescent patient who lost a graft due to humoral rejection associated with lack of adherence to treatment. During chronic peritoneal dialysis therapy, the patient developed pain and increased volume in the graft area, fever, gross hematuria and leukocyturia upon urine examination. The patient was diagnosed with graft immune intolerance syndrome and transplantectomy was suggested. Finally, a graft embolization was performed. A decrease in symptoms was observed until the patient became asymptomatic.
文摘Objective To investigate the clinical efficacy of mycophenolate mofetil(MMF) with low dose CsA for chronic rejection in primary cadaveric renal recipients. Methods A total of 8 renal recipients who were clinically diagnosed as chronic rejection were given triimmunosuppressive agents: MMF 1.5～2.0 g/d+ CsA 2 to 3 mg/kg*d-1 and pred 10 mg/d.Results Blood creatinine reduced to normal level and urine protein disappeared in five cases, blood creatinine and urine protein decreased obviously in two cases, and kidney function deteriorated in another patient 4 to 9 weeks after this strategy. No acute rejection episodes or liver damage occurred among these patients during treatment. White blood cells reduced in one case, but it improved after therapy. Conclusion MMF combined with low dose CsA can bring a considerable efficacy in reversing chronic rejection of renal recipients. This immunosuppressive strategy may be a useful routine in the treatment of chronic rejection.
基金Supported by European Union-NextGenerationEU,through The National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008-C01.
文摘Pancreatic islet transplantation is a minimally invasive procedure aiming to reverse the effects of insulin deficiency in patients with type 1 diabetes(T1D)by transplanting pancreatic beta cells.Overall,pancreatic islet transplantation has improved to a great extent,and cellular replacement will likely become the mainstay treatment.We review pancreatic islet transplantation as a treatment for T1D and the immunological challenges faced.Published data demonstrated that the time for islet cell transfusion varied between 2 and 10 h.Approximately 54%of the patients gained insulin independence at the end of the first year,while only 20%remained insulin-free at the end of the second year.Eventually,most transplanted patients return to using some form of exogenous insulin within a few years after the transplantation,which imposed the need to improve immunological factors before transplantation.We also discuss the immunosuppressive regimens,apoptotic donor lymphocytes,anti-TIM-1 antibodies,mixed chimerism-based tolerance induction,induction of antigen-specific tolerance utilizing ethylene carbodiimide-fixed splenocytes,pretransplant infusions of donor apoptotic cells,B cell depletion,preconditioning of isolated islets,inducing local immunotolerance,cell encapsulation and immunoisolation,using of biomaterials,immunomodulatory cells,etc.
文摘Background: Although not life-saving procedures like liver or heart transplantation, renal transplantation is the preferred treatment for many patients with end-stage renal disease because it improves patients’ quality of life, while other forms of renal replacement therapy (RRT) such as haemodialysis (HDX) shown to regain only 10% of the patient’s renal function [1]. Transplantation releases patients from the dietary and fluid restrictions and the physical constraints imposed by other forms of (RRT), patients become able to return to their normal activities. Patient’s 5-year survival is higher post transplant. Patients and methods: This is Descriptive, retro-prospective, cross sectional analytic and multicentre study done in Ahmed Gasim Cardiac and Renal Transplant Centre including 105 patients. After meeting the Inclusion Criteria and exclusion Criteria, then cases were selected and written in constructed questionnaire. The aim of the study was to evaluate the outcome of renal transplantation in Sudan. Results: 105 cases were used with male predominate and ratio male to female ratio 3:1, the main age of presentation between 31 - 45 years, most of the patients discharge uneventful with good outcome. During one-year follow-up following renal transplantation. Patient survival 95.2 % graft survival 82.4%. Overall morbidity shows 70.5%. Conclusion: this study showed that the one-year patient survival of 95.2%. Actuarial one-year graft survival of 92.4%. Renal transplantation complications can be reduced by meticulous preoperative workup including good cardiovascular assessment, tissue mismatch and BMI good postoperative follow up for early detection of graft rejection and long-term complications and finally patient education.
文摘AIM:To assess the effect of human leukocyte antigen(HLA) mismatching on liver graft outcome and acute rejection from a meta-analysis of available cohort studies.METHODS:Articles in PubMed/MEDLINE,EMBASE and the Cochrane database from January 1970 to June 2009,including non-English literature identified in these databases,were searched.Only studies comparing HLA or sub-phenotype matching with mismatching were extracted.The percentage of graft survival was extracted by "Engauge Digitizer" from survival curves if the raw data were not displayed.A meta-analysis was performed when at least 3 studies provided data.RESULTS:Sixteen studies met the inclusion criteria.A lower number of HLA mismatches(0-2 vs 3-6) did reduce the incidence of acute rejection(relative risk:0.77,P = 0.03).The degree of HLA mismatching(0-2 vs 3-6) had no significant effect on 1-year [hazard ratio(HR):1.04,P = 0.68] and 5-year(HR:1.09,P = 0.38) graft survival.In sub-phenotype analysis,the degree of HLA-A,B and DR mismatching(0 vs 1-2) had no significant effect on 1-year and 5-year graft survival,either.The HRs and P-values were 0.95,0.71(HLA-A,1-year);1.06,0.60(HLA-A,5-year);0.77,0.16(HLA-B,1-year);1.07,0.56(HLA-DR,1-year);1.18,0.23(HLADR,5-year),respectively.CONCLUSION:The results of this systematic review imply that good HLA compatibility can reduce the incidence of acute rejection in spite of having no influence on graft outcomes.To obtain a short recovery time and minimize rejection post transplantation,HLA matching studies should be considered before the operation.
基金the National Nat-ural Science Foundation of China(81625003,81800578,and 81930016)Key Research&Development Plan of Zhejiang Province(2019C03050 and 2021C03118)Projects of Medical and Health Technology Program in Zhejiang Province(WKJ-ZJ-2120).
文摘Background:The shortage of donor liver restricts liver transplantation(LT).Nowadays,donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver.Although it is now possible to perform ABO-incompatible(ABO-I)LT,antibody-mediated rejection(AMR)has been recognized as the primary cause of desperate outcomes after ABO-I LT.Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury.Therapeutic plasma ex-change(TPE)can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity.Data sources:We searched PubMed and CNKI databases using search terms“therapeutic plasma ex-change”,“ABO-incompatible liver transplantation”,“ABO-I LT”,“liver transplantation”,“LT”,“antibody-mediated rejection”,and“AMR”.Additional publications were identified by a manual search of references from key articles.The relevant publications published before September 30,2020 were included in this review.Results:Different centers have made different attempts on whether to use TPE,when to use TPE and how often to use TPE.However,the control standard of lectin revision level is always controversial,the target titer varies significantly from center to center,and the standard target titer has not yet been estab-lished.TPE has several schemes to reduce antibody titers,but there is a lack of clinical trials that provide standardized procedures.Conclusions:TPE is essential for ABO-I LT.Hence,further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.
文摘BACKGROUND Biliary complications(BCs)after liver transplantation(LT)remain a considerable cause of morbidity,mortality,increased cost,and graft loss.AIM To investigate the impact of BCs on chronic graft rejection,graft failure and mortality.METHODS From 2011 to 2016,215 adult recipients underwent right-lobe living-donor liver transplantation(RT-LDLT)at our centre.We excluded 46 recipients who met the exclusion criteria,and 169 recipients were included in the final analysis.Donors’and recipients’demographic data,clinical data,operative details and postoperative course information were collected.We also reviewed the management and outcomes of BCs.Recipients were followed for at least 12 mo post-LT until December 2017 or graft or patient loss.RESULTS The overall incidence rate of BCs including biliary leakage,biliary infection and biliary stricture was 57.4%.Twenty-seven(16%)patients experienced chronic graft rejection.Graft failure developed in 20(11.8%)patients.A total of 28(16.6%)deaths occurred during follow-up.BCs were a risk factor for the occurrence of chronic graft rejection and failure;however,mortality was determined by recurrent hepatitis C virus infection.CONCLUSION Biliary complications after RT-LDLT represent an independent risk factor for chronic graft rejection and graft failure;nonetheless,effective management of these complications can improve patient and graft survival.
文摘Lung transplantation(LT)is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease.Furthermore,as a therapeutic option for high-risk candidates,single LT(SLT)can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single(double)LT(SSLTx).Still,the long-term overall survival is,in general,better for SSLTx.Despite the great success over the years,the early post-SLT period remains a perilous time for these patients.Patients who undergo SLT are predisposed to evolving early or late postoperative complications.This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction,native lung complications,anastomosis complications,infections,cardiovascular,gastrointestinal,renal,and metabolite complications,and their association with morbidity and mortality in these patients.Furthermore,we discuss the incidence of malignancy after SLT and their correlation with immunosuppression therapy.
文摘AIM:To evaluate the midterm outcomes of penetrating keratoplasty(PK)following allogeneic cultivated limbal epithelial transplantation(CLET)for bilateral total limbal stem cell deficiency(LSCD).METHODS:Ten patients(10 eyes)with bilateral LSCD were enrolled in this prospective noncomparative case series study.Each participant underwent PK approximately 6 mo after a CLET.Topical tacrolimus,topical and systemic steroids,and oral ciclosporin were administered postoperatively.Best-corrected visual acuity(BCVA),intraocular pressure(IOP),ocular surface grading scores(OSS),corneal graft epithelial rehabilitation,persistent epithelial defect(PED),immunological rejection,and graft survival rate were assessed.RESULTS:The time interval between PK and allogeneic CLET was 6.90±1.29(6-10)mo.BCVA improved from 2.46±0.32 log MAR preoperatively to 0.77±0.55 log MAR post-PK(P<0.001).Kaplan-Meier analysis of mean graft survival revealed graft survival rates of 100%at 12 and 24 mo and 80.0%at 36 mo.PEDs appeared in 5 eyes at different periods post-PK,and graft rejection occurred in 4 eyes.The total OSS decreased from 12.4±4.4 before allogeneic CLET to 1.4±1.51 after PK.CONCLUSION:A sequential therapy design of PK following allogeneic CLET can maintain a stable ocular surface with improved BCVA despite the relatively high graft rejection rate.
文摘BACKGROUND Once daily tacrolimus regimen was found to exhibits similar bioavailability,safety and efficacy properties compared to twice-daily tacrolimus in kidney transplantation patients.AIM To compare the efficacy and safety of once-daily prolonged release tacrolimus compared to twice-daily tacrolimus in liver transplantation patients.METHODS MEDLINE,EMBASE,CENTRAL databases were searched for clinical trials until December 2020.Efficacy outcome measured as the rate of treatment failure indicated by biopsy-proven acute rejection,Serum creatinine,graft loss,or death.Two reviewers independently selected studies,collected data and assessed risk of bias.The results are reported as risk ratio with 95%confidence interval(CI)for dichotomous data.RESULTS Seven studies included with 965 patients.All the included studies were of moderate quality according to the risk of bias assessment using Cochrane Risk of Bias tool.Biopsy-proven acute rejection was reported in four studies,and pooled analysis of those studies indicated similar rejections in both twice daily and once daily tacrolimus groups(risk ratio:1.06,95%CI:0.84-1.34,n=758,I2=0%)and also we found no significant difference between both groups for renal outcome(serum creatinine;mean difference,0.001 mg/dL,95%CI:-0.042 to 0.043,n=846,I2=18.6%).Similarly,there was similar number of adverse events such as hypertension,headache,back pain,blood related disorders,infections and nausea observed in both groups.CONCLUSION The analysis findings confirm that both once daily and twice daily tacrolimus formulations are comparable in terms of efficacy and safety outcomes.
文摘Transplant recipients usually have increased chances of graft rejection and graft vs host disease,requiring chronic immunosuppressive therapy.Nonetheless,longterm immunosuppression risks malignancies such as skin cancer,lymphoma,and Kaposi sarcoma.However,there are very few studies that included solid organ transplant recipients while studying the efficacy of immunotherapy.“Immunotherapy after liver transplantation:Where are we now?”is a study,where the authors described the mechanism of action and outcomes of immune checkpoint inhibitors specific to liver transplant recipients.The authors reported the graft rejection rates and the factors contributing to the rejection in the liver transplant recipients.
文摘BACKGROUND Immunosuppression(IS)therapy may contribute to cancer development.Some authors have proposed to reduce immunosuppression drugs dose in case of viral infections,in immunosuppression-related diseases,and in patients undergoing radiotherapy.The present analysis reports the results of a systematic review on kidney transplant recipients undergoing immunosuppression and radiotherapy.AIM To define if it is necessary reduce immunosuppression drugs during radiotherapy.METHODS The literature search was based on three electronic databases(Pubmed,Scopus,and Web of Science)using selected keywords linked through the"AND"and"OR"Boolean operators to build specific strings for each electronic search engine.Two researchers independently screened the citations,and disagreement was resolved by discussion or through the intervention of a third author.The review was conducted and reported according to the PRISMA statement.Extracted data were narratively synthesized,and,where possible,frequencies,percentages,and ranges were calculated.RESULTS The literature search resulted in 147 citations.After abstracts screening,21 records were selected for full-text evaluation.Fifteen of these were excluded,leaving six papers considered suitable for analysis.There is still no clear evidence that withdrawing antimetabolites and/or calcineurin inhibitors and/or mammalian target of rapamycin-inhibitors,as opposed to continuing maintenance IS,improves patient survival in kidney transplant recipients with cancer undergoing radiotherapy.Only few retrospective studies on small cancer patient cohorts are available in this setting,but without comparison of different immunosuppression treatments.Even where immunosuppression therapy was described,patient survival seemed to be correlated only with cancer stage and type.CONCLUSION The results of this systematic review do not support the reduction of immunosuppression dose in patients undergoing radiotherapy.
文摘The aim of the work was to analyze and expose the donor and recipient riskfactors in pancreas transplantation. In the following paper, we exposed the 2018Spanish Consensus Document on Donor and Recipient Selection Criteria forPancreas Transplantation. An assessment of the previous Selection Criteria forDonors and Recipients of Pancreas Transplantation, published in 2005 by theSpanish Pancreas Transplant Group (GETP) and the National TransplantOrganization (ONT) was performed. A literature review was performed usingCochrane Library, PubMed and Google Scholar databases. Some of the followingterms were used for the literature search: “Diabetes Mellitus,” “PancreasTransplantation,” “Insulin-Secreting Cells,” “Pancreas Allograft Thrombosis,”“Allograft Pancreatitis,” “Donors’ Risk Factors,” “Recipients’ Risk Factors,”“Pancreas Allograft Rejection” and “Pancreas Allograft Survival.” After anextended search, different inclusion criteria were established. Articles anddocuments with abstracts of full text and in English or Spanish language wereselected. Subsequently, different scientific meetings took place during 2015 and2016 by the GETP. Finally, the updated criteria were published by the GETP andONT in 2018. Several risk factors have been described in pancreas transplantationthat can be divided into donor risk factors: Advanced age (> 50 years);high bodymass index (BMI) (> 30 kg/m2);cause of death (e.g., stroke);previoushyperglycemia;hyperamylasemia;cold ischemia time (greater than 8 or 12 h,depending on the type of donation);the use of vasopressors in the intensive careunit or cardiac arrest;and the macroscopic aspect of the pancreas allograft. Thefollowing are recipient risk factors: Advanced age (> 50 years);active smoking;high BMI (> 30 kg/m2);and peripheral artery disease or sensorimotorpolyneuropathy. Based on the aforementioned parameters, different selectioncriteria have been established for the recipients depending on the type of pancreastransplantation. Knowledge of the risk factors for pancreas transplantation allowsthe establishment of reliable selection criteria for choosing donors and recipients.
