Average Donor Age Research Articles

First Report of the Korean Lung Transplantation Registry

BackgroundThe Korean Organ Transplantation Registry (KOTRY) began to register lung transplants in 2015. This is an initial report on the status of patients receiving lung transplants over the past 2 years. MethodsWe analyzed a total of 69 patients who received lung transplants in 2015 and 2016 and who registered with the KOTRY. ResultsThe 69 patients were treated in 5 institutions. The average (SD) donor age was 39.2 (12.6) years; there were 40 male patients. The average (SD) recipient age was 55.7 (10.0) years, and the number of male recipients was 46. A total of 66 patients underwent bilateral lung transplantation, 3 underwent single-lung transplantation, and 1 underwent simultaneous heart-lung transplantation. The most frequent indication for lung transplantation was idiopathic pulmonary fibrosis (35 patients), followed by connective tissue disease-related interstitial lung disease (9) and acute respiratory failure (8). Prior to transplantation, 23 patients required ventilator care, and 12 required extracorporeal membrane oxygenation while on the waiting list. Episodes of acute rejection during follow-up were reported in 4, 2, 1, and 1 patients at 3, 6, 9, and 12 months, respectively. Infections requiring hospitalization were reported in 27, 10, 4, and 3 patients at 3, 6, 9, and 12 months, respectively. ConclusionThe establishment of KOTRY renders it possible to collect nationwide data on lung transplantation, improving research on the topic and clarifying clinical feasibility.

The Fountain of Youth: Outcomes of Nonmyeloablative (NMA), HLA-Haploidentical Related (Haplo) Bone Marrow Transplantation (BMT) with Post-Transplantation Cyclophosphamide (PTCy) Best with Younger Donors Regardless of Relationship to Patient

▪NMA haplo BMT with PTCy is an increasingly used therapeutic strategy in patients with hematological malignancies (HM). Data demonstrating the safety of this NMA approach in older patients has led to an increased percentage of BMT performed in patients aged > 60 years. Consequently, the average age of potential related donors to be evaluated is also increasing. We sought to determine if donor age and donor relationship to the patient affected outcomes in patients undergoing NMA haplo BMT with PTCy.We retrospectively evaluated 586 adult and pediatric patients with HM who underwent NMA haplo BMT with PTCy from October 2002 through 2015. All patients received NMA conditioning with fludarabine, Cy, and total body irradiation, followed by allografting bone marrow stem cells from a first-degree relative. Graft-versus-host disease (GVHD) prophylaxis consisted of two doses of high-dose PTCy, mycophenolate mofetil and either sirolimus or tacrolimus. Donor age range was categorized into <30 years, 30-45 years and >45 years. Patients not receiving their first allogenic BMT were excluded.The median patient age was 57 years (range 1-76) and 63% were male. The indication for BMT was AML in 163 patients (27.8%), MDS in 34 (5.8%), MPN in 7 (1.2%), ALL in 52 (8.9%), CML in 15 (2.6%),CMML in 6 (1.0%), biphenotypic leukemia in 6 (1.0%), aggressive B cell lymphoma (BCL) in 94 (16.0%), T cell lymphoma in 36 (6.1%), mantle cell lymphoma in 31 (5.3%), Hodgkin's lymphoma in 54 (9.2%), indolent BCL in 34 (5.8%), CLL in 33 (5.6%), multiple myeloma in 13 (2.2%) and other HM in 8 (1.4%). Donor age ranged from 13-79 years. Donors were divided into three age categories: 146 of donors were <30 years (24.9%), 231 were 30-45 years (39.4%) and 209 were >45 years (35.7%). The most common donor relationship to the patient was children (83.6%) from donors <30 years, children (69.7%) from donors 30-45 years and siblings (56.9%) from donors >45 years. There was no correlation between donor and recipient age, with the older patients having the youngest donors and vice versa (Figure 1). Disease Risk Index score (DRI) was low in 90 patients (15.4%), intermediate in 368 (62.8%), high/very high in 94 (16.0%) and not determined in 34 (5.8%). Median follow-up was 2.9 years (range 9 days-11.4 years). Median CD34 infused was 4.61x106/kg from donors <30 years, 4.11x106/kg from donors 30-45 years and 3.62x106/kg from donors >45 years (p=0.0001). Younger donors were associated with lower non-relapse mortality (NRM); on competing-risk analysis, the cumulative incidence of NRM was 6% (95% CI 2−10%) at 3 years in patients with donors <30 years, 16% (95% CI 11−22%) in patients with donors 30−45 years and 15% (95% CI 10−20%) in patients with donors >45 years (p=0.02, Figure 2A).The probability of progression free survival (PFS) at 3 years was 45% (95% CI 37−55%) in patients with donors <30 years, 37% (95% CI 30-44%) 30-45 years and 37% (95% CI 31−45%) >45 years (p=0.23). The probability of overall survival (OS) at 3 years was 61% (95% CI 52−71%) in donors <30 years, 49% (95% CI 42−57%) 30-45 years, and 49% (95% CI 43−57%) >45 years (p=0.08, Figure 2B). The donor relationship did not influence outcomes with the probability of PFS at 3 years 40% (95% CI 30−54%) with parental donors, 39% (95% CI 32−47%) with sibling donors, and 39% (95% CI 33−45%) in child donors (p= 0.99). The probability of OS at 3 years was 53% (95% CI 42−67%) with parental donors, 51% (95% CI 44−59%) with sibling donors and 52% (95% CI 46−59%) in child donors (p= 0.97).These results confirm the benefit of using donors <30 years of age for NMA haplo BMT with PTCy. This adds to the increasing evidence that donor age is a universal risk factor in BMT. Although reasons for this association have been suggested (i.e. a higher proportion of memory T cells in older donors), this requires further analysis. The data also illustrate that the donor's relationship to the patient (i.e. sibling, child or parent) had no significant impact on NRM, OS, or PFS. With this transplantation platform, the youngest haplo relative, regardless of their relationship to the patient, should be considered the preferred donor source for patients in need of BMT. Since previous analyses have shown no difference between haplo with PTCy and matched sibling donor (MSD) BMT, consideration should be given to selecting a younger haplo donor over an older MSD; however, further work in this area is needed before adopting such a strategy widely. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Systematic review and meta‐analysis of liver transplantation using grafts from deceased donors aged over 70 years

Due to the current organ shortage, nearly 20% of patients die waiting for a liver transplant (LT). The average donor age is on the rise, and grafts from elderly donors are offered as extended criteria grafts. This is a meta-analysis comparing the outcome differences of adult patients undergoing LT using grafts from <70-year-old donors vs >70-year-old donors. The primary end-points were graft and patient survival. Secondary outcomes were biliary and vascular complications as well as graft function. The odds ratio (OR) is a summary statistic with the corresponding 95% confidence interval; P<.05 was considered to be statistically significant. Eight nonrandomized comparative studies with 4376 LT recipients were included. About 79.9% and 20.1% of the grafts were from <70-year-old and >70-year-old donors, respectively. Graft survival at 1year was similar between the two groups (P=.11), but there was better 3-year and 5-year graft survival in the >70-year-old group (P=.006 and P<.0001, respectively). Patient survival was also similar between the groups at 1year (P=.54), but with better survival at 3-year and 5-year follow-ups (P=.007 and P<.0001, respectively) in the >70-year-old group. There were no statistically significant differences in the incidence of biliary, vascular, and graft functional-related complications. Liver grafts from selected >70-year-old donors do not pose added organ-specific risks and thus have comparable transplantation outcomes.

Age-related histologic and biochemical changes in auricular and septal cartilage.

To characterize the histologic and biochemical properties of auricular and septal cartilage and analyze age-related changes in middle-aged to older adults. Cross-sectional study of auricular and septal cartilage from 33 fresh cadavers. Auricular and septal cartilage specimens were stained using Safranin O for glycosaminoglycans, Verhoeff's stain for elastin, and Masson's trichrome for collagen. Percentage of tissue stained, cell density and size were quantified. Relationships between donor characteristics and histologic properties were evaluated using mixed model analyses. The average donor age was 75 years (standard deviation = 11 years; range, 55-93 years). In auricular cartilage, each 1-year increase in age was associated with a 0.97% decrease in glycosaminoglycans (P < .001) and a 0.98% decrease in elastin (P < .001). In septal cartilage, glycosaminoglycans decreased 2.4% per year (P < .001). Age did not affect collagen content significantly in auricular (P = .417) or septal cartilage (P = .284). Cell density and cell size declined with age in auricular (both P < .001) and septal cartilage (P = .044, P = .032, respectively). Compared to septal cartilage in patients of all ages, auricular cartilage had more glycosaminoglycans, less collagen, higher cell density, and smaller cells. In auricular and septal cartilage, glycosaminoglycans, elastin, cell density, and cell size decrease significantly with age in patients over 55 years of age. Glycosaminoglycan content declines faster with age in septal cartilage than auricular cartilage. These age-related changes may affect biomechanical properties and tissue viability, and thereby have implications for graft choice in functional, aesthetic, and reconstructive nasal surgery. NA. Laryngoscope, 127:E399-E407, 2017.

Cartilage Regeneration in Full-Thickness Patellar Chondral Defects Treated with Particulated Juvenile Articular Allograft Cartilage: An MRI Analysis.

Background Full-thickness cartilage lesions of the patella represent a common source of pain and dysfunction. Previously reported surgical treatment options include marrow stimulation, cell-based treatments, and osteochondral transfer. Minced juvenile allograft cartilage is a novel treatment option that allows for a single stage approach for these lesions. Hypothesis Particulated juvenile allograft cartilage (PJAC) for the treatment of chondral defects of the patella would offer acceptable lesion fill rates, mature over time, and not be associated with any negative biologic effects on the surrounding tissue. Methods A retrospective chart review of prospectively collected data was conducted to identify consecutive patients who were treated with PJAC for a full thickness symptomatic cartilage lesion. Qualitative (fast spin echo) and quantitative (T2 mapping) magnetic resonance imaging (MRI) was undertaken at the 6-, 12-, and 24-month postoperative mark. Numerous patient, lesion, and graft specific factors were assessed against MRI scores and percent defect fill of the graft. Graft maturation over time was also assessed. Results Forty-five patients total were included in the study. Average age at the time of surgery was 26.5 years (range 13-45 years), average lesion size was 208 mm2 (range 4-500 mm2), and average donor age was 49.5 months (range 3-120 months). Sixty percent of the patients were female, while 93% of all patients underwent a concomitant procedure at the time of the index operation. Six-month MRI findings revealed that no patient-, graft-, or donor-specific factors correlated with MR scores, and 82% of the knees demonstrated good to excellent fill. Twelve-month MRI findings revealed that T2 relaxation times of deep graft demonstrated negative correlation with patient age ( P = 0.049) and donor age ( P = 0.006), the integration zone showed a negative correlation with donor age ( P = 0.026). In all, 85% of patients at 12 months displayed good to moderate fill of the graft. At 24 months, patient age demonstrated negative correlation with average T2 relaxation times of the deep and superficial graft ( P = 0.005; P = 0.0029) and positive correlation with the superficial zone of the adjacent cartilage ( P = 0.001). Donor age showed negative correlation with grayscale score ( P = 0.004) and T2 relaxation times at deep integration zone ( P = 0.018). T2 relaxation times of deep and superficial graft and integration zone improved over time ( P < 0.001) and between each time point. Conclusions Particulated juvenile allograft tissue appears to be an acceptable reconstructive option for full-thickness cartilage lesions of the patella, offering satisfactory tissue defect fill at 6, 12, and 24 months after surgery. Imaging of the repaired cartilage demonstrates progressive graft maturation over time.

The International Society for Biological and Environmental Repositories Presents Abstracts from Its Annual Meeting Due North: Aligning Biobanking Practice with Evolving Evidence and Innovation May 9–12, 2017 Toronto, Canada

The International Society for Biological and Environmental Repositories Presents Abstracts from Its Annual Meeting Due North: Aligning Biobanking Practice with Evolving Evidence and Innovation May 9–12, 2017 Toronto, Canada

Breaking the 5 Year Mark with 100% Survival for Intestinal Transplant -Time to become protagonist in the management of intestinal failure?

Introduction: Historically intestinal graft survival declines continuously from 80% 1 year- to ~ 40% at 5 year-post transplant. Adult patient survival is ~ 60% 5 year[1]. Closer surveillance and better understanding of immunological events has led to intestinal transplant becoming a more efficient and safe procedure in our center. Methods: We described our experience with Isolated Intestinal Transplant in the last 6 years. Results: From December 2010 to December 2016 we performed 26 transplants in 25 patients. 19 of the patients were adults. Average age was 32 years. All the patients but one had complications from PN. Average donor age was 13 years. Blood type was identical in 19 of them and compatible in 7. Four patients had positive crossmatch. Colon was part of the graft in 80% of the patients. Portal drainage was used in 30% of the cases. All the patients received induction with anti-thymocyte + rituximab. Basiliximab was given on POD14 and then monthly for a total of 3 doses. Tacrolimus was used in association with mTor inhibitors. Steroids were weaned over 3 months. All the patients are alive. Overall graft survival is 85% (90% for adults). One adult patient lost the graft due to rupture of a mycotic aneurism 12 days post-transplant and one pediatric patient lost the graft due to a volvulus 6 weeks after the transplant. One pediatric patient developed refractory severe rejection. One adult patient was noncompliant and had the graft removed 21 months post-transplant. From these 4 patients, one child was retransplanted 6 months after graft loss and is well now >1 year post-retransplant. Moderate to severe rejection occurred in 3 adults and 1 child. One adult developed PTLD with total remission. None of the patients developed GVHD.FigureFigureDiscussion: No mortality associated with excellent graft survival achieved in this series makes intestinal transplantation the standard of care for intestinal failure. From the four graft losses, 2 of them were due to technical complications and one for noncompliance. Retrospectively, just one of the graft losses was completely unavoidable. Five year survival for patients in parenteral nutritional varies from 70 to 90%. Based on our experience, intestinal transplantation provides not only superior quality of life but also superior survival. This cohort represents patients with classic indications of intestinal transplant but preemptive transplant may be considered from now on based on these results. Reference: 1. Smith JM et al. OPTN/SRTR 2015 Annual Data Report: Intestine. Am J Transplant. 2017 Jan;17 Suppl 1:252–285.

Influence of Aging on Microvascular Supply of the Gluteus Medius Tendon: A Cadaveric and Histologic Study

The purpose of this cadaveric study was to assess the relation between age and microvascular supply of 3 areasof the gluteus medius tendon using a previously validated CD31 immunohistochemistry staining technique. Twenty-four fresh-frozen gluteus medius specimens were obtained through a posterolateral approach to the hip. Specimens aged 18years or older, of either sex, and of any race were considered for this study. The average age of donors was 47.3years (range, 18-68years). Each sample was divided into 3 portions: musculotendinous, tendinous, and tendon-bone junction. H&E staining was used for qualitative structural analysis, and then all samples underwent staining with CD31 immunohistochemistry for quantitative assessment of vessels per square millimeter. A comparison of the microvessel density between zones according to age was performed by an analysis of variance. To evaluate the relation between microvessel supply and age, a regression model with curvilinear estimation was used. The data were fitted to a quadratic model. Vascular supply in transversal and longitudinal cuts regardless of the zone was, on average, 53.9 ± 32.1 vessels/mm2 and 51.1 ± 19.3 vessels/mm2, respectively. All the areas of the tendon showed a strength of relation (R) ranging from 0.41 to 0.76 between age and vascular supply. In addition, the proportion of vascular supply change explained by age (R2) was significant in most cases (ranging from 0.17 to 0.56, with P < .05). There is a chronological relation between aging and microvascular supply of the gluteus medius tendon, in which an initial increase occurs from 18years of age to 30 to 40years of age, with a progressive decrease after 50years of age. The findings of our study may have implications for increased vulnerability of the gluteus medius tendon and decreased healing potential.

Actual Risk of Using Very Aged Donors for Unselected Liver Transplant Candidates: A European Single-center Experience in the MELD Era.

To evaluate the whole experience of liver transplantation (LT) with donors ≥70 years in a single center not applying specific donor/recipient matching criteria. LT with very old donors has historically been associated with poorer outcomes. With the increasing average donor age and the advent of Model for End-stage Liver Diseases (MELD) score-based allocation criteria, an optimal donor/recipient matching is often unsuitable. Outcomes of all types of LTs were compared according to 4 study groups: patients transplanted between 1998 and 2003 with donors <70 (group 1, n = 396) or ≥70 years (group 2, n = 88); patients transplanted between 2004 and 2010 with donors <70 (group 3, n = 409), or ≥70 years (group 4, n = 190). From 2003, graft histology was routinely available before cross-clamping, and MELD-driven allocation was adopted. Groups 1 and 2 were similar for main donor and recipient variables, and surgical details. Group 4 had shorter donor ICU stay, lower rate of moderate-to-severe graft macrosteatosis (2.3% vs 8%), and higher recipient MELD score (22 vs 19) versus group 3. After 2003, median donor age, recipient age, and MELD score significantly increased, whereas moderate-to-severe macrosteatosis and ischemia time decreased. Five-year graft survival was 63.6% in group 1 versus 59.1% in group 2 (P = 0.252) and 70.9% in group 3 versus 67.6% in group 4 (P = 0.129). Transplants performed between 1998 and 2003, recipient HCV infection, balance of risk score >18, and pre-LT renal replacement treatments were independently associated with worse graft survival. Even without specific donor/recipient matching criteria, the outcomes of LT with donors ≥70 and <70 years are comparable with appropriate donor management.

LAPAROSCOPIC LEFT LATERAL SECTIONECTOMY IN LIVING LIVER DONOR

Introduction.Living donor liver transplantation has proved to be an effective, safe and radical treatment modality for patients with end-stage liver diseases. Left lateral section (LLS) of donor’s liver is used in pediatric recipients. Laparoscopic LLS procurement was fi rst described by D. Cherqui in 2002. At present, this technique is routinely used only by 5 hospitals in the world. However, up to date, some authors consider it to be a new standard to perform such a surgery in living donors.Aim.To analyze the fi rst Russian experience in laparoscopic left lateral sectionectomy (LapLLS) in living related donor.Materials and methods.From May to September 2016 fi ve LapLLS were performed in living donors. In all cases donors were women (mothers in 4 cases and aunt in 1 case). Recipients were children aged from 6 months through 3 years with body mass from 5.6 to 12.5 kg. Liver transection was carried out under conditions of maintained blood supply. Parenchymal transection was performed using a harmonic scalpel, bipolar coagulation and ultrasound dissection.Results. Average donor age was 32 ± 5 years. Average operation time was 287 ± 16 min. Average LLS graft weight was 220 ± 16 g. Intraoperative blood loss did not exceed 100 ml (95 ± 5 ml). Donors were discharged on the 3rd–4th post-op day. There were no postoperative complications in donors. Recipients were also characterized by a standard course of the postoperative period.Conclusion.LapLLS is an effective and safe method with several advantages. Primarily, these are early rehabilitation of the donors and shortening of the hospital stay, which are important for the quick return to normal way of live. Excellent visualization of anatomical structures, including vascular and biliary ones, allows performing precise selection. In addition, good cosmetic effect is also an important aspect.

Estimation of seroprevalence of HIV, hepatitis B and C virus and syphilis among blood donors in the hospital of Aïoun, Mauritania.

IntroductionTo estimating the seroprevalence of HIV, hepatitis B, hepatitis C and syphilis among blood donors in the Aïoun hospital.MethodsThis is a retrospective study from 1 January 2010 to 31 December 2015.ResultsOn the five-year study period, 1,123 donors were collected. Of these, 182 were HIV-positive, an overall prevalence of 16.2% with predominance in male with a sex ratio Man/Woman of 5.2. The average age of donors was 32.7 ± 10 years (range 17-73 years). The most represented that age group 21-30 years (40.5%). The seroprevalence found were 1.2% for HIV, 11.8% for HBV, HCV 0.2% and 3% for syphilis. Co-infection was found in 0.7% of which 0.5% of dual HIV HBV/Syphilis and 0.2% in HBV/HIV.ConclusionThe transmission of infectious agents related to transfusion represents the greatest threat to transfusion safety of the recipient. Therefore, a rigorous selection and screening of blood donors are highly recommended to ensure blood safety for the recipient.

Liver Allograft Provides Immunoprotection for the Cardiac Allograft in Combined Heart-Liver Transplantation.

When transplanted simultaneously, the liver allograft has been thought to have an immunoprotective role on other organs; however, detailed analyses in simultaneous heart-liver transplantation (SHLT) have not been done to date. We analyzed patient outcomes and incidence of immune-mediated injury in 22 consecutive SHLT versus 223 isolated heart transplantation (IHT) recipients between January 2004 and December 2013, by reviewing 3912 protocol- and indication-specific cardiac allograft biopsy specimens. Overall survival was similar (86.4%, 86.4%, and 69.1% for SHLT and 93.3%, 84.7%, and 70.0% for IHT at 1, 5, and 10 years; p = 0.83). Despite similar immunosuppression, the incidence of T cell-mediated rejection (TCMR) was lower in SHLT (31.8%) than in IHT (84.8%) (p < 0.0001). Although more SHLT patients had preexisting donor-specific HLA antibody (22.7% versus 8.1%; p = 0.04), the incidence of antibody-mediated rejection was not different in SHLT compared with IHT (4.5% versus 14.8%, p = 0.33). While the left ventricular ejection fraction was comparable in both groups at 5 years, the incidence and severity of cardiac allograft vasculopathy were reduced in the SHLT recipients (42.9% versus 66.8%, p = 0.03). Simultaneously transplanted liver allograft was associated with reduced risk of TCMR (odds ratio [OR] 0.003, 95% confidence interval [CI] 0-0.02; p < 0.0001), antibody-mediated rejection (OR 0.04, 95% CI 0-0.46; p = 0.004), and cardiac allograft vasculopathy (OR 0.26, 95% CI 0.07-0.84; p = 0.02), after adjusting for other risk factors. These data suggest that the incidence of alloimmune injury in the heart allograft is reduced in SHLT recipients.

Heart transplant program at IRCCS-ISMETT: Impact of mechanical circulatory support on pre- and post -transplant survival

BackgroundHeart transplantation (HTx) improves the quality of life and survival in patients affected by end-stage heart failure. The purpose of the current study is to present the patients' clinical data and results of HTx in a single Center of Sicily. Focus on survival after pre and post HTx mechanical circulatory support use will be performed. Methods. 133 HTx were done from 2004 to the end of 2015.The average donor age was 34±13.5years and the proportion of male donors was 67%. Percentage of use of mechanical circulatory support to bridge patients to HTx was 18%. Results. Overall pre-transplant mechanical circulatory support was not correlated to worse post-transplant prognosis, p=0.757. Severe primary early graft failure requiring extra corporeal membrane oxygenator support strongly impact the early mortality after heart transplantation (p<0.001). Conclusions. The results of HTx at ISMETT are comparable to those reported in high volume Italian transplant centers as well as in the ISHLT registry. The favorable outcome can be related to focus on multidisciplinary approach, strict recipients' selection and young donor population. Post HTx mechanical circulatory support use in general remains associated with worse post-transplant outcomes. This does not apply to pre-op mechanical circulatory support population.

A Novel Assessment of Vascular Regions Using an Intraoperative Near-Infrared Fluorescence

IntroductionThe risk of complications and transplant renal function increases in multiple arterial renal transplantations compared with single arterial renal transplantations. Even when multiple arteries are involved, with the introduction of laparoscopic nephrectomy, I mainly choose the left side kidney. Therefore, the number of renal artery reconstructions is increasing, and simultaneous imaging of arterial rebuilding during the donor nephrectomy is important. MaterialBetween 2006 and 2015, we performed 132 living donor kidney transplantations at our center and analyzed 32 cases that were diagnosed pre- and intraoperatively. MethodWe compared the single renal artery (SRA) and multiple renal arteries (MRA) groups and analyzed the number of renal arteries, reconstruction methods, donor and recipient ages, sex, total ischemic times, and 1-month serum creatinine values. ResultIn the MRA and SRA groups, the average recipient age was 52.3 and 47.0 years, respectively, while the average donor age was 52.9 and 53.1 years, respectively. In SRA and MRA groups, total ischemic time (TIT) was 96.1 and 143.6 min (P < .01). Serum creatinine level 1 month post-transplantation was 1.54 and 1.25, respectively (P < .001). Here we experienced 12 cases of living renal donor nephrectomy with multiple vessels in which the vascular supply territory was first assessed in April 2013 using an intraoperative near-infrared fluorescence camera system. In addition, regarding TIT, it is possible to shorten surgery by using individual anastomosis and ligation. ConclusionBy managing multiple donors; arteries by nephrectomy, it is possible to improve kidney transplantation results.

Single institution outcomes in the first 3 years of pancreas transplantation from brain dead donors.

A total of 26 pancreas transplants from brain dead donors, including 21 simultaneous pancreas and kidney (SPK) transplantation procedures, have been performed at Fujita Health University Hospital since the new pancreas transplant program was initiated in August 2012. The objective of this study is to investigate the outcomes of pancreatic transplantation in our facility in first 3 years of the program. The background characteristics of the donors and the outcomes of 26 pancreas transplant recipients were analyzed. The mean age of the recipients was 44.0 years, and all recipients had a long-term history of diabetes (mean: 30.2 years). In the SPK cases, the patients also had a long history of hemodialysis (mean: 6.3 years). Although the average donor age was 41.0 years and more than half of the donors were marginal donors (defined according to Kapur's criteria and Troppmann's criteria), the patient survival and pancreatic graft survival rates were 100% and 91.7%, respectively. Unfortunately, two recipients experienced graft failure due to graft thrombosis, which resulted in graft loss. The new pancreas transplant program at Fujita Health University has provided excellent outcomes for patients with type 1 diabetes.

Evaluating twenty-years of follow-up after orthotopic liver transplantation, best practice for donor-recipient matching: What can we learn from the past era?

AIMTo characterize major determinants of 20-year survival after liver transplantation (LT).METHODSThis longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease (labMELD)-score and the Eurotransplant Donor Risk Index (ET-DRI) to unravel their impact on 20-year survival after LT.RESULTSTwenty-year survivors were significantly younger (44 vs 50 years, P = 0.001), more likely to be female (49% vs 36%, P = 0.03) and less likely to be obese at the time of LT (19% vs 32%, P = 0.011). Mean labMELD-score (P = 0.156), rate of high-urgency LT (P = 0.210), cold-ischemia time (P = 0.994), rate of retransplantation (P = 0.12) and average donor age (28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors (P = 0.007). ET-DRI > 1.4 (P = 0.020) and donor age ≥ 30 years (P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labMELD-score categories (P = 0.263).CONCLUSIONLT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.

Pediatric En Bloc Kidney Transplants: Clinical and Immediate Postoperative US Factors Associated with Vascular Thrombosis.

Purpose To evaluate clinical and immediate postoperative ultrasonographic (US) risk factors associated with vascular thrombosis of pediatric en bloc kidney grafts. Materials and Methods This institutional review board-approved HIPAA-compliant retrospective study consisted of 195 recipients of pediatric en bloc kidney grafts throughout a 10-year period. The average recipient and donor age was 45 years (range, 7-74 years) and 9 months (range, 0-84 months), respectively. Clinical factors and immediate postoperative US findings were assessed. Categorical variables were evaluated by using the Fisher exact test and linear models with generalized estimating equations. Results Seventeen patients (23 kidneys) experienced thrombotic events. In six patients (eight kidneys), thrombosis occurred intraoperatively. The remaining 11 patients (15 kidneys) received a diagnosis of thrombosis on postoperative days 1-13. Recipients more than 40 years old had a higher incidence of arterial thrombosis than did younger recipients (eight of 62 vs three of 133, respectively; P < .01). Recipients were more likely to develop thrombosis with donor weight less than 5 kg (10 of 52 vs seven of 140 with donor weight of ≥ 5 kg; P < .01), with intraoperative perfusional concern (10 of 21 vs seven of 174 without; P < .01), or with right-sided allograft placement (10 of 64 vs seven of 131 left sided; P = .03). At US of the 15 postoperative thrombotic events, the incidence of thrombosis was greater when donor arterial velocity was less than 100 cm/sec (seven of 56 vs four of 126 with velocity ≥ 100 cm/sec; P = .04). An intrarenal arterial resistive index of less than 0.6 was associated with higher incidence of arterial thrombosis (nine of 123 vs zero of 217, respectively; P = .01). A resistive index greater than 0.8 was associated with a higher incidence of venous thrombosis (four of 13 vs one of 217, respectively; P = .04). Conclusion Clinical factors and immediate US findings can help stratify patients receiving pediatric en bloc kidneys into risk categories for vascular thrombosis that, if proven in prospective studies, could affect immediate postoperative treatment. (©) RSNA, 2015.

Seroprevalence of human T-cell lymphoma/leukemia virus type-1 (HTLV-1) antibodies among blood donors at Enugu, Nigeria

BackgroundHuman T-cell lymphotrophic/leukemia virus (HTLV-1) is a retrovirus implicated in transfusion-transmitted infection.ObjectiveThe objective of this study was to determine the seroprevalence of HTLV-1 antibodies among blood donors at the University of Nigeria Teaching Hospital, Enugu, Eastern Nigeria.MethodsA cross-sectional study was carried out on consented participants over 4 months. A total of 300 blood donors were recruited consecutively from the blood bank. The serum of the collected 5 mL of blood obtained from each participant was stored at −20°C until required for analysis. The serum samples were then analyzed for antibodies to HTLV-1 using a one-step incubation double-antigen sandwich ELISA (enzyme-linked immunosorbent assay) kit. Participants’ demographic characteristics and degree of exposure to the risk factors associated with HTLV-1 infection were captured using a questionnaire. Statistical analysis of results was done using SPSS version 17.ResultsOf the 300 blood donors, 288 (96%) were male, while 12 (4%) were female. The average age of the blood donors was 26.85±8.52 years. The age group with the highest representation among the blood donors were those aged between 21 and 25 years. Only 22.3% of the blood donors were above 30 years. None of the 300 screened blood donors tested positive to HTLV-1 antibodies. Hence, the seroprevalence of HTLV-1 infection among blood donors was 0%. Of the blood donors, 5% had history of previous sexually transmitted disease, while 34.7% used condoms during sexual intercourse.ConclusionThe seroprevalence obtained in this study cannot statistically support the justification of routine screening of blood donors for HTLV-1 infection. More prospective and multicentered studies are required to determine the infectivity of HTLV-1 in blood donors in Nigeria.

SOROPREVALÊNCIA DE DOENÇAS INFECCIOSAS EM DOADORES DE SANGUE DO HEMOCENTRO REGIONAL DE CRUZ ALTA-RIO GRANDE DO SUL

Introduction: Clinical and serological screening of blood donors is an essential strategy to prevent transmission of infectious agents during blood transfusion. Objective: To determine the seroprevalence of infectious diseases in blood donors at the Blood Center of Cruz Alta. Method: Prospective cross-sectional study conducted at the Blood Center of Cruz Alta, Rio Grande do Sul, from January 2013 to June 2014. Results: 6139 donations were made during the study period, 280 (4,56%) of which were considered unfit for presenting some positive serological marker. The average age of unfit donors was 38 years, and 171 (61.1%) donors were male. Regarding the serological markers, 151 (46.1%) donors were positive for anti-HBc, 15 (5.4%) for HBsAg, 21 (7.5%) for anti-HCV, 15 (5.4%) for HIV, 19 (6.8%) for HIV-Ag AC, 6 (2.1%) for HTLV-I /II, 64 (22.9%) for Chagas disease, and 37 (13.2%) for syphilis (VDRL). Conclusion: The results show the importance of serological screening in order to ensure transfusion safety and prevent infection of individuals who need blood transfusions.

Cyclosporin A, but not tacrolimus, negatively affects the hepatic extraction fraction of hepatobiliary scintigraphy in liver transplant recipients.

BackgroundHepatobiliary scintigraphy using 99mTc-mebrofenin has been used as an investigation to study liver function after liver transplantation (LTx). Hepatic extraction fraction (HEF) is a measurement of the hepatic extraction efficiency and hepatic extraction rate. With the purpose of evaluating a possible diverging effect of cyclosporin A (CSA) and tacrolimus (TAC) on the HEF, we compared the HEF with biochemical and histological parameters in LTx patients receiving either CSA or TAC.MethodsThirty-nine adult patients who underwent LTx due to hepatitis C virus (HCV) cirrhosis were evaluated. All patients underwent a 3-month and 1-year follow-up that included hepatobiliary scintigraphy and biochemistry tests. Liver biopsy was performed at 1 year. These clinical parameters were compared between the two groups, TAC (n = 15) and CSA (n = 24).ResultsThe average HEF was significantly lower in the CSA group compared to the TAC group both at 3 months and 1 year after LTx. The liver biochemistry tests, average donor and recipient age, average cold ischemia time (CIT), and a clearance were comparable in the two groups. The TAC group had more inflammation than the CSA group. Moreover, three patients who converted from CSA to TAC increased their HEF values.ConclusionsCSA-treated patients presented a lower HEF value on hepatobiliary scintigraphy in spite of comparable liver function by traditional measurements indicating a decrease on HEF values by CSA.