Lower Graft Research Articles

Comparison of Tuberculosis Infection Rates in a National Database of Renal Transplant Patients With Data From a Single Center in Taiwan

Successful renal transplantation (RT) improves quality of life and patient survival. Advances in immunosuppressants for RT have improved the prevention and treatment of acute rejection as well as reduced the risk of chronic graft damage, but immunodeficiency may render patients vulnerable to opportunistic infections. We conducted this study to compare the difference in tuberculosis (TB) infection rates between a single institution and a national database of RT recipients in Taiwan. There were 153 patients with TB (3.2%) among 4,835 RT recipients in the database during the period 2000–2009, with a higher prevalence of men (P = .018) and diabetes patients (P = .029). In our institution's registry, 33 patients (2.7%) developed 35 episodes of TB infection among 1,209 RT recipients, but there were no significant differences in general characteristics among different subgroups. Interestingly, the use of cyclosporine was significantly more frequent in RT recipients with TB than in those without in both the national database and in our institution. In contrast, TB infection was negatively correlated with the use of tacrolimus (TAC) and mycophenolate (MPA). RT recipients with TB infection had poor survival (P = .0013) and low graft survival (P = .0003). Taken together, analyses of the national database and the RT patients in our institution revealed that the use of long-term cyclosporine-based immunosuppressive agents was associated with a greater risk of developing post-transplantation TB compared with that of other immunosuppressive agents, but the chronicity and accumulation effect of TAC and MPA should be observed despite the negative correlation found herein. In conclusion, post-transplantation TB is a serious health threat and one of the major causes of death among RT recipients, and a high index of suspicion to ensure early diagnosis and prompt initiation of treatment for TB is crucial. The use of optimal immunosuppressive agents to minimize acute rejection, monitoring of high-risk recipients, prompt diagnosis, and appropriate treatment are required to manage TB infection in endemic areas such as Taiwan.

Auto-/homografting can work well even if both autograft and allograft are meshed in 4: 1 ratio

Patients suffering major burns of more than 50% total burn surface area lack an adequate skin graft donor site to resurface extensive burn wounds and usually need widely meshed autografting and allografting. Anything over the 3:1 expansion ratio is strongly associated with low graft take, poor or delayed epithelialization, and hypertrophic scarring. In this study, both autografts and allografts were expanded at a 4:1 ratio. We aimed to use skin grafts effectively and to decrease the morbidity due to graft harvesting. Nine patients with major burns were treated with this method. Graft gain ratio and percentage of actual expansion to predicted expansion were calculated. Ten auto-allografting procedures were performed on a mean of day 16. Graft take was over 95% successful. Five patients survived, and four patients died. The mean total burn surface area was 58.8% in patients who recovered, and 77.5% in the patients who died. The graft gain ratio was 74.8%. The actual expansion rate was 43.7% of the predicted expansion rate. In this study, we demonstrated that the donor site morbidities were reduced and successful epithelialization was completed on the eighth day after using both autograft and allograft meshed with a 4:1 ratio.

On the feasibility of utilizing allogeneic bone blocks for atrophic maxillary augmentation.

Purpose. This systematic review was aimed at assessing the feasibility by means of survival rate, histologic analysis, and causes of failure of allogeneic block grafts for augmenting the atrophic maxilla. Material and Methods. A literature search was conducted by one reviewer in several databases. Articles were included in this systematic review if they were human clinical trials in which outcomes of allogeneic bone block grafts were studied by means of survival rate. In addition other factors were extracted in order to assess their influence upon graft failure. Results. Fifteen articles fulfilled the inclusion criteria and subsequently were analyzed in this systematic review. A total of 361 block grafts could be followed 4 to 9 months after the surgery, of which 9 (2.4%) failed within 1 month to 2 months after the surgery. Additionally, a weighed mean 4.79 mm (95% CI: 4.51–5.08) horizontal bone gain was computed from 119 grafted sites in 5 studies. Regarding implant cumulative survival rate, the weighed mean was 96.9% (95% CI: 92.8–98.7%), computed from 228 implants over a mean follow-up period of 23.9 months. Histologic analysis showed that allogeneic block grafts behave differently in the early stages of healing when compared to autogenous block grafts. Conclusion. Atrophied maxillary reconstruction with allogeneic bone block grafts represents a reliable option as shown by low block graft failure rate, minimal resorption, and high implant survival rate.

Preoperative selective desensitization of live donor liver transplant recipients considering the degree of T lymphocyte cross-match titer, model for end-stage liver disease score, and graft liver volume.

Several studies have suggested that a positive lymphocyte cross-matching (XM) is associated with low graft survival rates and a high prevalence of acute rejection after adult living donor liver transplantations (ALDLTs) using a small-for-size graft. However, there is still no consensus on preoperative desensitization. We adopted the desensitization protocol from ABO-incompatible LDLT. We performed desensitization for the selected patients according to the degree of T lymphocyte cross-match titer, model for end-stage liver disease (MELD) score, and graft liver volume. We retrospectively evaluated 230 consecutive ALDLT recipients for 5 yr. Eleven recipients (4.8%) showed a positive XM. Among them, five patients with the high titer (> 1:16) by antihuman globulin-augmented method (T-AHG) and one with a low titer but a high MELD score of 36 were selected for desensitization: rituximab injection and plasmapheresis before the transplantation. There were no major side effects of desensitization. Four of the patients showed successful depletion of the T-AHG titer. There was no mortality and hyperacute rejection in lymphocyte XM-positive patients, showing no significant difference in survival outcome between two groups (P=1.000). In conclusion, this desensitization protocol for the selected recipients considering the degree of T lymphocyte cross-match titer, MELD score, and graft liver volume is feasible and safe.

Coupled atom transfer radical coupling and atom transfer radical polymerization approach for controlled grafting from poly(vinylidene fluoride) backbone

A new “grafting from” strategy for grafting of different monomers (methacrylates, acrylates, and acrylamide) on poly(vinylidene fluoride) (PVDF) backbone is designed using atom transfer radical coupling (ATRC) and atom transfer radical polymerization (ATRP). 4-Hydroxy TEMPO moieties are anchored on PVDF backbone by ATRC followed by attachment of ATRP initiating sites chosen according to the reactivity of different monomers. High graft conversion is achieved and grafting of poly(methyl methacrylate) (PMMA) exhibits high degree of polymerization (DPn = 770) with a very low graft density (0.18 per hundred VDF units) which has been increased to 0.44 by regenerating the active catalyst with the addition of Cu(0). A significant impact on thermal and stress–strain property of graft copolymers on the graft density and graft length is noted. Higher tensile strain and toughness are observed for PVDF-g-PMMA produced from model initiator but graft copolymer from pure PVDF exhibits higher tensile strength and Young's modulus. © 2013 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2014, 52, 995–1008

Significance of isoagglutinin titer in ABO-incompatible kidney transplantation

ABO-incompatible (ABO-i) kidney transplantation (KT) has emerged for overcoming the shortage of organ donors. Although this technique initially achieved only low graft survival due to isoagglutinin, recently developed desensitization protocols have improved survival to levels that are comparable to ABO-compatible KT. However, isoagglutinin is still regarded as a major obstacle to ABO-i KT. In this study, we evaluate the impact of isoagglutinin titer on clinical outcomes as well as factors that may influence isoagglutinin titers. In total, data from 95 patients who underwent ABO-i KT were analyzed. Preoperatively, rituximab administration and plasmapheresis were performed until the titer was reduced to ≤1:4. Retrospective analysis included blood group; timing and dosage of rituximab; isoagglutinin titer; number of plasmapheresis; and clinical outcomes including graft survival and serum creatinine. Graft survival was 95.8% (n = 91) and average serum creatinine at 1- and 1.5-year post-ABOi-KT was 1.3. Three patients died of sepsis. The identified predictors of titer-rebound after transplant were short interval (<7 days) between rituximab and first plasmapheresis (P = 0.004); high initial titer (≥256) (P = 0.023); low titer-reduction rate (P < 0.001); and blood group O (P < 0.001). One patient who experienced a rebound developed antibody-mediated rejection. With low-dose (200 mg) rituximab, the change in isoagglutinin titer-rebound was not significant and the infection rate was significantly decreased (P = 0.001). In conclusion, isoagglutinin titer-rebound within the first 2 weeks after KT may be a risk factor for rejection. The factors identified as affecting titer-rebound after KT were high initial isoagglutinin titer, low titer-reduction rate, short interval, and blood group O.

Recipient perioperative cholesterolaemia and graft cholesterol metabolism gene expression predict liver transplant outcome

We analysed for the first time whether recipient perioperative serum total cholesterol (sTC) concentration is associated with liver transplantation outcome. We studied noncholestatic cirrhotics submitted to primary deceased-donor liver transplantation in a prospective group (n=140) from Rome and in a validation retrospective cohort (n=157) from Udine, Italy. Pre-ischaemia and post-reperfusion cholesterol metabolism gene mRNA was measured by RT-PCR in 74 grafts of the study group. At Cox regression analysis, independently from confounders including recipient MELD score, the recipient pre-operative sTC pooled quintiles 2-5, compared with the lowest quintile showed HR (95% CI) and significances for overall graft loss (GL) of 0.215 (0.104-0.444) P<0.001 in the study group and 0.319 (0.167-0.610) P=0.001 in the validation cohort. Analysing sTC as a continuous variable, the risk of overall GL for every 10-mg/dl decrease in pre-operative sTC increased by 13% and by 9% in the study group and in the validation cohort respectively. In the study group, independent associations at multivariate analyses were: (a) high graft pre-ischaemia expression of INSIG-1, which indicates hepatocellular cholesterol depletion, with post-reperfusion graft necrosis; (b) GL with inadequate graft post-reperfusion response to cholesterol depletion, shown by a failure to reduce the PCSK9 to LDLR expression ratio; (c) GL with a relative increase of sTC on post-operative day-7, selectively because of the LDL fraction, which indirectly suggests poor cholesterol uptake from blood. Low recipient pre-transplant sTC concentration, its post-operative day-7 increase and a genetically determined low graft cholesterol availability predict poor liver transplant outcome.

Retrospective Comparison Of Autologous Transplantation Results Of Decreased MNC Viability Graft Cases (n=52) To Good Viability Graft Cases (n=306), a Single Centre Experience

Importance of the viability of stem cell grafts on transplantation outcome is not fully explored; however, presumably better viability results in better posttransplantation disease course. The results of the past eight years gained in our center with autologous hemopoietic stem cell transplantation were analysed, mainly in multiple myeloma (MM), Non-Hodgkin lymphoma (NHL), Hodgkin disease (HD) and some autoimmune diseases.Right before the beginning of the transplantation procedure a small aliquot of the cell products were transferred to a haematological cell counter (Abacus Junior, Diatron, Austria), CD34+ cell counts were established by immunophenotyping, and to assess the global MNC viability trypan blue dye exclusion was used (European Pharmacopoeia 7.0; 01/2008:20729). A retrospective survey of our regular autologous transplant cases and their follow up was analysed in the so called poor viability cases, as opposed to the so called better viability cohort. Our arbitrary poor viability cut off point was less than 81% global MNC viability. To characterize the transplantation outcome the following parameters were used: duration of aplasia, length of neutrophil and platelet engraftment, post transplantation overall survival data. We could not rely upon standard progression free survival asssessment and median survival analysis, due to the broad range of the timing of the interventions (including quite recent cases, too) and also due to changes in therapy along with the new innovative agents used predominantly more recently.We performed 358 autologous transplants between 2006 and June 2013. Considering our viability cut-off point we divided our patients into good viability graft group (n=306) and into poor viability graft group (n=52). The poor viability grafts contained significantly lower stem cells, but we did not identify how this viability data affected the rather mixed other cell lines of the MNC complex.There were no significant differences observed regarding the duration of aplasia, neutrophil and platelet engraftment times between two groups (Table 2).Table 1Main graft parameters in two patient group (Mean±SD)Low viability graftGood viability graftP valueMNC (×108/bw)4.132±3.6894.969±5.881P=0.3215CD34+ (×106/bw)3.554±2.2245.527±2.339P<0.001Table 2Post transplantation parameters in the poor viability graft groupDg<0.5 G/L WBC(day)<20 G/L PLT(day)Aplasia(day)Engraftment time(>1.0 G/L WBC)HD7.69.84.610.3NHL9.210.25.210.2MM4.83.82.910.6There was no correlation between low viability CD34+ cell number and survival time if analysed independently of the diagnosis. No more severe neutropenic infections (grade III-IV) were registered in the low viability graft cohort compared to the good viability patients. Interestingly 7 out of 11 patients autotransplanted with autoimmune diseases had low viability cell product and this subgroup mortality was better, i.e. 29% compared the good viability cases (less T cells contributing to autoimmunity?). However, the cumulative mortality of the hematological patients was associated with excess mortality in our low viability group (Table 3).Table 3Comparison of graft and mortality of transplantation according to diagnostic subgroups with poor or good graft viability (MNC (×108/bw) and CD34+ (×106/bw); Mean±SD)DgParameterLow viability graftGood viability graftPHDn1238MNC3.625±2.2324.989±4.4700.3161CD34+4.008±2.2205.818±3.3890.09mortality33%24%NHLn15104MNC6.700±5.1355.274±4.4960.2616CD34+3.013±1.5815.145±2.1790.0004mortality47%20%MMn17156MNC2.859±2.3194.797±6.9570.2563CD34+2.971±1.4995.626±2.073<0.0001mortality53%23%Poor viability, defined arbitrarily as 80% or less graft MNC trypan blue stain assay resulted in worse outcome in our retrospective analysis of autografted multiple myeloma, Hodgkin and non-Hodgkin lymphoma cases. The corrected CD34+ count seemed to be less important, as the length of aplasia, engraftment period, severe neutropenic infections, etc. seems to be identical with the good viability cohort results. Our results are suggesting that the diminished viability of non CD34+ components of the graft MNC (most likely T cells) might influence the long-term outcome of autologous transplant patients. This hypothesis needs further support, i.e. well planned, prospective, comprehensive analysis, focusing on the autografted T lymphocytes. Disclosures:No relevant conflicts of interest to declare.

Understanding coronary artery bypass transit time flow curves: role of bypass graft compliance

Low mean bypass graft flow (Q) and high pulsatility index (PI) measured by the transit time flow measurement method are not specific for anastomotic stenosis, but occur with competitive flow and poor coronary run-off. We hypothesized that graft compliance is responsible for these changes and that flow measured at the proximal end of the coronary bypass can be viewed as a sum of the graft capacitive flow and flow that passes through the distal anastomosis. Transit time flow measurements (TTFMs) of 15 left internal thoracic artery (LITA) to LAD bypass grafts and 10 saphenous vein grafts (SVGs) to either the right coronary artery (RCA) or posterior descending artery (PDA) were analysed. The TTFM was performed on the proximal and distal end of the graft, and proximally with distal occlusion of the graft. Low mean bypass graft flow PI and diastolic filling (DF) measured distally and proximally were compared, and graft compliance was estimated. Diastolic filling was higher distally in every single case (LITA-LAD: distal DF 76 ± 12% vs proximal 66 ± 13%, P = 0.005; SVG-RCA/PDA: distal 72 ± 15% vs proximal 63 ± 12%, P = 0.018). There were no significant differences in Q and PI. Subtracting the distal from the proximal flow gave a result identical to the proximal TTFM in distally occluded grafts, confirming the presence of graft capacitive flow. Graft compliance estimated from the flow of distally occluded grafts was 0.99 ± 0.47 μl/mmHg for LITA grafts and 0.78 ± 0.42 μl/mmHg for SVG grafts. The study confirmed that the TTFM measured at the proximal end of the coronary bypass could be viewed as a sum of graft capacitive flow and the flow that passes through the distal anastomosis. Graft capacitive flow increases the systolic and decreases the diastolic TTFM when measured at the proximal end of the graft. It explains the higher DF when the TTFM is measured at the distal end of the graft and the increase in the PI at the proximal end when Q decreases. As the influence of graft capacitive flow on the PI in low Q can be eliminated by performing the TTFM at the distal end of the graft, we believe that the value of PI is clinically irrelevant.

Does graft mass impact on pediatric kidney transplant outcomes?

The aim of this study is to assess the evolution of renal size and function in pediatric transplant patients according to the graft mass/recipient size ratio. Fifty pediatric renal transplant recipients were followed over 2 years. Grafts were weighed, and three different graft mass/m(2) ratios were determined: (1) low graft mass (58 g/m(2), range 31-57 g/m(2)), (2) median (142 g/m(2), range 59-141 g/m(2)) and high (267 g/m(2), range 143-353 g/m(2)). Patients underwent repeated ultrasound Doppler scans and repeated measurements of estimated glomerular filtration rate (eGFR; 1 week and 1, 6, 12 and 24 months), urinary retinol-binding protein (RBP) and proteinuria (1 week and 6, 12 and 24 months). The volume of renal tissue increased by 12 ± 5.6 cm(3) at 24 months (p = 0.035) in the low graft mass and decreased by -14 ± 7 cm(3) (p = 0.046) in the high graft mass. The eGFR increased when either low (30 ± 5 ml/min/1.73 m(2), p < 0.001) or median (19 ± 4 ml/min/1.73 m(2), p < 0.001) graft mass was transplanted but remained stable when high graft mass was transplanted. The resistive index (RI) presented a significant decrease throughout early follow-up in the transplants involving low and median graft mass, whereas a slight rise was observed in those involving high graft mass. A significant difference was apparent 6 months post-transplant. Transplants of low and median graft mass were associated with an initial higher urinary RBP. No significant differences in proteinuria were detected. Small kidneys undergo increases in volume and function without escalation of either proteinuria or urinary RBP, characterizing an adequate adaptation to the recipient. Children receiving larger kidneys present a reduction in volume, stable GFR and higher RI at 6 months.

Early bone resorption of free microvascular reanastomized bone grafts for mandibular reconstruction – A comparison of iliac crest and fibula grafts

ObjectivesPatients with continuous bone defects of the mandible after ablative tumor surgery need bony reconstruction for proper function and aesthetics. Free microvascular reanastomized bone grafts provide a clinically proven option for such patients, yet the optimal source of donor tissue has not yet been established. The aim of this study was to evaluate and compare the bone volume stability of vascularized bone grafts, particularly in the early highly resorptive phase, from the iliac crest (DCIA) and the fibula and to assess the implantologic rehabilitations. Materials and methodsThirty-six patients with mandibular continuity defects due to tumor resection were reconstructed by the use of vascularized bone grafts; 21 patients received DCIA flaps and 15 patients received a composite free fibular flap, depending on the size and location of the defect. Bone resorption was assessed using digital panographs. Radiographs were taken immediately after bone reconstruction, 6 months postoperatively, prior to implant surgery, and at prosthetic loading. ResultsAfter a mean observation period of 6 months, vertical bone resorption was 6.79% for the patients of the iliac crest group (DCIA), 10.20% after 11 months, and 12.58% after 17 months. Fibular grafts showed a bone resorption of 5.30% after a mean observation time of 6 months, 8.26% after 11 months, and 16.95% after 17 months. Eighteen patients received 71 implants for implant-retained dental reconstructions. ConclusionsMicrovascular reanastomized bone grafts represent a reliable treatment option for reconstruction in cases of large defects of the mandible, with low graft resorption in the early healing phase. Additionally, the compared grafts provide sufficient bone volume to permit implant rehabilitation.

Thermomechanical Properties of Bimodal Brush Modified Nanoparticle Composites

The enthalpic incompatibility of organic polymer matrices and high surface energy inorganic nanoparticles often leads to phase separation in polymer nanocomposites (PNC) precluding the realization of anticipated property enhancements. The grafting of polymer chains to nanoparticles holds promise as a means for controlling dispersion. A single population of polymer chains with tunable graft density (σ) and molecular weight (N) is observed to have antithetical enthalpic and entropic effects on interface compatibility. We report the use of bimodal polymer brushes with fundamentally decoupled enthalpic and entropic parameters. Bimodal polystyrene brushes were grafted from 15 nm colloidal silica nanoparticles by a previously reported consecutive RAFT (reversible addition–fragmentation chain transfer) polymerization technique. The combination of a high graft density short brush and a low graft density long brush was found to cause improved nanoparticle dispersion in a polystyrene matrix when compared to single populations of long and short brushes of corresponding graft densities and molecular weights. A new quantitative model was developed to understand these results and was found capable of predicting dispersions in grafted nanoparticle composites in the allophobic dewetting regime. The bimodal-brush-graft particles were also found to be remarkably well dispersed in an entropically unfavorable higher molecular weight matrix. This facilitated a study of the role of matrix–brush entanglement on the thermomechanical properties of PNCs, isolated from the effects of particle dispersion. The best enhancements in glassy properties resulted from improved matrix–brush entanglement, attained by lowering the long chain graft density and increasing the long chain to matrix molecular weight ratio.

Rootstocks resistant to Meloidogyne incognita and compatibility of grafting in net melon

Due to the few studies about grafting in net melon, in order to obtain better control of soil pathogens, the aim of the present study was to evaluate 16 genotypes of Cucurbitaceae: Benincasa hispida, Luffa cylindrica, pumpkin 'Jacarezinho', pumpkin 'Menina Brasileira', squash 'Exposição', squash 'Coroa', pumpkin 'Canhão Seca', pumpkin 'Squash', pumpkin 'Enrrugado Verde', pumpkin 'Mini Paulista', pumpkin 'Goianinha', watermelon 'Charleston Gray', melon 'Rendondo Gaucho', melon 'Redondo Amarelo', cucumber 'Caipira HS' and cucumber 'Caipira Rubi', regarding to compatibility of grafting in net melon and resistance to Meloidogyne incognita, based on the reproduction factor (RF), according to Oostenbrink (1966). To assess resistance, the seedlings were transplanted to ceramic pots and inoculated with 300/mL eggs and/or second stage juveniles of M. incognita. At 50 days after transplanting, the plants were removed from the pots and the resistance was evaluated. The compatibility between resistant rootstock and grafts of net melon was determined by performing simple cleft grafting, in a commercial net melon hybrid of great market acceptance and susceptible to M. incognita (Bonus no. 2). The genotypes Luffa cylindrica, pumpkin 'Goianinha', pumpkin 'Mini-Paulista', melon 'Redondo Amarelo', watermelon 'Charleston Gray' are resistant to the nematode M. incognita. The better compatibilities occurred with the rootstocks melon 'Amarelo', which presented 100% of success, followed by pumpkin 'Mini-Paulista' with 94%. On the other hand, Sponge gourd, watermelon 'Charleston Gray' and pumpkin 'Goianinha' showed low graft take percentages of 66%, 62% and 50%, respectively.

Therapeutic Cells via Functional Modification: Influence of Molecular Properties of Polymer Grafts on In Vivo Circulation, Clearance, Immunogenicity, and Antigen Protection

Modulation of cell surface properties via functional modification is of great interest in cell-based therapies, drug delivery, and in transfusion. We study the in vivo circulation, immuogenicity, and mechanism of clearance of hyperbranched polyglycerol (HPG)-modified red blood cells (RBCs) as a function of molecular properties of HPGs. The circulation half-life of modified cells can be modulated by controlling the polymer graft concentration on RBCs; low graft concentrations (0.25 and 0.5 mM) showed normal circulation as that of control RBCs. Molecular weight of HPG did not affect the circulation of modified RBCs. HPG grafting on RBCs reduced CD47 self-protein accessibility in a graft concentration-dependent fashion. HPG-grafted RBCs are not immunogenic, as is evident from their similar circulation profile upon repeated administration in mice and monitoring over 100 days. Histological examination of the spleen, liver, and kidneys of the mice injected with modified RBCs revealed distinct differences, such as elevated iron deposits and an increase in the number of CD45 expressing cells at high graft concentration of HPGs (1.5 mM); no changes were seen at low graft concentration. The absence of iron deposits in the white pulp region of the spleen and its presence in the red pulp region indicates that the clearance of functional RBCs occurs in the venous sinuses mechanical filtering system, similar to the clearance of unmodified senescent RBCs. HPG modification at grafting concentrations that yield long circulation in mice produced camouflage of a large number of minor blood group antigens on human RBCs, demonstrating its utility in chronic transfusion. The normal circulation, nonimmunogenic nature, and the potential to modulate the circulation time of modified cells without toxicity make this HPG-based cell surface modification approach attractive for drug delivery and other cell-based therapies.

Low Graft Function and Ongoing Hyperparathyroidism Are Closely Related to Post-Transplantation Osteoporosis

IntroductionRenal transplantation (RT) is the gold standard therapy for chronic renal failure. Immunosuppressive drug choice, malnutrition, adynamic bone disease and hyperparathyroidism are important factors impacting the development of posttransplant osteoporosis. Body composition analysis with bioimpedance devices (BIA) is a useful noninvasive tool to detect malnutrition among the RT population. We investigated the effects of graft function, immunosuppressive drug regimens and biochemical characteristics on bone mineral density of RT patients as well as the reliability of BIA measurements to diagnose osteoporosis. MethodsOne hundred three recipients with a minimum of 12 months post-RT follow-up underwent body composition analysis using the Tanita Analyzer. The last 6 months of monthly biochemical parameters and glomerular filtration rates (GFR) as well as drug regimens were collected retrospectively from patient charts. Patients were divided into 2 groups, according to their femoral neck and lumbal T scores, as osteoporosis (n = 42) and control groups (n = 61). ResultsThe mean GFR of osteoporotic patients was significantly lower (P = .04) and parathyroid hormone (PTH) levels significantly higher (P = .002). According to BIA, osteoporotic patients showed lower bone mass, fat mass, visceral fat ratio, muscle mass, waist-hip ratios, and body mass index values (P < .05). Correlation analysis revealed GFR to negatively correlate with PTH (r = −0.231, P = .010) and positively with femur t scores (r = 0.389, P = .0001) as well as with BIA findings (P = .0001). In contrast, PTH levels in negatively correlated with lumbar and femoral neck t scores (r = −0.22, −0.4 and P = .026, .0001, respectively) but not with BIA findings including bone mass. ConclusionChanges in bone density after RT were affected by graft function. The rapid loss of bone mineral density emphasizes the need for prevention started in the early posttransplant period. BMD measurements provided a guide for treatment and for subsequent evaluation.

Role of adipose‐derived stem cells in enhancing angiogenesis early after aspirated fat transplantation: induction or differentiation?

Autologous fat tissue has been used as a potential filler for soft-tissue defects, despite unpredictable clinical outcomes and low graft survival. Co-transplantation of adipose-derived stem cells (ASCs) is an alternative therapeutic approach to effectively enhance the survival and quality of transplanted fat tissue by increasing neovascularization. Nevertheless, the mechanisms by which ASCs exerted their angiogenic effects remain obscure. ASCs can secrete several angiogenic growth factors, for example vascular endothelial growth factor, hepatocyte growth factor and basic fibroblast growth factor. Hypoxic conditions may promote the proliferation of ASCs and their secretion. However, the differentiation of ASCs into endothelial cells (ECs), pericytes and smooth muscular cells in vivo has not been confirmed. The role of ASCs early after aspirated fat transplantation may be to induce new vessels from the recipient region to grow around and into the graft by releasing significant amounts of angiogenic growth factors rather than to differentiate into ECs, pericytes or smooth muscular cells forming new vessels, an effect that might be enhanced by hypoxia.

Editorial Comment: Endoscopic vein harvest: standard of care?

Editorial Comment: Endoscopic vein harvest: standard of care?

Drug release studies of N-isopropyl acrylamide/acrylic acid grafted polypropylene nonwoven fabric

Radiation-induced graft copolymerization of N-isopropyl acrylamide (NIPAAm) and acrylic acid (AA) mixture was carried out on polypropylene (PP) nonwoven fabric to develop a thermosensitive material. The immobilization and release behaviour of 4-acetamidophenol onto the modified PP nonwoven fabric were studied. The effect of degree of grafting and temperature on the drug release behaviour was investigated. At 32 °C temperature, a small amount of drug was released, and a relatively large amount of drug still remained in the polymer matrix. However, when the release temperature was 40 °C (above the LCST of 37.5 °C), the drug release was greatly accelerated due to temperature induced structure changes of the grafted copolymer chains. It was also observed that the drug release was higher for samples with higher degree of grafting. At higher graft levels, the grafted chains are longer and form the hydrogel network which leads to the more efficient entrapment of the drug within the network on the surface and consequently, more drug tends to diffuse out as compared to the low graft levels. The resulting grafted membranes exhibited temperature-triggered drug release behavior, and have enormous potential for use as drug carriers.

Cloisite-g-Methacrylic Acid Copolymer Nanocomposites by Graft from Method for Leather Processing

A series of novel facile water dispersible cloisite-g-methacrylic acid copolymers were prepared by graft from method. These graft copolymers were applied on goat skin before and after neutralization processes to produce lightweight, soft, grain tight, and water vapor permeable leather. All the graft copolymers and polymethacrylic acid (PMA) were thoroughly characterized by spectroscopic methods and thermal property changes. The intercalated cloisite-g-methacrylic acid copolymer nanocomposites exhibit a decreasing trend in viscosities with increase in the weight percentage of cloisite. The cloisite-g-methacrylic acid (C-g-MA) copolymers exhibit better thermal stability. All the nanocomposites showed a shear-thickening flow behavior. The stress–strain measurements of leather treated with nanocomposite samples reveal an increase in modulus property with the increase in cloisite content. The low weight percentage graft copolymers nanocomposite treated leathers are lightweight, have better smoothness, and show...

LOW Tranplant Related Mortality and LOW GRAFT Rejection After Related Haploidentical STEM CELL Transplantation (HAPLO-SCT) Prepared with NON Myeloablative CONDITIONING REGIMEN (NMA) and Posttransplant Cyclophosphamide for Advanced Lymphoid Malignancies.

AbstractAbstract 3031 Introduction:The use of hematopoietic stem cells from partially matched family donors has become an alternative transplant option for patients with no HLA identical donor available. It might be even a first choice, especially in advanced hematological maligancies, because of the presumed stronger graft versus tumor effect relied to the partial HLA identity. However, haplo-SCT is associated with high risk of graft rejection (GR) and severe graft versus host disease (GvHD), especially after non NMA. High dose posttransplant Cyclophosphamide (Cy) has been shown to prevent GvHD and GR. Aim:This retrospective analysis report the outcome of 15 patients (pt) using posttransplant Cy after a NMA in our center. Results:Fifteen adult pt (Male=9) with high risk lymphoid malignancies for whom a HLA matched related or unrelated donor were not available, underwent haplo-SCT from February 2011 to June 2012. The median pt age was 41years (y) (range, 20–60). Diagnosis were Hodgkin Lymphoma in 5 pt, Non Hodgkin Lymphoma in 4 pt, Chronic Lymphatic Leukemia in 2 pt, Multiple Myeloma in 2 pt and Acute Lymphoblastic Leukemia in 3 pt. All pt were heavily pretreated with a median of 3 or more chemotherapy regimens including failure of previous autologous (12pt) or allogeneic transplantation (3pt). At time of transplant 9pt (60%) were in complete remission (CR1=6, CR2=3). The NMA consisted in Fludarabine 30mg/m2 iv on days -6 to -2, Cyclophospamide 14.5mg/kg iv from days -6 and -5 and Total Body Irradiation 200cGy on day -1. For Graft versus Host Disease prophylaxis all pt received postransplant Cy 50mg/kg iv on days + 3 and +4 with Mesna. One day later, all pt started with Cyclosporine (CSA) 3mg/kg/day and Mycophenolatemofetil (MMF) 15mg/kg/day and Filgrastim 5ug/kg/day until neutrophil recovery. MMF was stopped at day+35 and CSA was given until day +180 in the absence of GvHD. Ten pt (67%) received bone marrow (BM) and 5 pt (33%) G-CSF mobilized peripheral blood stem cells (PBSC) as graft source. All donors were HLA haploidentical first degree family donors (Male=8) including brothers (7), sisters (2), mothers (4) and son (1). Median donor age was 49 y (range, 23–66). Pt had HLA typing at the allele or antigen level (A, B, Cw, DRB1, DQ) whereas 8 pt were mismatched at 5 loci, 1 pt at 4 loci, 4 pt at 3 and 2 pt at 2 loci. BM grafts contained a medium of 2×106/kg CD34+ cells and 22×106/kg CD3+ cells. PBSC grafts contained a medium of 6×106/kg CD34+ cells and 298×106/kg CD3+ cells. The engraftment rate was 93%, with a median time to neutrophil recovery (>500 G/l) of 20.5 days (range, 14–26) and to platelet recovery (>20 000 G/l) of 28.5 days (range, 14–41). Compared to BM recipients, pt receiving PBSC experienced faster neutrophil [(17 days (range, 14–23) vs 21 days (range, 18–26), p=0.04] and platelet recovery [(23 days (range, 14–30) vs 30 days (range, 23–41), p=0.04)]. One pt with ALL did not engraft and died at day +40 for infectious complication. One pt died of treatment related mortality with a cumulative incidence of 7% [96%CI (0–20)]. Two pt developped acute GvHD grade 2. No chronic GvHD was observed in pt surviving beyond day 100. Four pt exerienced relapse or progression of the underlying disease. After a median follow up of 197 days (range, 40–518) the actuarial overall survival and event-free survival at 2 years were 87% [95% CI (70–100)] and 51 % [95% CI (16–85)], respectively. Conclusion:NMA haplo-SCT with postransplant Cy in pt with advanced lymphoid malignancies is associated with low NRM, low acute GvHD and low graft rejection. However, better disease control in selected pt is needed to overcome early relapse or progression. Even if follow-up is short, PBSC seems to be an promising option to bone marrow as stem cell source. [Display omitted] Disclosures:No relevant conflicts of interest to declare.