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Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?

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World Journal of transplantation 2020年第7期10卷 206-214页

作者： Jeevan Prakash Gopal Frank JMF Dor Jeremy S Crane Paul E Herbert Vassilios E Papalois Anand SR Muthusamy imperial college renal and transplant Center Imperial College Healthcare NHS TrustHammersmith HospitalLondon W120HSUnited Kingdom Department of Surgery and Cancer Imperial CollegeLondon W120HSUnited Kingdom

BACKGROUND Despite technical refinements,early pancreas graft loss due to thrombosis continues to *** coagulation tests(CCT)do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left ***(TEG)is an in-vitro diagnostic test which is used in liver transplantation,and in various intensive care settings to guide *** is better than CCT because it is dynamic and provides a global hemostatic profile including *** To compare the outcomes between TEG and CCT(prothrombin time,activated partial thromboplastin time and international normalized ratio)directed anticoagulation in simultaneous pancreas and kidney(SPK)transplant *** A single center retrospective analysis comparing the outcomes between TEG and CCT-directed anticoagulation in SPK recipients,who were matched for donor age and graft type(donors after brainstem death and donors after circulatory death).Anticoagulation consisted of intravenous(IV)heparin titrated up to a maximum of 500 IU/h based on CCT in conjunction with various clinical parameters or directed by TEG *** loss due to thrombosis,anticoagulation related bleeding,radiological incidence of partial thrombi in the pancreas graft,thrombus resolution rate after anticoagulation dose escalation,length of the hospital stays and,1-year pancreas and kidney graft survival between the two groups were *** Seventeen patients who received TEG-directed anticoagulation were compared against 51 contemporaneous SPK recipients(ratio of 1:3)who were anticoagulated based on *** graft losses occurred in the TEG group,whereas 11 grafts(7 pancreases and 4 kidneys)were lost due to thrombosis in the CCT group(P=0.06,Fisher’s exact test).The overall incidence of anticoagulation related bleeding(hematoma/gastrointestinal bleeding/hematuria/nose bleeding/re-exploration for bleeding/post-operative blood transfusion)was 17.65%in the TEG group and 45

关键词： Anticoagulation Pancreas transplantation Thromboelastography Thrombosis Hypercoagulability

Translational research and innovation in modern transplant practice:Paradigms from Greece and around the world

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World Journal of transplantation 2023年第2期13卷 25-27页

作者： Georgios Tsoulfas Ioannis Boletis Vassilios Papalois Department of transplantation Surgery Aristotle University School of MedicineThessaloniki 54124Greece Department of Nephrology EKPA UniversityAthens 11527Greece Department of transplant Surgery Imperial College Renal and Transplant CentreLondon W120HSUnited Kingdom

The continuous clinical and technological advances,together with the social,health and economic challenges that the global population faces,have created an environment where the evolution of the field of transplantation is essentially *** goal of this special issue is to provide a picture of the current status of transplantation in Greece as well as in many other countries in Europe and around the *** from Greece and several other countries provide us with valuable insight into their respective areas of transplant expertise,with a main focus on the field of translational research and *** papers that are part of this Special Issue“Translational Research and Innovation and the current status of transplantation in Greece”have presented innovative and meaningful approaches in modern transplant research and *** provide us with a clear overview of the current landscape in transplantation,including liver transplantation in the context of a major pandemic,the evolution of living donor kidney transplantation or the evolution of the effect of hepatitis C virus infection in transplantation,while at the same time explore more recent challenges,such as the issue of frailty in the transplant candidate and the changes brought by newer treatments,such as immunotherapy,in transplant ***,they offer us a glimpse of the effect that technological innovations,such as virtual reality,can have on transplantation,both in terms of clinical and educational *** as critical is the fact that this Special Issue emphasizes the multidisciplinary,collaborative efforts currently taking place that link transplant research and innovation with other cutting-edge disciplines such as bioengineering,advanced information technology and artificial *** this Special Issue,in addition to the clinical and research evolution of the field of transplantation,we are witnessing the importance of interdisciplinary collaboration in medicine

关键词： Translational research Non-alcoholic fatty liver disease Immunotherapy Pandemic Liver transplantation Bioengineering Artificial intelligence Immunosuppression transplant oncology Living donor kidney transplantation

Unspecified live kidney donation by urological patients

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World Journal of transplantation 2020年第8期10卷 215-222页

作者： Sebastiaan Ceuppens Hendrikus J A N Kimenai Karel W J Klop Willij C Zuidema Michiel G H Betjes Willem Weimar Jan N M IJzermans Frank J M F Dor Robert C Minnee Division of transplant Surgery Department of SurgeryErasmus MC University Medical CenterRotterdam 3015GDNetherlands Department of Internal Medicine Nephrology and Kidney Transplant UnitRotterdam 3000CANetherlands imperial college renal and transplant Unit Hammersmith HospitalImperial College Healthcare NHS TrustLondon W120HSUnited Kingdom

BACKGROUND Individuals with benign kidney disorders undergoing nephrectomy have three possibilities:Autotransplantation,with a certain risk of complications,but without a clear benefit;discarding the kidney;or living kidney *** To investigate whether patients with benign kidney disorders and a medical indication for nephrectomy are suitable as unspecified live kidney *** We searched all clinical data from 1994-2019 for unspecified donors and their transplant recipients(n=160).Nine of these 160 donors had pre-existing kidney disorders necessitating nephrectomy and had decided to donate their kidney anonymously after discussing the possibility of kidney *** studied the clinical course of these nine donating patients and their transplant *** Seven of nine donating patients indicated unbearable loin pain as the main complaint,one donating patient refused ureterocutaneostomy and one had two aneurysms of the renal ***,seven donating patients described absence of pain and one a significant reduction after the *** average 1-year creatinine level in the donating patients was 88μmol/L and after a median of 6.9 years the average creatinine level was 86.6μmol/*** the transplant recipients,one major complication occurred which led to death and in one transplant recipient graft function failed to normalize at first but has been stable for nine years ***,all transplant recipients are off *** Our data show that patients undergoing nephrectomy as part of treatment in selected kidney disorders can function as live kidney donors.

关键词： Unspecified donor Live kidney donation Benign kidney disorder Living donors Kidney transplantation

Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol

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World Journal of transplantation 2017年第1期7卷 34-42页

作者： Michelle Willicombe Anna Rizzello Dawn Goodall Vassilios Papalois Adam G Mc Lean David Taube imperial college Kidney and transplant centre Hammersmith Hospital

AIM To analyse the risk factors and outcomes of delayed graft function(DGF) in patients receiving a steroid sparing protocol. METHODS Four hundred and twenty-seven recipients of deceased donor kidney transplants were studied of which 135(31.6%) experienced DGF. All patients received monoclonal antibody induction with a tacrolimus based, steroid sparing immunosuppression *** Five year patient survival was 87.2% and 94.9% in the DGF and primary graft function(PGF) group respectively, P = 0.047. Allograft survival was 77.9% and 90.2% in the DGF and PGF group respectively, P transplant period than the group with DGF who received alemtuzumab induction. On multivariate analysis, risk factors for DGF were male recipients, recipients of black ethnicity, circulatory death donation, preformed DSA, increasing cold ischaemic time, older donor age and dialysis *** Alemtuzumab induction may be of benefit in preventing early rejection episodes associated with DGF. Prospective trials are required to determine optimal immunotherapy protocols for patients at high risk of DGF.

关键词： Allograft failure Deceased donors Delayed graft function Cold ischaemic time Rejection Steroid sparing Alemtuzumab

China organ donation and transplantation update: the Hangzhou Resolution

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Hepatobiliary & Pancreatic Diseases International 2014年第2期13卷 122-124页

作者： Jie-Fu Huang Shu-Sen Zheng Yong-Feng Liu Hai-Bo Wang Jeremy Chapman Philip O'Connell Michael Millis John Fung Francis Delmonico Department of Liver Surgery Peking Union Medical College Hospital National Organ transplant Committee Ministry of Health The First Affiliated Hospital of Zhejiang University The First Hospital of China Medical University Department of Surgery The University of Hong Kong China Organ transplant Response System Research Center centre for renal and transplant Research Westmead Millenium InstituteSydney University Section of transplantation Liver Transplantation and Hepatobiliary SurgeryUniversity of Chicago Department of General Surgery Transplant CenterDigestive Disease Institute Department of Surgery Massachusetts General Hospital

The much-anticipated change in the practice of organ donation and transplantation in China is now underway and affirmed by an important Hangzhou Resolution promulgated at the 2013 China transplant *** of the National Health and Family Planning Commission On October 29,2013,in a meeting of the National Health and Family Planning Commission (NHFPC)officials with Jie-Fu Huang,Head of National Organ transplant Committee(OTC), Hai-Bo Wang,Director of China Organ transplant Response System (COTRS)

关键词： Li China organ donation and transplantation update the Hangzhou Resolution Jun

renal transplantation in gigantism: A case report

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World Journal of transplantation 2022年第4期12卷 65-71页

作者： Jeevan Prakash Gopal Sotirios Charalampidis Jinpo Xiang Frank JMF Dor Vassilios E Papalois imperial college renal and transplant Center Imperial College Healthcare NHS TrustHammersmith HospitalLondon W120HSUnited Kingdom imperial college School of Medicine Imperial CollegeLondon W120HSUnited Kingdom Department of Surgery and Cancer Imperial CollegeLondon W120HSUnited Kingdom

BACKGROUND Gigantism,characterized by excessive growth and height is due to increased secretion of growth hormone,most commonly from a pituitary *** addition to the surgical and anesthetic complexity,the extreme stature of these patients presents a unique challenge for kidney transplantation in deciding whether to proceed with a single or dual kidney *** lack of relevant literature further adds to the *** SUMMARY A 45-year-old patient with untreated gigantism and end stage renal failure on renal replacement therapy was waitlisted for a deceased donor dual kidney transplantation due to the extreme physical stature(Height-247 cm and weight-200 kg).He was offered 2 kidneys from a 1-0-1 HLA mismatched 24-year-old DCD donor(Height-179 cm and weight-75 kg),and was planned for a bilateral retroperitoneal implantation into the recipient external iliac *** immunosuppression consisted of alemtuzumab induction(50 mg)and steroidfree maintenance with *** donor’s right kidney was uneventfully implanted extra-peritoneally into the right external iliac *** contralateral exposure,the left common and external iliac arteries were ectatic and frail.A complex vascular reconstruction was not preferred in order to preserve the arterial supply to the left lower limb,to minimise the cold ischemia time and prevent additional warm ischemic insult to the second ***,it was decided not to proceed with dual *** concerns of nephron mass insufficiency,the graft function was remarkable with a serum creatinine of 120μmol/L within a month from transplantation and 94μmol/L at 1-year post transplantation,and without *** To our knowledge,this is the first case report on kidney transplantation in *** it is believed that dual kidney transplantation is ideal,a single kidney transplantation from an appropriately selected donor can provide sufficient functioning nephron mass in patients with

关键词： Gigantism Giantism renal transplantation Kidney transplantation Pituitary adenoma Case report

Current and future pharmacological therapies for managing cirrhosis and its complications

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World Journal of Gastroenterology 2019年第8期25卷 888-908页

作者： David Kockerling Rooshi Nathwani Roberta Forlano Pinelopi Manousou Benjamin H Mullish Ameet Dhar Liver Unit/Division of Integrative Systems Medicine and Digestive Disease Imperial College London

Due to the restrictions of liver transplantation,complication-guided pharmacological therapy has become the mainstay of long-term management of *** article aims to provide a complete overview of pharmacotherapy options that may be commenced in the outpatient setting which are available for managing cirrhosis and its complications,together with discussion of current controversies and potential future ***/Medline/Cochrane Library were electronically searched up to December 2018 to identify studies evaluating safety,efficacy and therapeutic mechanisms of pharmacological agents in cirrhotic adults and animal models of ***-selective betablockers effectively reduce variceal re-bleeding risk in cirrhotic patients with moderate/large varices,but appear ineffective for primary prevention of variceal development and may compromise renal function and haemodynamic stability in advanced *** observational studies suggest protective,haemodynamically-independent effects of beta-blockers relating to reduced bacterial *** gut-selective antibiotic rifaximin is effective for secondary prophylaxis of hepatic encephalopathy;recent small trials also indicate its potential superiority to norfloxacin for secondary prevention of spontaneous bacterial *** remain the mainstay of uncomplicated ascites treatment,and early trials suggest alpha-adrenergic receptor agonists may improve diuretic response in refractory *** have not demonstrated clinical effectiveness in treating refractory ascites and may cause detrimental *** initial hepatotoxicity concerns,safety of statin administration has been demonstrated in compensated ***,statins are suggested to have protective effects upon fibrosis progression,decompensation and *** as to whether proton pump inhibitors cause gut-liver-brain axis dysfunction is *** evidence indicates that anticoa

关键词： Cirrhosis Beta-blockers Rifaximin Diuretics Statins Proton pump inhibitors Pharmacology

Pre-emptive live donor kidney transplantation-moving barriers to opportunities:An ethical,legal and psychological aspects of organ transplantation view

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World Journal of transplantation 2021年第4期11卷 88-98页

作者： David van Dellen Lisa Burnapp Franco Citterio Nizam Mamode Greg Moorlock Kristof van Assche Willij CZuidema Annette Lennerling Frank JMF Dor Department of renal and Pancreas transplantation Manchester University NHS Foundation TrustManchester M139WLUnited Kingdom Department of Faculty of Biology Medicine and HealthUniversity of ManchesterManchester M139PLUnited Kingdom Department of transplantation Guy's and St.Thomas'NHS Foundation TrustLondon SE19RTUnited Kingdom Department of Surgery Renal TransplantationCatholic UniversityRome 00153Italy Warwick Medical School University of WarwickCoventry CV47ALUnited Kingdom Res Grp Personal Rights&Property Rights University of AntwerpAntwerp 2000Belgium Departments of Internal Medicine Erasmus Medical CentreRotterdam CE 1015Netherlands The transplant centre Sahlgrenska University HospitalGothenburg S-41345Sweden Institute of Health and Care Sciences The Sahlgrenska AcademyUniversity of GothenburgGothenburg S-40530Sweden imperial college renal and transplant centre Hammersmith HospitalLondon W21NYUnited Kingdom

Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft ***-emptive LDKT,prior to requirement for renal replacement therapy(RRT),provides further advantages,due to uraemia and dialysis *** are a number of potential barriers and opportunities to promoting pre-emptive *** infrastructure is needed to deliver robust programmes,which varies based on socio-economic *** frameworks can impact on national prioritisation of pre-emptive LDKT and supporting education *** on other programme’s components,including deceased kidney transplantation and RRT,can also hamper *** programmes are designed to provide maximal benefit to the recipient,which is specifically true for pre-emptive *** care providers need to be educated to maximize early LDKT *** access for varying population groups,without socioeconomic bias,also requires *** barriers,including religious influence,also need consideration in developing successful *** addition,the benefit of pre-emptive LDKT needs to be emphasised,and opportunities provided to potential donors,to ensure timely and safe work-up *** education and preparation for pre-emptive LDKT needs to ensure increased *** of the benefits of pre-emptive transplantation require prioritisation for this population *** recommend an approach where patients approaching ESRD are referred early to pre-transplant clinics facilitating early discussion regarding pre-emptive LDKT and potential donors for LDKT are prioritized for work-up to ensure *** regarding preemptive LDKT should be the norm for patients approaching ESRD,appropriate for the patient’s cultural needs and physical ***-emptive transplantation maximize benefit to potential recipients,with the potential to occur within successful service *** f

关键词： Pre-emptive Kidney transplantation Living donor Ethics End-stage renal disease

Overall Survival with Adjuvant Pembrolizumab in renal-Cell Carcinoma

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四川生理科学杂志 2024年第4期46卷 872-872页

作者： Toni K Choueiri Poznan University of Medical Sciences Poznan Samsung Medical Center Sungkyunkwan University School of Medicine Beatson West of Scotland Cancer centre and the University of Glasgow Glasgow Fiona Stanley Hospital Perth WA Edinburgh Cancer centre and the University of Edinburgh Edinburgh Fakultní Nemocnice Ostrava Ostrava imperial college Healthcare NHS Trust Abramson Cancer Center Penn Medicine Philadelphia Fundación Arturo López Pérez Santiago Chile University Hospital Bordeaux–Hôpital Saint-André Bordeaux the University of Texas Southwestern Medical Center Dallas Rocky Mountain Cancer Centers Aurora CO Texas Oncology–Houston Houston Omsk Clinical Oncology Dispensary Omsk Russia the University of Michigan Ann Arbor Hôpital Européen Georges Pompidou Université Paris Cité Paris the University of Toyama Toyama Japan Instituto de Cancer e transplante de Curitiba Curitiba Brazil the London Regional Cancer Program London Health Sciences Centre Western University London ON Canada Merck Rahway NJ Barts Health NHS Trust and the Royal Free NHS Foundation Trust Barts Cancer Institute Queen Mary University of London

Background:Adjuvant pembrolizumab therapy after surgery for renal-cell carcinoma was approved on the basis of a significant improvement in disease-free survival in the KEYNOTE-564 *** the results regarding overall survival from the third prespecified interim analysis of the trial would also favor pembrolizumab was ***:In this phase 3,double-blind,placebo-controlled trial,we randomly assigned(in a 1:1 ratio)participants with clear-cell renal-cell carcinoma who had an increased risk of recurrence after surgery to receive pembrolizumab(at a dose of 200 mg)or placebo every 3 weeks for up to 17 cycles(approximately 1 year)or until recurrence,the occurrence of unacceptable toxic effects,or withdrawal of consent.A significant improvement in disease-free survival according to investigator assessment(the primary end point)was shown *** survival was the key secondary end *** was a secondary end point.

关键词： Carcinoma Survival specified