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Comparative study of living donor kidney transplants:Right vs left

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World Journal of transplantation 2025年第1期15卷 115-123页

作者： Taqi Khan Nadeem Ahmad Qaisar Iqbal Muneeb Hassan Lajward Asnath Naveed Khan Sajid Shakeel Kidney transplant Unit Rehman Medical InstitutePeshawar 25100Khyber PakhtunkhwaPakistan Department of Surgery Princess Noura Binti AbdulRehman UniversityRiyadh 84428Saudi Arabia

BACKGROUND transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft ***,circumstances may arise where selecting the RK over the left kidney(LK)is ***,it is crucial to thoroughly examine the implications of such a choice on the overall transplant *** To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these *** We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December *** included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based *** variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)*** used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney *** Of the 250 transplants performed during the period,56(22%)were *** recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for *** and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being *** complications,however,were not related to the venous *** RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical *** post-transplant SC trend and mean SC at the last follow-up were similar across both kidney *** The donor kidney side has little impact on post-transplant

关键词： Living donor Right kidney Right renal vein Venous anastomosis Technical graft loss Early graft function

Endothelial dysfunction in the kidney transplant population:Current evidence and management strategies

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World Journal of transplantation 2025年第1期15卷 24-43页

作者： Arun Prabhahar Akshey Batta Juniali Hatwal Vivek Kumar Raja Ramachandran Akash Batta Department of Telemedicine(Internal Medicine and Nephrology) Post Graduate Institute of Medical Education and ResearchChandigarh 160012India Department of Urology and Renal transplant Neelam HospitalRajpura 140401PunjabIndia Department of Internal Medicine Post Graduate Institute of Medical Education and ResearchChandigarh 160012India Department of Nephrology Post Graduate Institute of Medical Education and ResearchChandigarh 160012India Department of Cardiology Dayanand Medical College and HospitalLudhiana 141001PunjabIndia

The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and *** dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future cardiovascular(CV)*** kidney disease,a state of chronic inflammation caused by oxidative stress,metabolic abnormalities,infection,and uremic toxins damages the *** is also associated with a decline in estimated glomerular filtration *** kidney transplantation,endothelial functions undergo immediate but partial restoration,promising graft longevity and enhanced CV ***,the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED,culminating in poor CV health and graft *** in kidney transplant recipients is an underrecognized and poorly studied *** diseases are the leading cause of death among kidney transplant candidates with functioning *** contributes to the pathogenesis of many of the CV *** biomarkers and vasoreactivity tests are available to study endothelial *** an increasing number of transplants happening every year,and improved graft rejection rates due to the availability of effective immunosuppressants,the focus has now shifted to endothelial protection for the prevention,early recognition,and treatment of CV diseases.

关键词： Endothelial dysfunction Endothelium Cardiovascular disease Kidney transplantation Chronic kidney disease Nitric oxide Flow-mediated dilatation Nitro-glycerine-mediated dilatation Biomarkers

Split liver transplantation: Current developments

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World Journal of Gastroenterology 2018年第47期24卷 5312-5321页

作者： Christina Hackl Katharina M Schmidt Caner Süsal Bernd Dohler Martin Zidek Hans J Schlitt Department of Surgery University Hospital RegensburgRegensburg 93053Germany Collaborative transplant Study (CTS) Institute of ImmunologyHeidelberg UniversityHeidelberg 69120Germany

In 1988, Rudolf Pichlmayr pioneered split liver transplantation(SLT), enabling the transplantation of one donor liver into two recipients-one pediatric and one adult patient. In the same year, Henri Bismuth and colleagues performed the first full right/full left split procedure with two adult recipients. Both splitting techniques were rapidly adopted within the transplant community. However, a SLT is technically demanding, may cause increased perioperative complications, and may potentially transform an excellent deceased donor organ into two marginal quality grafts. Thus, crucial evaluation of donor organs suitable for splitting and careful screening of potential SLT recipients is warranted. Furthermore, the logistic background of the splitting procedure as well as the organ allocation policy must be adapted to further increase the number and the safety of SLT. Under defined circumstances, in selected patients and at experienced transplant centers, SLT outcomes can be similar to those obtained in full organ LT. Thus, SLT is an important tool to reduce the donor organ shortage and waitlist mortality, especially for pediatric patients and small adults. The present review gives an overview of technical aspects, current developments, and clinical outcomes of SLT.

关键词： Liver transplantation organ shortage in situ split extended right lobe left lateral lobe living donor

Hepatic vein reconstruction during hepatectomy:A feasible and underused technique

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Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 421-427页

作者： Manish Ahuja Kunal Joshi Chris Coldham Paulo Muiesan Bobby Dasari Manuel Abradelo Ravi Marudanayagam Darius Mirza John Isaac David Bartlett Nikolaos A Chatzizacharias Robert P Sutcliffe Keith J Roberts Department of HPB and Liver transplant Surgery University Hospitals Birmingham NHS Foundation TrustBirminghamUK institute of immunology and Immunotherapy University of BirminghamBirminghamUK

Complete surgical resection(R0)of liver tumors,primary or metastatic,remains the main objective in management of primary and metastatic liver tumors[1].Tumors invading to the proximity of the hepatic venous outflow pose a peculiar challenge to achieve R0 resections,because this location may render a tumor *** median survival of patients with liver tumor without surgery is less than 12 months[2].Even with surgery,post-hepatectomy liver failure and subsequently increased mortality are the main problems associated with complex resection[3].Moreover,when the vein is affected,vein resection and subsequent reconstruction are *** resection is a standard practice in liver resection and transplantation[4],for example,hepatic vein reconstruction during a living-donor liver transplant,porto-mesenteric axis reconstruction during resection of advanced pancreatic cancer and caval reconstruction during resection of retroperitoneal ***,novel techniques like total hepatic vascular exclusion(HVE)[5],veno-venous bypass[6]and ex vivo hepatic resection[7,8]have facilitated curative resections of tumors close to one or more major hepatic veins.

关键词： hepatectomy surgery mortality

Ciliated hepatic foregut cyst:an increasingly diagnosed condition

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Hepatobiliary & Pancreatic Diseases International 2008年第6期7卷 581-589页

作者： Sharad Sharma Amanda G.Dean Ayumi Corn Vivek Kohli Harlan I Wright Anthony Sebastian Nicolas Jabbour Methodist University Hospital transplant institute 1265 Union Avenue Nazih Zuhdi transplant institute 3300 North West Expressway

BACKGROUND:Ciliated foregut cysts of the liver are rare, with only 96 cases diagnosed since the first description in *** are being increasingly diagnosed recently;the majority of the cases have been reported in the last 15 years. Although they bear a close resemblance to the simple cyst of the liver which has essentially a benign course,ciliated hepatic foregut cysts(CHFCs)can progress to malignancy with devastating *** is imperative that this group of conditions be diagnosed and treated adequately. DATA SOURCES:This review includes discussion of the data from all the 96 reported cases from English and non-English *** of the incidence rates, embryogenesis,growth,clinical features,risk of malignancy and the prognosis are highlighted *** roles of various diagnostic modalities including ultrasound, CT,MRI,fine needle aspiration cytology(FNAC), immunohistochemistry and surgery are further discussed. RESULTS:The mean age of patients with CHFC was 48± 12 *** male/female ratio was 1.1∶*** majority of patients with CHFC(62%)were asymptomatic,and the common mode of presentation was right upper abdominal *** cysts occurred in the left lobe in 51 patients, with sole location in segmentⅣin 44,and in the right lobe in *** average size of the cysts was 3.6±2.12 cm. The majority of the cysts were unilocular,and only 7 cases were *** contents were described as viscous or mucinous in 73 patients,whereas bilious fluid was noted in *** cysts having squamous carcinoma were cited in 3 patients,and 2 had extensive squamous metaplasia without *** had benign histopathology. CONCLUSIONS:Clinicians have become increasingly aware of *** alone is not diagnostic per se, but when considered in the context of the global picture does provide important clues to the *** is diagnostic by the presence of the ciliated columnar aspirate but lacks *** presentation is usua

关键词： ciliated hepatic foregut cyst squamous cell carcinoma cystic liver disease

Recirculating IL-1R2^(+) Tregs fine-tune intrathymic Treg development under inflammatory conditions

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Cellular & Molecular immunology 2021年第1期18卷 182-193页

作者： Eirini Nikolouli Yassin Elfaki Susanne Herppich Carsten Schelmbauer Michael Delacher Christine Falk Ilgiz A.Mufazalov Ari Waisman Markus Feuerer Jochen Huehn Department of Experimental immunology Helmholtz Centre for Infection ResearchBraunschweigGermany institute for Molecular Medicine University Medical Center of the Johannes Gutenberg-University MainzMainzGermany Regensburg Center for Interventional immunology(RCI) Chair for ImmunologyUniversity Regensburg and University Hospital RegensburgRegensburgGermany institute of transplant immunology Integrated Research and Treatment Center TransplantationIFB-TxHannover Medical SchoolHannoverGermany Hannover Medical School HannoverGermany

The vast majority of Foxp3^(+)regulatory T cells(Tregs)are generated in the thymus,and several factors,such as cytokines and unique thymic antigen-presenting cells,are known to contribute to the development of these thymus-derived Tregs(tTregs).Here,we report the existence of a specific subset of Foxp3^(+)Tregs within the thymus that is characterized by the expression of IL-1R2,which is a decoy receptor for the inflammatory cytokine *** flow cytometric analysis of the thymocytes from Foxp3^(hCD2)xRAG1^(GFP) reporter mice revealed that the IL-1R2^(+)Tregs are mainly RAG1^(GFP-)and CCR6^(+)CCR7^(-),demonstrating that these Tregs are recirculating cells entering the thymus from the periphery and that they have an activated *** the spleen,the majority of IL-1R2^(+)Tregs express neuropilin-1(Nrp-1)and Helios,suggesting a thymic origin for these ***,among all tissues studied,the highest frequency of IL-1R2^(+)Tregs was observed in the thymus,indicating preferential recruitment of this Treg subset by the *** fetal thymic organ cultures(FTOCs),we demonstrated that increased concentrations of exogenous IL-1β blocked intrathymic Treg development resulting in a decreased frequency of CD25^(+)Foxp3^(+)tTregs and an accumulation of CD25^(+)Foxp3^(-)Treg ***,the addition of IL-1R2^(+)Tregs,but not IL-1R2^(+)Tregs,to reaggregated thymic organ cultures(RTOCs)abrogated the IL-1β-mediated blockade,demonstrating that these recirculating IL-1R2^(+)Tregs can quench IL-1 signaling in the thymus and thereby maintain thymic Treg development even under inflammatory conditions.

关键词： Thymus Treg development Inflammation IL-1 system

Using on-site liver 3-D reconstruction and volumetric calculations in split liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 587-592页

作者： Trevor W Reichman Brittany Fiorello Ian Carmody Humberto Bohorquez Ari Cohen John Seal David Bruce George E Loss Ochsner Multi-Organ transplant institute Ochsner Medical Center

BACKGROUND： Split liver transplantation increases the number of grafts available for transplantation. Pre-recovery assessment of liver graft volume is essential for selecting suitable recipients. The purpose of this study was to determine the ability and feasibility of constructing a 3-D model to aid in surgical planning and to predict graft weight prior to an in situ division of the donor liver. METHODS： Over 11 months, 3-D volumetric reconstruction of 4 deceased donors was performed using Pathfinder Scout liver volumetric software. Demographic, laboratory, operative, perioperative and survival data for these patients along with donor demographic data were collected prospectively and analyzed retrospectively. RESULTS： The average predicted weight of the grafts from the adult donors obtained from an in situ split procedure were 1130 g （930-1458 g） for the extended right lobe donors and 312 g （222-396 g） for left lateral segment grafts. Actual adult graft weight was 92% of the predicted weight for both the extended right grafts and the left lateral segment grafts. The predicted and actual graft weights for the pediatric donors were 176 g and 210 g for the left lateral segment grafts and 308 g and 280 g for the extended right lobe grafts,respectively. All grafts were transplanted except for the right lobe from the pediatric donors due to the small graft ***： On-site volumetric assessment of donors provides useful information for the planning of an in situ split and for selection of recipients. This information may expand the donor pool to recipients previously felt to be unsuitable due to donor and/or recipient weight.

关键词： split liver transplantation reduced-size liver transplantation 3-D reconstruction

Serum thioredoxin activity:a promising biomarker for assessment of coronary stenosis severity in patients with coronary artery disease

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Science Bulletin 2017年第11期62卷 752-754页

作者： Jinling Li Pei Wang Li Xiao Jianmin Yu Xianrui Kong Liangwei Zhong Medical School University of Chinese Academy of Sciences Beijing Key Laboratory of immunology Regulation and Organ transplantation Basic Research Laboratory of Organ Transplant Institutethe 309th Hospital of the People's Liberation Army

Coronary artery disease(CAD)is one of the major death causes *** methods may improve the progress of ***,specific biomarkers are required for detecting coronary stenosis severity and monitoring *** spiral computed tom... 详细信息

关键词：动脉狭窄冠心病生物标记物蛋白活性冠状动脉造影冠状动脉疾病患者评价

Unusual complication in patient with Gardner's syndrome: Coexistence of triple gastrointestinal perforation and lower gastrointestinal bleeding: A case report and review of literature

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World Journal of Clinical Cases 2018年第10期6卷 393-397页

作者： Sami Akbulut Cemalettin Koc Abuzer Dirican Department of Surgery and Liver transplant institute Inonu University Faculty of Medicine

Gardner's syndrome(GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and midrectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodenojejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.

关键词： Gastrointestinal perforation Gastrointestinal bleeding Adenosquamous carcinoma Complications Gardner’s syndrome