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Critical considerations for the management of acute abdomen in transplant patients

World Journal of transplantation 2024年第2期14卷 8-12页

作者： Efstathios T Pavlidis Georgios Katsanos Athanasios Kofinas Georgios Tsoulfas Ioannis N Galanis Theodoros E Pavlidis The 2^(nd)Department of Propaedeutic surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece Department of transplantation surgery Center for Research and Innovation in Solid Organ TransplantationAristotle University of ThessalonikiSchool of MedicineThessaloniki 54642Greece

The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine ***,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute *** problems in immunocompromised patients may not only include graft-related problems but also nongraft-related *** perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these *** perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic *** in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation *** times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and *** computed tomo-graphy is of utmost importance for early diagnosis and *** recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and *** is necessary to follow evidence-based therapeutic ***,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive s

关键词： Acute abdomen Abdominal emergency surgery transplantation Immunocompromised patients Immuno-suppression Posttransplantation surgery

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Metabolic and functional effects of exercise training in diabetic kidney transplant recipients

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World Journal of transplantation 2022年第7期12卷 184-194页

作者： Vassiliki Michou Maria Nikodimopoulou Asterios Deligiannis Evangelia Kouidi Sports Medicine Laboratory School of Physical Education&Sport ScienceAristotle UniversityThessaloniki 57001Greece transplant surgery clinic of aristotle university of thessaloniki Hippokration General HospitalThessaloniki 54642Greece

BACKGROUND Physical activity levels are significantly lower in kidney transplant(KT)recipients compared to the general *** effects of exercise training in KT recipients with diabetes mellitus remain unclear,and so little is known about the role of increased exercise on cardiovascular risk and metabolic profile of KT *** To investigate the effects of a 6-mo home-based exercise training program on functional capacity,glucose levels and lipid profile of diabetic KT *** In total,21 type II diabetic KT recipients were randomly assigned into two groups:Exercise(n=11,aged 52.9±10.1 years)and control(n=10,aged 53.01±9.5 years).All participants at baseline and the end of the study underwent biochemical tests for fasting plasma glucose levels,glycated hemoglobin and lipid profile and cardiopulmonary exercise testing for maximum oxygen uptake[(VO2)peak]*** exercise group followed a 6-mo supervised home-based aerobic and progressive resistance exercise program of moderate intensity 3 times per week,while the control group continued to receive usual *** At the end of the 6-mo study,the exercise group had significantly lower values in fasting plasma glucose by 13.4%(from 120.6±28.9 mg/dL to 104.8±21.9 mg/dL,P=0.01),glycated hemoglobin by 1.5%(from 6.7%±0.4 to 6.6%±0.4,P=0.01)and triglycerides by 8.5%(from 164.7±14.8 mg/dL to 150.8±11.6 mg/dL,P<0.05)and higher values in high-density lipoprotein by 10.2%(from 51.4±8.8 mg/dL to 57.2±8.7 mg/dL,P<0.05)and(VO_(2))_(peak)by 4.7%(from 22.7±3.3 to 23.8±4.2,P=0.02)than the control *** were statistically significant differences between the two groups at the end of the study for fasting plasma glucose(decreased by 9.6%,P<0.05),triglycerides(decreased by 4.5%,P=0.04)and(VO_(2))_(peak)(increased by 4.4%,P=0.01).Finally,after training,there was a moderate,positive linear relationship between(VO_(2))_(peak)and glycated hemoglobin in the exercise group(r=0.408,P=0.03).CONCLUSION The res

关键词： Renal transplant recipients Diabetes mellitus exercise Lipid profile Glucose control Functional capacity

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Effects of an active lifestyle on the physical frailty of liver transplant candidates

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World Journal of transplantation 2022年第11期12卷 365-377页

作者： Ilias Marios Oikonomou Emmanouil Sinakos Nikolaos Antoniadis Ioannis Goulis Olga Giouleme Maria Anifanti Georgios Katsanos Konstantina-Eleni Karakasi Georgios Tsoulfas Evangelia Kouidi Department of transplant surgery Aristotle University of ThessalonikiThessaloniki 54642Greece The Fourth Department of Internal Medicine Aristotle University of ThessalonikiThessaloniki 54642Greece The Second Propaedeutic Department of Internal Medicine Aristotle University of ThessalonikiThessaloniki 54642Greece Laboratory of Sports Medicine Aristotle University of ThessalonikiThessaloniki 57001Greece

BACKGROUND Liver transplantation is the most important therapeutic intervention for end-stage liver disease(ELD).The prioritization of these patients is based on the model for end-stage liver disease(MELD),which can successfully predict short-term ***,despite its great validity and value,it cannot fully incorporate several comorbidities of liver disease,such as sarcopenia and physical frailty,variables that can sufficiently influence the survival of such ***,there is growing interest in the importance of physical frailty in regard to mortality in liver transplant candidates and recipients,as well as its role in improving their survival *** To evaluate the effects of an active lifestyle on physical frailty on liver transplant *** An observational study was performed within the facilities of the Department of transplant surgery of aristotle university of *** liver transplant candidate patients from the waiting list of the department were included in the *** that were bedridden,had recent cardiovascular incidents,or had required inpatient treatment for more than 5 d in the last 6 mo were excluded from the *** following variables were evaluated:Activity level via the International Physical Activity Questionnaire(IPAQ);functional capacity via the 6-min walking test(6MWT)and cardiopulmonary exercise testing;and physical frailty via the Liver Frailty Index(LFI).RESULTS According to their responses in the IPAQ,patients were divided into the following two groups based on their activity level:Active group(A,10 patients);and sedentary group(S,10 patients).Comparing mean values of the recorded variables showed the following results:MELD(A:12.05±5.63 vs S:13.99±3.60;P>0.05);peak oxygen uptake(A:29.78±6.07 mL/kg/min vs S:18.11±3.39 mL/kg/min;P<0.001);anaerobic threshold(A:16.71±2.17 mL/kg/min vs S:13.96±1.45 mL/kg/min;P<0.01);6MWT(A:458.2±57.5 m vs S:324.7±55.8 m;P<0.001);and LFI(A:3.75±0.31 vs

关键词： Liver transplantation Frailty Six-minute walk test Cardiopulmonary exercise testing Exercise therapy Observational study

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Short vs long-course antibiotic therapy in adults with acute cholangitis:A systematic review,meta-analysis,and evidence quality assessment

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World Journal of Gastroenterology 2023年第19期29卷 3027-3039页

作者： Karampet Kasparian Chrysanthos D Christou Konstantinos Petidis Michail Doumas Olga Giouleme clinic of Oncology Gastroenterology and HematologyAlfried Krupp HospitalEssen 45131Germany Second Propedeutic Department of Internal Medicine Hippokration General HospitalAristotle University of ThessalonikiThessaloniki 54642Greece Department of transplantation surgery Hippokration General HospitalAristotle University of ThessalonikiThessaloniki 54642Greece

BACKGROUND Acute cholangitis(AC)constitutes an infection with increased mortality rates in the *** to new diagnostic tools and therapeutic methods,the mortality of AC has been significantly reduced *** initial antibiotic treatment of AC has been oriented to the most common pathogens connected to this ***,the optimal duration of the antibiotic treatment of AC is still *** To investigate if shorter-course antibiotic treatments could be similarly effective to long-course treatments in adults with *** This study constitutes a systematic review and meta-analysis of the existing literature concerning the duration of antibiotic therapy of AC and an assessment of the quality of the *** study was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Review and *** studies were included in the systematic review,and eight were eligible for *** to heterogeneous duration cutoffs,three study-analysis groups were formed,with a cutoff of 2-3,6-7,and 14 *** A total of 2763 patients were included in the systematic review,and 1313 were accounted for the *** mean age was 73.66±14.67 years,and the male and female ratio was 1:*** significant differences were observed in the mortality rates of antibiotic treatment of 2-3 d,compared to longer treatments(odds ratio=0.78,95% confidence interval:0.23-2.67,I2=9%)and the recurrence rates and hospitalization length were also not different in all study *** Short-and long-course antibiotic treatments may be similarly effective concerning the mortality and recurrence rates of *** conclusions cannot be extracted concerning the hospitalization duration.

关键词： Acute cholangitis Antibiotic Short-course Long-course Antimicrobial Treatment duration

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Effect of panel reactive antibodies on T cell immunity reinstatement following renal transplantation

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World Journal of transplantation 2022年第10期12卷 313-324页

作者： Lampros Vagiotas Maria Stangou Efstratios Kasimatis Aliki Xochelli Grigorios Myserlis Georgios Lioulios Vasiliki Nikolaidou Manolis Panteli Konstantinos Ouranos Nikolaos Antoniadis Daoudaki Maria Aikaterini Papagianni Georgios Tsoulfas Asimina Fylaktou Department of transplant surgery School of MedicineAristotle University of ThessalonikiHippokration General HospitalThessaloniki 54642Greece Department of Nephrology School of MedicineAristotle University of ThessalonikiHippokration General HospitalThessaloniki 54642Greece Department of Immunology National Peripheral Histocompatibility CenterHippokration General HospitalThessaloniki 54642Greece Medical School aristotle university of thessaloniki Biochemistry LaboratorySchool of MedicineAristotle University of ThessalonikiThessaloniki 54124Greece

BACKGROUND Chronic kidney disease is associated with immunological disorders,presented as phenotypic alterations of T *** changes are expected to be restored after a successful renal transplantation;however,additional parameters may contribute to this *** To evaluate the impact of positive panel reactive antibodies(PRAs)on the restoration of T cell phenotype,after renal *** CD4CD28null,CD8CD28null,natural killer cells(NKs),and regulatory T cells(Tregs)were estimated by flow cytometry at T0,T3,and T6 which were the time of transplantation,and 3-and 6-mo follow-up,*** were estimated regarding the presence or absence of *** Patients were classified in two groups:PRA(-)(n=43)and PRA(+)(n=28)*** and their subtypes were similar between the two groups at T0,whereas their percentage was increased at T3 in PRA(-)compared to PRA(+)[23(10.9-47.9)vs 16.4(7.5-36.8)μ/L,respectively;P=0.03].Lymphocyte changes in PRA(-)patients included a significant increase in CD4 cells(P<0.0001),CD8 cells(P<0.0001),and Tregs(P<0.0001),and a reduction of NKs(P<0.0001).PRA(+)patients showed an increase in CD4(P=0.008)and CD8(P=0.0001),and a reduction in NKs(P=0.07).CD4CD28null and CD8CD28null cells,although initially reduced in both groups,were stabilized *** Our study described important differences in the immune response between PRA(+)and PRA(-)patients with changes in lymphocytes and lymphocyte ***(+)patients seemed to have a worse immune profile after 6 mo follow-up,regardless of renal function.

关键词： Chronic kidney disease Panel reactive antibodies Lymphocyte subpopulation CD4CD28null cells CD8CD28null cells

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COVID-19 and Liver transplantation:Challenges and Opportunities

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Journal of clinical and Translational Hepatology 2023年第3期11卷 521-522页

作者： Georgios Tsoulfas Department of transplantation surgery Aristotle University School of MedicineThessalonikiGreece

Coronavirus disease 2019(COVID-19)has presented hu-manity with a significant global challenge that has neces-sitated changes and adaptations at all *** transplant(LT)activity could not have been an exception,as it was impacted both by changes in the urgency of the use of medi-cal resources,including shortage of hospital and intensive care unit beds,problems in outpatient follow-up,redefining the urgency of a LT among *** addition to the fact that the quarantines placed and the resulting emotional isolation have led to increased alcohol use and abuse.1,2 An effort by several transplant associations and the Centers for Medicare and Medicaid led to issuing guidance and recommendations regarding transplantation surgery during COVID-19.3,4 In the paper“Impact of COVID-19 on Liver transplant Activity in the USA:Variation by Etiology and Cirrhosis Complications”by Kuo et al.,5 the authors provide us with a thorough evalu-ation of the impact of the COVID-19 pandemic on LT activity based on etiology in the USA,by analysing data from the United Network of Organ Sharing(UNOS)database(2018-2021).The authors looked at two different time periods,one in the pre-COVID era between April 2018 and February 2020.

关键词： Liver alcohol unit

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Global dissemination of minimally invasive living donor hepatectomy: What are the barriers?

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World Journal of Gastrointestinal surgery 2023年第5期15卷 776-787页

作者： Christos Dimitrios Kakos Angelos Papanikolaou Ioannis A Ziogas Georgios Tsoulfas surgery Working Group Society of Junior DoctorsAthens 15123Greece Department of transplant surgery Aristotle University of ThessalonikiSchool of MedicineThessaloniki 54622Greece Department of surgery Johns Hopkins University School of MedicineBaltimoreMD 21287United States Department of surgery University of Colorado Anschutz Medical CampusAuroraCO 80045United States

Minimally invasive donor hepatectomy(MIDH)is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of *** an initial period in which donor safety was not effectively validated,MIDH currently seems to provide improved results,provided that it is conducted by experienced *** selection criteria are crucial to achieve better outcomes in terms of complications,blood loss,operative time,and hospital *** a pure laparoscopic technique,various approaches have been recommended such as hand-assisted,laparoscopic-assisted,and robotic *** latter has shown equal outcomes compared to open and laparoscopic approaches.A steep learning curve seems to exist in MIDH,mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of *** review investigated the challenges and the opportunities of MIDH and the barriers to its global *** need expertise in liver transplantation,hepatobiliary surgery,and minimally invasive techniques to perform *** can be categorized into surgeon-related,institutionalrelated,and *** robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.

关键词： Minimally invasive donor hepatectomy Liver transplantation Living donation Laparoscopic donor hepatectomy Global surgery

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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

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Growing challenge of post-liver transplantation non-alcoholic fatty liver disease

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World Journal of transplantation 2022年第9期12卷 281-287页

作者： Maria Styliani Kalogirou Olga Giouleme Gastroenterology and Hepatology Division of the Second Propedeutic Department of Internal Medicine Hippokration General HospitalMedical SchoolAristotle University of ThessalonikiThessaloniki 54642Greece

Non-alcoholic fatty liver disease(NAFLD)is one of the leading causes of chronic liver disease,cirrhosis,and hepatocellular carcinoma worldwide,with an estimated prevalence of 25%.Post-liver transplantation(LT)recurrent or de novo hepatic steatosis is a common complication in recipients,irrespective of transplantation *** factors for graft steatosis mainly include obesity,immunosuppression,donor steatosis,and genetic *** transplant recipients are at high risk of developing insulin resistance,new-onset diabetes,and posttransplantation metabolic syndrome that is highly associated with immunosuppressive ***-LT NAFLD is often underdiagnosed due to the poor sensitivity of most routine imaging *** gold standard for the diagnosis of hepatic steatosis is liver biopsy,which is,however,limited to more complex cases due to its invasive *** is no approved pharmacotherapy in *** modification remains the cornerstone in NAFLD *** treatment strategies in post-LT NAFLD include lifestyle modifications,pharmacotherapy,bariatric surgery,and tailored ***,these approaches originate from recommendations in the general population,as there is scarce data regarding the safety and efficacy of current management strategies for NAFLD in liver transplant *** prospective studies are required to achieve tailored treatment for these patients.

关键词： Non-alcoholic fatty liver disease Steatohepatitis Hepatic steatosis Liver transplantation Cirrhosis Metabolic syndrome

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Pediatric transplantation during the COVID-19 pandemic

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World Journal of transplantation 2022年第5期12卷 88-99页

作者： Christos Dimitrios Kakos Ioannis A Ziogas Georgios Tsoulfas surgery Working Group Society of Junior DoctorsAthens 15123Greece Division of Hepatobiliary surgery and Liver transplantation Department of SurgeryVanderbilt University Medical CenterNashvilleTN 37232United States Department of transplantation surgery Aristotle University School of MedicineThessaloniki 54622Greece

Children infected by severe acute respiratory syndrome coronavirus 2(SARSCoV-2)seem to have a better prognosis than ***,pediatric solid organ transplantation(SOT)has been significantly affected by the unprecedented coronavirus disease 2019(COVID-19)pandemic during the pre-,peri-,and posttransplant ***,immunosuppression constitutes a real challenge for transplant clinicians as increased immunosuppression may prolong disease recovery,while its decrease can contribute to more severe *** date,most pediatric SOT recipients infected by SARS-CoV-2 experience mild disease with only scarce reports of life-threatening *** a consequence,after an initial drop during the early phase of the pandemic,pediatric SOTs are now performed with the same frequency as during the pre-pandemic *** review summarizes the currently available evidence regarding pediatric SOT during the COVID-19 pandemic.

关键词： Pediatric transplantation SARS-CoV-2 COVID-19 Immunosuppression

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