1,721,312 research outputs found
Metabolic Disorders Following Kidney Transplantation
No full textSeveral metabolic processes are altered by kidney transplantation (KT), mainly due to a mechanism of overlapping between preexisting favoring conditions and side effects of immunosuppressive agents. Among the metabolic alterations commonly observed after KT, diabetes mellitus, dyslipidemias, and uric acid metabolism represent the most important ones, mainly due to the clinical impact they may present not only in relation to graft function but also in terms of patient survival. The most recent (as of 2017) national guidelines, randomized controlled trials, and metaanalyses on these arguments are reported in this chapter, with the intent to better clarify the therapeutic strategies to adopt in case of metabolic disorder after KT
Transplantation for hepatocellular cancer. Pushing to the limits?
No full textMilan criteria (MC) represents the cornerstone in the selection of patients with hepatocellular cancer (HCC) waiting for liver transplantation (LT). MC represent the precursor of the scores based on the idea of “utility”: in other terms, the scoring systems typically used in the field of LT oncology present the exclusive aim of selecting the cases with the best post-LT outcomes. However, some other scores have been proposed specifically investigating the risk of death or tumour progression during the waiting list. In this case, the selection process is connected with the idea of “priority”: patients at higher risk for drop-out (DO) should be selected, prioritising them or, conversely, deciding to de-list them due to the high risk of post-LT futile transplant. Lastly, models based on the concept of “benefit”, namely the balancing between priority and utility, have been recently created. The present review aims to examine these three different types of scoring systems, trying to underline their pro and cons in the allocation process of HCC patients
Reply to "Association between donor age and risk of graft failure after liver transplantation: an analysis of the Eurotransplant database”
No full textReply to https://doi.org/10.1111/tri.1335
Donor diabetes and prolonged cold ischemia time increase the risk of graft failure after liver transplant: Should we need a redefinition of the donor risk index?
No full textDear Editors,
We read with great interest the paper by Brüggenwirth et al. (1) about the importance of cold ischemia time (CIT) and diabetes type II (DM-2) in increasing the risk of graft failure after liver transplantation (LT). The results obtained from the UNOS database are in line with those obtained in a recently published study coming from our center. (2) Our retrospective, single-center analysis was based on data from 1,354 adult LTs performed at the University of Pisa Medical School Hospital: in all the cases, whole sized livers coming from deceased-brain donors were transplanted. Using a propensity score approach, 448 patients receiving a graft younger than 70 years were finally matched with 515 counterparts receiving grafts older than 70 years. Four variables were found to be independently significant as risk factors for graft loss, namely HCV positivity (HR=2.1; p<0.001), donor age (HR=1.0; 95% p<0.001), CIT (HR=1.0; p=0.042), and donor DM-2 status (HR=1.5; p=0.047). It is extremely interesting to underline that two apparently very different databases like a North American and an Italian one consented to obtain similar results, mainly in consideration of their big numerosity (58,226 and 1,354 respectively). In both the contexts, the synergic action of acute (prolonged CIT) and chronic (DM-2) damages eventually ended in promoting post-LT graft failure. Indeed, the fact that advanced donor age is an amplifying factor of chronic damages induced by DM-2 looks to be as a natural consequence. Also Brüggenwirth et al. reported that “the only risk factor that meaningfully altered the HR for DM-2 (and remained statistically significant) in the final models was donor age”.(1) Here comes the problem connected with the vagueness of the definition of donor DM-2. In fact, defining DM-2 status as “use of insulin” or “altered blood sugar levels” is not enough for completely capturing the real pathological changes induced by the disease. For example, using these dichotomous variables completely fails in defining the length and the severity of DM-2: thus, age is probably only a very good surrogate for this purpose. For this reason, identification of pathological markers (3) consenting to pre-operatively define the grafts at high-risk for poor post-LT function should represent a real revolution in the selection and allocation processes. We strongly believe that not age per se, but a combination of acute and chronic damages associated with age, mainly due to metabolic diseases, play a fundamental role in worsening results when using older grafts.
Under the light of these experiences, and in agreement with other Authors,(4) a re-evaluation of the Donor Risk Index (DRI) should be considered. In fact, after the publication by Feng et al. in 2006,(5) a larger use of the so called extended criteria donors has been observed, in particular of donors with multiple comorbidities. As a consequence, a new analysis able to update the donor-related risk stratification should be considered. We believe that a new universal DRI should be the future target, including international experiences, and not being limited only to regional databases which may not be able to intercept specific behaviors or needs of a particular region of the world
Hybrid partial ALPPS. a feasible approach in case of right trisegmentectomy and macrovascular invasion
No full textI read with great interest the excellent
article ‘‘The Impact of Different Surgical
Techniques on Outcomes in Laparoscopic
Sleeve Gastrectomies’’1 from Berger et al,
published in the September 2016 issue of
Annals of Surgery. The role of the impact
of different technical details on the outcome
of sleeve gastrectomies is particularly
relevant, and several aspects pointed out by
the authors certainly deserve the maximum
attention of the international bariatric
surgical community.
The set of data reported in the study is
impressive and very informative. However,
some concerns need to be raised because they
constitute excellent examples of the strength
and limitations of a data registry observational
retrospective study, even if large and very
well conducted.
One of the main conclusion of the
article is related to the increased risk of a
leak associated with buttressing. Certainly,
the authors clarify that the literature on staple
line reinforcement has conflicting results.
They also acknowledge the lack of specific
information about the buttressing products
used in their series. This limitation is, indeed,
very relevant as it has been shown that there
are significant differences between them
The dangers of immunosuppression and solid organ transplant in the SARS-CoV-2 pandemic era
Full text linkThe dangers of immunosuppression and solid organ transplant in the SARS-CoV-2 pandemic er
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Stabilization of Nanosized Borohydrides for Hydrogen Storage: Suppressing the Melting with TiCl 3 Doping
No full textLightweight complex hydrides, M(BH4)n (M = Li, Na, Mg, and Ca; n = 1 for Li and Na, n = 2 for Mg and Ca), are believed to be promising hydrogen storage materials with extreme high hydrogen density up to 18.5 mass %. However, these materials suffer high dehydrogenation temperature, melting, and reversibility problems, which exclude them from the list of practical hydrogen storage systems. Herein, borohydrides (M(BH4)n-Ti, with M = M1 or M2 and n = 1 or 2), were modified with TiCl3 via a wet chemistry approach, and in some cases this led to the formation of solvent-stabilized nanoparticles. As a result of TiCl3 modification, the melting before hydrogen release was suppressed as evidenced by DSC and thermal microscopy observations. Furthermore, the hydrogen release temperature of M(BH4)n-Ti was significantly reduced. For example, the dehydrogenation temperature of NaBH4-Ti was reduced from 570 to 120 °C. Ti modification was also found to improve to some extent the reversibility of the doped materials. In particular, up to 2 mass% H2 was reversibly cycled for Ca(BH4)2-Ti at 300 °C and 9 MPa H2 pressure, in comparison to 400 °C and 70 MPa for pristine Ca(BH4)2. This study demonstrates a simple method to synthesize surfactant-free Ti-doped nanosized borohydrides, and by removing the melting of these materials, it provides a new path toward the stabilization of borohydride particles at the nanoscale
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