1,721,082 research outputs found
Current Opinion in Organ Transplantation - April 2021- Volume 26 (issue 2)
No full textno abstract availabl
Letter to the editor on endovascular revascularization with stent implantation in patients with acute mesenteric ischemia due to acute arterial thrombosis: clinical outcome and predictive factors
Full text linkWe read with great interest the article of Pedersoli et al. [1] recently published in an issue of the journal. The authors retrospectively described their experience on the emergency treatment of acute mesenteric ischemia with endovascular stenting of the superior mesenteric artery (SMA) and/or celiac trunk (CA). A total of 17 of the 40 patients (42.5%) presented with bowel necrosis (2/17) or ischemia (15/17) on pre-interventional computed tomography. Two out of 40 patients (5%) underwent surgery before stent deployment. Revascularization of the target vessel was successful in 36/40 patients (90%). After stenting, 25 out of 40 patients (62.5%) underwent abdominal laparoscopy or laparotomy; specifically, in 12 patients (48%) the ischemic bowel was resected, and in the remaining 13 patients (52%) no additional surgery was needed or possibl
Letter to the Editor on "CD4+ T cells persist for years in the human small intestine and display a TH1 cytokine profile"
No full textWe read and appreciated the recent study by Bartolome’-Casado R et al.1: the authors examined the turnover of CD4+ T cells in human transplanted duodenum, showing that the majority of CD4+ T cells were still donor-derived 1 year after transplantation and suggesting that immune-surveillance in non-lymphoid tissues is dominated by CD4+ T cell-resident populations. In their opinion most CD4+ T cells in human small intestine under normal conditions are non-circulating, resident cells that most likely perpetuate for years and tissue residency represents a major mechanism for CD4+ memory T cell immune-surveillance in human small bowel. In their study transplanted patients with episodes of acute cellular rejection (ACR) or with donor-specific antibodies (DSA) were excluded. Notwithstanding, there was a large variation in persisting donorderived CD4+ T cells among human duodenal grafts after 1 year: the Authors explained the phenomenon with the probability of undiagnosed intermittent rejection episodes (or other clinical problems) among patients between 6 and 52 weeks after transplantation. Rejection episodes dramatically increase the replacement kinetics of immune cells and microchimerism
Comment on "European Pediatric Surgeon' Association survey on the management of Short-Bowel Syndrome"
No full textWe read with interest the article by Dariel et al “European Pediatric Surgeon’ Association survey on the management of short-bowel syndrome” recently published in the journal.1 Based on our pediatric surgical experience previously in Manchester (UK)2 and ongoing in Florence (Italy)3 which has been double-checked by an external reviewer/author (A.L.), we would like to provide comments on the article (►Table 1). Regarding institutional practices, Manchester and Florence are high-volume centers with an Intestinal Rehabilitation Program but no transplant surgeon. As with most of the European centers, we use surgical strategies (>3 procedures/year in Manchester and 3 procedures/year in Florence) to facilitate enteral autonomy, promoting intestinal adaptation through an early stoma closure
Surgeon's perspective on short bowel syndrome: Where are we?
Full text linkShort bowel syndrome (SBS) is due to a massive loss of small bowel: the reduction of gut function is below the minimum necessary to maintain health (in adults) and growth (in children) so intravenous supplementation is required. Parenteral nutrition represents the milestone of treatment and surgical attempts should be limited only when the residual bowel is sufficient to increase absorption, reducing diarrhea and slowing the transit time of nutrients, water and electrolytes. The surgical techniques lengthen the bowel (tapering it) or reverse a segment of it: developed in children, nowadays are popular also among adults. The issue is mainly represented by the residual length of the small bowel where ileum has shown increased adaptive function than jejunum, but colon should be considered because of its importance in the digestive process. These concepts have been translated also in intestinal transplantation, where a colonic graft is nowadays widely used and the terminal ileum is the selected segment for a living-related donation. The whole replacement by a bowel or multivisceral transplant is still affected by poor long term outcome and must be reserved to a select population of SBS patients, affected by intestinal failure associated with irreversible complications of parenteral nutrition
Pregnancy after liver and other transplantation
No full textSince the frst human liver transplant performed in 1963 by Thomas Starzl (University of Colorado) [1], many advances in surgical techniques and immunosuppressive therapy have helped to increase the numbers of women who undergo allogenic organ transplantation each year. In 1978, Walcott [2] documented the frst known pregnancy in a liver transplant recipient, which resulted in a successful delivery with both mother and infant in excellent health. Many times, a transplanted organ normalizes a woman’s hormonal imbalance and restores fertility, thus offering the prospect of pregnancy and providing many women with end-stage organ disease a chance to conceive and bear children. As a result, among liver transplant recipients, a higher survival rate and a return to a good quality of life have been achieved. In 1991, the National Transplantation Pregnancy Registry (NTPR) was established at Thomas Jefferson University in Philadelphia, Pennsylvania, to analyze pregnancy outcomes in solid-organ transplant recipients [3]
Colonic stent for bridge to surgery for acute left-sided malignant colonic obstruction: A review of the literature after 2020
Full text linkIt has been found that 8%-29% of colorectal cancers are obstructive. The use of “stent as bridge to surgery” is one of the most debated topics in obstructive left-sided colorectal cancer management. The endoscopic placement of a self-expanding metallic stent as bridge to surgery (BTS) could turn an emergency surgery to an elective one, increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one. However, in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted. Therefore, despite the useful short-term outcomes related to BTS, the recent literature has focused on long-term outcomes investigating the disease-free survival, the recurrence rate and the overall survival. Due to discordant data, international guidelines are still conflicting, and the debate is still open. There is not agreement about using self-expanding metallic stent for BTS as the gold standard
Immunosuppression, compliance, and tolerance after orthotopic liver transplantation: state of the art
Full text linkOrthotopic liver transplantation is the treatment of choice for several otherwise irreversible forms of acute and chronic liver diseases. Early implemented immunosuppressant regimens have had disappointing results with high rejection rates. However, new drugs have reduced the daily immunosuppression requirements, thereby improving graft and patient survival as well as kidney function. Liver rejection is a T-cell-driven immune response and is the active target of immunosuppressive agents. Immunosuppressants can be divided into pharmacological or biological drugs: the gold standard is the calcineurin inhibitors, steroids, mycophenolate mofetil, and mechanistic target of rapamycin inhibitors. Compliance with these agents is essential, although they can increase the risk of infections and neoplastic diseases. In some patients, graft tolerance can be achieved. Graft tolerance is defined as the absence of acute and chronic rejection in a graft, with normal function and histology in an immunosuppression-free, fully immunocompetent host, usually as the final result of a successful attempt at immunosuppression withdrawal. The occurrence of immunosuppressive-related complications has led to new protocols aimed at protecting renal function and preventing de novo cancer and dysmetabolic syndrome. The backbone of immunosuppression remains calcineurin inhibitors in association with other drugs, mainly over the short-term period. To avoid rejection and the side effects on renal dysfunction, de novo cancer, and cardiovascular syndrome, optimal long-term immunosuppressive therapy should be tailored in liver transplant recipients
- …
