1,721,130 research outputs found
Pancreas transplantation
No full textPURPOSE OF REVIEW: To define recent changes and future directions in the practice of pancreas transplantation (PT). Two major events have occurred in the past 18 months: COVID-19 pandemic, and the first world consensus conference on PT. Several innovative studies were published after the consensus conference. RECENT FINDINGS: During COVID-19 pandemic PT activity decreased. COVID-19 in transplant recipients increases mortality rates, but data from kidney transplantation show that mortality might be higher in waitlisted patients.The world consensus conference provided 49 jury deliberations on the impact of PT on management of diabetic patients and 110 practice recommendations.Recent evidence demonstrates that PT alone is safe and effective, that results of simultaneous pancreas and kidney (SPK) remain excellent despite older recipient age and higher prevalence of type 2 diabetes, that use of hepatitis C virus (HCV)-positive donors into HCV-negative recipients is associated with good outcomes, and that use of sirolimus as primary immunosuppressant and costimulation blockade does not improve results of SPK. SUMMARY: COVID-19 pandemic and the first world consensus conference on PT were major events. Although COVID-19 pandemic should not reduce PT activity in the future, a major positive impact on both volume and outcomes of PT is awaited from the proceedings of the world consensus conference
Computer-Aided Altruistic Unbalanced Paired Kidney Exchanges Based on Virtual Crossmatching and Predicted Post-Transplant Creatinine Clearance
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The Current Perspective on the Application of Robotic Surgery to Beta-cell Replacement or Salvage Therapies: Pancreas Transplantation, Living Donor Segmental Pancreatectomy and Pancreatic Resections with Concurrent Islet Autotransplantation
No full textMonitoring Human Immune Competence Using a Symbiont Virus: From Bench to Bedside
No full textMonitoring immune competence in transplant recipients would help tailor-made induction and maintenance immunosuppression: to date, no comprehensive test is available on the market.
Torquetenovirus (TTV) is an orphan human virus with > 95% prevalence worldwide. Once acquired, it establishes chronic viremia (approximatively 3 log10 in healthy donors), which goes up to > 5 logs in every condition of immune suppression. Since 2008, our group first reported kinetics of TTV in myeloma and lymphoma patients receiving high-dose chemotherapy supported by autologous hematopoietic stem cell transplantation (Focosi et al, Transplantation, 2008). The clinical utility of TTV viremia determination was promptly shown by correlation with opportunistic CMV reactivations, and ability to predict time needed for return to normal immune competence.
A very recent work (de Vlaminck et al, Cell, 2013) has shown that TTV is the only virus in the human plasma virome whose load changes significantly after heart or lung transplantation. The authors used shotgun sequencing, a very costly technique unapt for routine diagnostic use. We report here a single-centre, prospective trial enrolling 100 orthotopic liver transplant recipients and 100 kidney and/or pancreas transplant recipients followed-up for 2 years. Plasma samples were collected before transplantation, and at months 1, 3, 6, 12, and 24. A cheap, simple, universal real-time PCR was used to determine overall TTV viremia. Liver transplant recipients were stratified according to the intensity of maintenance immune suppression. Kidney and/or pancreas transplant recipients were stratified according to intensity of induction immune suppression.
We report a significant association between TTV viremia and CMV reactivations, and biopsy-proven graft rejection.
In conclusion, our data support the emerging concept that this marker can be of help for noninvasively confirm the clinical suspicion of graft rejection
First World Consensus Conference on Pancreas Transplantation
No full textThe First World Consensus Conference on Pancreas Transplantation was convened in Pisa, Italy, from October 17 to 19, 2019, to establish comprehensive evidence-based guidelines for the practice of pancreas transplantation. To avoid potential conflicts of interest, deliberations on issues regarding the impact of pancreas transplantation on the management of diabetes were taken by an independent jury, according to the Zurich-Danish model. Recommendations on technical issues were instead decided by a group of experts, and were validated using the Appraisal of Guidelins for REsearch and Evaluation II (AGREE II) instrument. Two rounds of discussion and voting occurred online, using the Delphi method (agreement rate ≥85%). Recommendations were finalized after live discussions. Quality of evidence was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology and each recommendation received a Grade of Recommendations Assessment, Development and Evaluation (GRADE) rating. A total of 35 queries were identified for jury deliberations and 109 for experts’ recommendations. Forty-nine jury deliberations were delivered and 110 experts’ recommendations were approved. In general, the level of evidence was quite low. No statement was GRADE 1A, because no meta-analysis of prospective and randomized trials exists for pancreas transplantation. Twenty-three of 49 Jury deliberations could not be graded. The remaining 26 deliberations were rated GRADE 2B (n = 22) and GRADE 2C (n = 4). Fifty-one of 110 expert recommendations could not be graded. The remaining 59 recommendations were rated GRADE 1B (n = 13), GRADE 1C (n = 2), GRADE 2A (n = 2), GRADE 2B (n = 20), and GRADE 2C (n = 22). In Jury deliberations both simultaneous pancreas-kidney and pancreas transplant alone were considered to prolong survival, ameliorate the course of chronic complications of diabetes, and improve quality of life. It is hoped that information provided by this consensus conference could be of help for further diffusion and safer practice of pancreas transplantation
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
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