Pretransplantation fetal-maternal microchimerism in pediatric liver transplantation from mother

AIM To investigate the rates of pretransplantation fetalmaternal microchimerism(MC) and its effect on rejection in children receiving maternal liver grafts. METHODS DNA or blood samples before liver transplantation(LT) were available in 45 pediatric patients and their mothers. The presence of pretransplantation MC to non-inherited maternal antigens(NIMAs)(NIMA-MC) in the peripheral blood was tested using nested PCRsingle-strand conformation polymorphism analysis for the human leukocyte antigen(HLA)-DRB1 alleles. NIMA-MC was successfully evaluated in 26 of the 45 children. Among these 45 pediatric LT recipients,23 children(51.1%) received transplants from maternal donors and the other 22 from non-maternal donors.RESULTS Among these 26 children,pretransplantation NIMAMC was detected in 23.1%(n = 6),6.1(range,0.8-14) years after birth. Among the children with a maternal donor,the rate of biopsy-proven cellular rejection(BPCR) was 0% in patients with NIMA-MC positivity(0/3) and those with HLA-DR identity with the mother(0/4),but it was 50% in those with NIMA-MC negativity(5/10). Patients with NIMA-MC positivity or HLA-DR identity with the mother showed significantly lower BPCR rate compared with NIMA-MC-negative patients(0% vs 50%,P = 0.04). NIMA-MC-positive patients tended to show lower BPCR rate compared with NIMAMC-negative patients(P = 0.23). CONCLUSION The presence of pretransplantation NIMA-MC or HLADR identity with the mother could be associated with BPCR-free survival in pediatric recipients of LT from maternal donors.

Spectral domain optical coherence tomography crosssectional image of optic nerve head during intraocular pressure elevation

AIM: To analyze changes of the optic nerve head(ONH) and peripapillary region during intraocular pressure(IOP) elevation in patients using spectral domain optical coherence tomography(SD-OCT).METHODS: Both an optic disc 200×200 cube scan and a high-definition 5-line raster scan were obtained from open angle glaucoma patients presented with monocular elevation of IOP(≥30 mm Hg) using SD-OCT. Additional baseline characteristics included age, gender, diagnosis,best-corrected visual acuity, refractive error, findings of slit lamp biomicroscopy, findings of dilated stereoscopic examination of the ONH and fundus, IOP, pachymetry findings, and the results of visual field.RESULTS: The 24 patients were selected and divided into two groups: group 1 patients had no history of IOP elevation or glaucoma(n =14), and group 2 patients did have history of IOP elevation or glaucoma(n =10). In each patient, the study eye with elevated IOP was classified into group H(high), and the fellow eye was classified into group L(low). The mean deviation(MD)differed significantly between groups H and L when all eyes were considered(P =0.047) and in group 2(P =0.042), not in group 1(P =0.893). Retinal nerve fiber layer(RNFL) average thickness(P =0.050), rim area(P =0.015),vertical cup/disc ratio(P =0.011), cup volume(P =0.028),inferior quadrant RNFL thickness(P =0.017), and clockhour(1, 5, and 6) RNFL thicknesses(P =0.050, 0.012, and0.018, respectively), cup depth(P =0.008), central prelaminar layer thickness(P =0.023), mid-inferior prelaminar layer thickness(P =0.023), and nasal retinal slope(P =0.034)were significantly different between the eyes with groups H and L.CONCLUSION:RNFLaveragethickness,rim area,vertical cup/disc ratio, cup volume, inferior quadrant RNFL thickness, and clock-hour(1, 5, and 6) RNFL thicknesses significantly changed during acute IOP elevation.