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A score model for predicting post-liver transplantation survival in HBV cirrhosis-related hepatocellular carcinoma recipients: a single center 5-year experience 被引量:4
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作者 Li-Ying Wang Shu-Sen Zheng +9 位作者 Xiao Xu Wei-Lin Wang Jian Wu Min Zhang Yan Shen Sheng Yan Hai-Yang Xie Xin-Hua Chen Tian-An Jiang Fen Chen 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2015年第1期43-49,共7页
BACKGROUND: The prognostic prediction of liver transplantation(LT) guides the donor organ allocation. However, there is currently no satisfactory model to predict the recipients’ outcome, especially for the patien... BACKGROUND: The prognostic prediction of liver transplantation(LT) guides the donor organ allocation. However, there is currently no satisfactory model to predict the recipients’ outcome, especially for the patients with HBV cirrhosis-related hepatocellular carcinoma(HCC). The present study was to develop a quantitative assessment model for predicting the post-LT survival in HBV-related HCC patients.METHODS: Two hundred and thirty-eight LT recipients at the Liver Transplant Center, First Affiliated Hospital, Zhejiang University School of Medicine between 2008 and 2013 were included in this study. Their post-LT prognosis was recorded and multiple risk factors were analyzed using univariate and multivariate analyses in Cox regression.RESULTS: The score model was as follows: 0.114×(Child-Pugh score)-0.002×(positive HBV DNA detection time)+0.647×(number of tumor nodules)+0.055×(max diameter of tumor nodules)+0.231×ln AFP+0.437×(tumor differentiation grade).The receiver operating characteristic curve analysis showed that the area under the curve of the scoring model for predicting the post-LT survival was 0.887. The cut-off value was 1.27, which was associated with a sensitivity of 72.5% and a specificity of 90.7%, respectively.CONCLUSION: The quantitative score model for predicting post-LT survival proved to be sensitive and specific. 展开更多
关键词 HBV cirrhosis hepatocellular carcinoma liver transplantation Hangzhou criteria post-LT survival
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Early ileocolonoscopy with biopsy for the evaluation of persistent post-transplantation diarrhea 被引量:1
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作者 Giorgos Bamias John Boletis +6 位作者 Theodoros Argyropoulos Chrysanthi Skalioti Spyros I Siakavellas Ioanna Delladetsima Irene Zouboulis-Vafiadis George L Daikos Spiros D Ladas 《World Journal of Gastroenterology》 SCIE CAS CSCD 2010年第30期3834-3840,共7页
AIM: To investigate the signifi cance of ileocolonoscopy with histology in the evaluation of post-transplantation persistent diarrhea (PD). METHODS: We retrospectively reviewed all records of renal transplant patients... AIM: To investigate the signifi cance of ileocolonoscopy with histology in the evaluation of post-transplantation persistent diarrhea (PD). METHODS: We retrospectively reviewed all records of renal transplant patients with PD, over a 3-year period. All patients were referred for ileocolonoscopy with biopsy, following a negative initial diagnostic work up. Clinical and epidemiological data were compared between cases with infectious or drug-induced diarrhea. RESULTS: We identif ied 30 episodes of PD in 23 renaltransplant patients (1-3 cases per patient). There were 16 male patients and the mean age at the time of PD was 51.4 years. The average time from transplantation to a PD episode was 62.3 ± 53.2 mo (range 1-199 mo). Ileocolonoscopy detected mucosal abnormalities in 19 cases, whereas the intestinal mucosa appeared normal in 11 cases. Histological examination achieved a specific diagnosis in 19/30 cases (63.3%). In nine out of 11 cases (82%) with normal endoscopic appearance of the mucosa, histological examination of blinded biopsies provided a specif ic diagnosis. The etiology of PD was infectious in 11 cases (36.6%), drug-related in 10 (33.3%), of other causes in three (10%), and of unknown origin in six cases (20%). Infectious diarrhea occurred in significantly longer intervals from transplantation compared to drug-related PD (85.5 ± 47.6 mo vs 40.5 ± 44.8 mo, P < 0.05). Accordingly, PD due to drug-toxicity was rarely seen after the f irst year post-transplantation. Clinical improvement followed therapeutic intervention in 90% of cases. Modif ication of immunosuppressive regimen was avoided in 57% of patients. CONCLUSION: Early ileocolonoscopy with biopsies from both affected and normal mucosa is an important adjunctive tool for the etiological diagnosis of PD in renal transplant patients. 展开更多
关键词 Endoscopy post-transplantation DIARRHEA HISTOLOGY ENTERIC infections MYCOPHENOLATE mofetilcolitis
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Recent insights in the pathogenesis of post-transplantation lymphoproliferative disorders 被引量:13
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作者 Julie Morscio Thomas Tousseyn 《World Journal of Transplantation》 2016年第3期505-516,共12页
Post-transplant lymphoproliferative disorder(PTLD) is an aggressive complication of solid organ and hematopoietic stem cell transplantation that arises in up to 20% of transplant recipients. Infection or reactivation ... Post-transplant lymphoproliferative disorder(PTLD) is an aggressive complication of solid organ and hematopoietic stem cell transplantation that arises in up to 20% of transplant recipients. Infection or reactivation of the Epstein-Barr virus(EBV), a ubiquitous human herpesvirus, in combination with chronic immunosuppression are considered as the main predisposing factors, however insight in PTLD biology is fragmentary. The study of PTLD is complicated by its morphological heterogeneity and the lack of prospective trials, which also impede treatment optimization. Furthermore, the broad spectrum of underlying disorders and the graft type represent important confounding factors. PTLD encompasses different malignant subtypes that resemble histologically similar lymphomas in the general population. Post-transplant diffuse large B-cell lymphoma(PT-DLBCL), Burkitt lymphoma(PTBL) and plasmablastic lymphoma(PT-PBL) occur most frequently. However, in many studies various EBV+ and EBV- PTLD subtypes are pooled, complicating the interpretation of the results. In this review, studies of the gene expression pattern, the microenvironment and the genetic profile of PT-DLBCL, PT-BL and PT-PBL are summarized to better understand the mechanisms underlying post-transplantation lymphomagenesis. Based on the available findings we propose stratification of PTLD according to the histological subtype and the EBV status to facilitate the interpretation of future studies and the establishment of clinical trials. 展开更多
关键词 EPSTEIN-BARR virus post-transplant LYMPHOPROLIFERATIVE disorder Immunodeficiency Diffuse large B-CELL LYMPHOMA BURKITT LYMPHOMA Plasmablastic LYMPHOMA
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Intraoperative management and early post-operative outcomes of patients with coronary artery disease who underwent orthotopic liver transplantation 被引量:1
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作者 Hai-Ying Kong Xian Zhao Kui-Rong Wang 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2020年第1期12-16,共5页
Background: Coronary artery disease (CAD) is frequently observed in aging end-stage liver disease (ESLD) patients who require orthotopic liver transplantation (OLT). This situation is challenging for both the pa- tien... Background: Coronary artery disease (CAD) is frequently observed in aging end-stage liver disease (ESLD) patients who require orthotopic liver transplantation (OLT). This situation is challenging for both the pa- tients and the medical staff. Methods: We retrospectively studied the case records of 26 ESLD patients with CAD who underwent OLT with total clamping of the inferior vena cava between 2014 and 2018. We analyzed the details of the pre-operative evaluation, intraoperative anesthetic management and post-operative prognosis of these patients. Results: All patients tolerated the anhepatic stage well. Post-reperfusion syndrome (PRS) was observed in 13 patients (50%) and 2 of them were severe but corrected well. ST-segment depression was frequently observed during the anhepatic stage and reperfusion stage. No mortality due to cardiac-related events occurred among the patients during hospitalization. OLT with the modi ed piggyback technique could successfully be performed in ESLD patients with mild and moderate CAD. Conclusions: A thorough evaluation and optimization of recipients, strict monitoring and optimized man-agement of circulation, knowledge of the complicated changes during OLT procedures, and strategies to ameliorate post-reperfusion syndrome favorite the outcomes. 展开更多
关键词 Orthotopic liver transplantation Coronary artery disease post-reperfusion syndrome
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Post-transplantation lymphoproliferative disorders:Current concepts and future therapeutic approaches 被引量:7
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作者 Fedaey Abbas Mohsen El Kossi +2 位作者 Ihab Sakr Shaheen Ajay Sharma Ahmed Halawa 《World Journal of Transplantation》 2020年第2期29-46,共18页
Transplant recipients are vulnerable to a higher risk of malignancy after solid organ transplantation and allogeneic hematopoietic stem-cell transplant.Posttransplant lymphoproliferative disorders(PTLD)include a wide ... Transplant recipients are vulnerable to a higher risk of malignancy after solid organ transplantation and allogeneic hematopoietic stem-cell transplant.Posttransplant lymphoproliferative disorders(PTLD)include a wide spectrum of diseases ranging from benign proliferation of lymphoid tissues to frank malignancy with aggressive behavior.Two main risk factors of PTLD are:Firstly,the cumulative immunosuppressive burden,and secondly,the oncogenic impact of the Epstein-Barr virus.The latter is a key pathognomonic driver of PTLD evolution.Over the last two decades,a considerable progress has been made in diagnosis and therapy of PTLD.The treatment of PTLD includes reduction of immunosuppression,rituximab therapy,either isolated or in combination with other chemotherapeutic agents,adoptive therapy,surgical intervention,antiviral therapy and radiotherapy.In this review we shall discuss the prevalence,clinical clues,prophylactic measures as well as the current and future therapeutic strategies of this devastating disorder. 展开更多
关键词 Lymphoproliferative disorders Epstein-Barr virus Solid organ transplant Hematopoietic stem cell transplant post-transplant lymphoproliferative disorder prevention Future therapies
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EBV-Associated Post-Transplantation B-Cell Lymphoproliferative Disorder in Patient after Allogenic Stem Cell Transplantation
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作者 Li Tang Yu Li 《Journal of Biosciences and Medicines》 2019年第5期11-15,共5页
Epstein-Barr virus (EBV)-associated B-cell post-transplantation lymphoproliferative disorder (PTLD) is a severe complication following solid-organ transplantation (SOT) and allogeneic hematopoietic stem cell transplan... Epstein-Barr virus (EBV)-associated B-cell post-transplantation lymphoproliferative disorder (PTLD) is a severe complication following solid-organ transplantation (SOT) and allogeneic hematopoietic stem cell transplantation (HSCT). We present a case of a 15-year-old male developing a monomorphic B-cell PTLD after receiving an allogenic stem cell transplant for acute acute myeloid leukemia. A diagnostic lymph node biopsy revealed monomorphic type, B cell phenotype, associated with Epstein-Barr virus, consistent with post-transplant lymphoproliferative disorder (PTLD). The morbidity and mortality of PTLD are high, and there is no standard protocol for treatment of PTLD. To prevent the occurrence of PTLD and early intervention are important for the prognosis of patients. 展开更多
关键词 post-transplantation LYMPHOPROLIFERATIVE Disorder Allogeneic Hematopoietic Stem Cell transplantation EPSTEIN-BARR Virus
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Impact of EBV infection and immune function assay for lymphoproliferative disorder in pediatric patients after liver transplantation: A single-center experience 被引量:9
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作者 Tian Qin Xiang-Qian Gu +5 位作者 Seog-Song Jeong Yan-Yan Song Jin-Chuan Liu Jian-Xin Zheng Feng Xue Qiang Xia 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2020年第1期3-11,共9页
Background:Post-transplant lymphoproliferative disorder(PTLD)is a lethal complication after pediatric liver transplantation,but information regarding risk factors for the development of PTLD remains unclear.This study... Background:Post-transplant lymphoproliferative disorder(PTLD)is a lethal complication after pediatric liver transplantation,but information regarding risk factors for the development of PTLD remains unclear.This study was to identify characteristics and risk factors of PTLD.Methods:A total of 705 pediatric patients who underwent liver transplantation between January 2017 and October 2018 were studied.Impact of clinical characteristics and Epstein-Barr virus(EBV)infection on the development of PTLD was evaluated.In addition,ImmuKnow assay was adopted in partial patients to analyze the immune status.Results:Twenty-five(3.5%)patients suffered from PLTD with a median time of 6 months(3–14 months)after transplantation.Extremely high tacrolimus(TAC)level was found in 2 fatal cases at PTLD onset.EBV infection was found in 468(66.4%)patients.A higher peak EBV DNA loads(>9590 copies/mL)within 3 months was a significant indicator for the onset of PTLD.In addition,the ImmuKnow assay demonstrated that overall immune response was significantly lower in patients with EBV infection and PTLD(P<0.0001).The cumulative incidence of PTLD was also higher in patients with lower ATP value(≤187 ng/mL,P<0.05).Conclusions:A careful monitoring of EBV DNA loads and tacrolimus concentration might be supportive in prevention of PTLD in pediatric patients after liver transplantation.In addition,application of the ImmuKnow assay may provide guidance in reducing immunosuppressive agents in treatment of PTLD. 展开更多
关键词 post-transplant lymphoproliferative disor Pediatric liver transplantation Epstein-Barr virus
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Surgical Complications of Kidney Transplantation in a Resource Limited Country: Retrospective Study of the First Five Years
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作者 Coulibaly Noël Yao Evrard Kouamé +3 位作者 Adebayo Tawakaltu Bolasade Tuo Legnima Sekou Michel Yeo Donafologo Daouda Dah Freddy 《Open Journal of Urology》 2023年第9期371-375,共5页
Background: Kidney transplantation is the most efficient treatment for renal failure but may be ruined by complications. Objective: To report the surgical complications of renal transplantation and the therapeutic mea... Background: Kidney transplantation is the most efficient treatment for renal failure but may be ruined by complications. Objective: To report the surgical complications of renal transplantation and the therapeutic means applied. Method: It was a retrospective study including 42 files of kidney transplantation in Côte d’Ivoire. We report 11 cases of surgical complications of the recipient’s intervention during the first five years. Results: The mean age was 42.64 years (±15.04). In 90.9% of the cases, there was a comorbidity factor. Lymphocele and stenosis of the uretero vesical anastomosis were the most frequent complications. One death was observed. Conclusion: Kidney transplantation is an effective way of managing chronic renal failure. Postoperative complications are polymorphic and unpredictable. 展开更多
关键词 Renal transplantation post Operative Complication Ureterovesical Stenosis LYMPHOCELE
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Transplantation Expression of 4-1BB molecule on peripheral blood T cells in liver transplanted patients and its clinical implication 被引量:3
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作者 Yun-Le Wan Shu-Sen Zheng +5 位作者 Chang-Ku Jia Ting-Bo Liang Dong-Sheng Huang Wei-Lin Wang Min-Wei Li Zhi-Cheng Zhao the Department of Hepatobiliary Pancreatic Surgery, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhe-jiang University School of Medicine, Hangzhou 310003, China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2003年第1期38-43,共6页
OBJECTIVE: To investigate the gene expression of 4-1BB in peripheral blood mononuclear cells (PBMCs) and its possible significance in clinical liver transplantation. METHODS: Reverse transcription-polymerase chain rea... OBJECTIVE: To investigate the gene expression of 4-1BB in peripheral blood mononuclear cells (PBMCs) and its possible significance in clinical liver transplantation. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) was used to determine the gene expression of 4-1BB in PBMCs from 22 patients receiving liver transplantation, 13 patients with primary liver carcinoma (PLC), and 12 healthy controls. To determine whether 4-1BB molecule is also expressed on the surface of CD4^+ and CD8^+ T cell, flow cytometry was used to analyse the phenotype of T cell subsets from the blood of liver transplantation patients. RESULTS: 4-1BB mRNA was detected in PBMCs from stable survivors after liver transplantation, but almost not deteeted in PBMCs from PLC patients and healthy controls. Meanwhile, 4-1BB was almost not expressed on the surface of CD4^+ and CD8^+ T cells in healthy controls and PLC patients. A low level of 4-1BB expression, however, was found on the surface of CD4^+ and CD8^+ T cells from the stable survivors after liver transplantation. CONCLUSIONS: This study demonstrates that although patients are stable after liver transplantation, effector T-cells can also be activated through the signal of 4-1BB molecule and persistent irmmune response to grafts. Blockage of 4-1BB/4-1BBL pathway may benefitially reduce the clinical dosage of immunosuppressive agents and prolong the survival of grafts. 展开更多
关键词 4-1BB liver transplantation activation of T cells
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A good prognostic predictor for liver transplantation recipients with benign end-stage liver cirrhosis 被引量:3
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作者 Qiang Wei Rahmeet Singh Nemdharry +9 位作者 Run-Zhou Zhuang Jie Li Qi Ling Jian Wu Tian Shen Lin Zhou Hai-Yang Xie Min Zhang Xiao Xu Shu-Sen Zheng 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2017年第2期164-168,共5页
BACKGROUND: Post-transplant model for predicting mortality(PMPM, calculated as-5.359+1.988×ln(serum creatinine [mg/d L])+1.089×ln(total bilirubin [mg/d L])) score has been proved to be a simple and ... BACKGROUND: Post-transplant model for predicting mortality(PMPM, calculated as-5.359+1.988×ln(serum creatinine [mg/d L])+1.089×ln(total bilirubin [mg/d L])) score has been proved to be a simple and accurate model for predicting the prognosis after liver transplantation(LT) in a single center study. Here we aim to verify this model in a large cohort of patients.METHODS: A total of 2727 patients undergoing LT with endstage liver cirrhosis from January 2003 to December 2010 were included in this retrospective study. Data were collected from the China Liver Transplant Registry(CLTR). PMPM score was calculated at 24-h and 7-d following LT. According to the PMPM score at 24-h, all patients were divided into the low-risk group(PMPM score ≤-1.4, n=2509) and the high-risk group(PMPM score 〉-1.4, n=218). The area under receiver operator characteristic curve(AUROC) was calculated for evaluating the prognostic accuracy.RESULTS: The 1-, 3-, and 5-year patient survival rates in the low-risk group were significantly higher than those in the high-risk group(90.23%, 88.01%, and 86.03% vs 63.16%, 59.62%, and 56.43%, respectively, P〈0.001). In the high-risk group, 131 patients had a decreased PMPM score(≤-1.4) at 7-d, and their cumulative survival rate was significantly higher than the other 87 patients with sustained high PMPM score(〉-1.4)(P〈0.001). For predicting 3-month mortality, PMPM score showed a much higher AUROC than post-transplant MELD score(P〈0.05).CONCLUSION: PMPM score is a simple and effective tool to predict short-term mortality after liver transplantation in patients with benign liver diseases, and an indicator for prompt salvaging treatment as well. 展开更多
关键词 cirrhosis liver transplantation post-transplant model for predicting mortality score prognosis
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Persistent Epstein-Barr viral load in Epstein-Barr viral na?ve pediatric heart transplant recipients:Risk of late-onset post-transplant lymphoproliferative disease 被引量:4
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作者 Bibhuti Das Robert Morrow +1 位作者 Rong Huang David Fixler 《World Journal of Transplantation》 2016年第4期729-735,共7页
AIM To examine the risk of late-onset post-transplant lymphoproliferative disorder(PTLD) in the presence of persisting high Epstein-Barr virus(EBV) in EBV na?ve pediatric heart transplant(HT) recipients. METHODS A ret... AIM To examine the risk of late-onset post-transplant lymphoproliferative disorder(PTLD) in the presence of persisting high Epstein-Barr virus(EBV) in EBV na?ve pediatric heart transplant(HT) recipients. METHODS A retrospective review of the medical records of the 145 pediatric HT recipients who had serial EBV viral load monitoring at our center was performed. We defined EBV naive patients whose EBV serology either IgM or IgG in the blood were negative at the time of HT and excluded passive transmission from mother to child in subjects less than 6 mo of age. RESULTS PTLD was diagnosed in 8 out of 145 patients(5.5%); 6/91(6.5%) in those who were EBV seropositive and 2/54(3.7%) in the EBV na?ve group at the time of HT(P = 0.71). We found 32/145(22%) patients with persistently high EBV load during continuing follow-up; 20/91(22%) in EBV seropositive group vs 12/54(22%) in EBV na?ve group(P = 0.97). There was no significant association between pre-HT serostatus and EBV load after transplant(P > 0.05). In the EBV seropositive group, PTLD was diagnosed in 15%(3/20) of patients with high EBV vs 4.2%(3/71) of patients with low or undetectable EBV load(P = 0.14) whereas in EBV na?ve patients 8.3%(1/12) of those withhigh EBV load and 2.3%(1/42) with low or undetectable EBV load(P = 0.41). There was a highly significant association between occurrence of PTLD in those with high EBV load and duration of follow up(4.3 ± 3.9 years) after HT by Cochran-Armitage test for the entire cohort(P = 0.005). At least one episode of acute rejection occurred in 72%(23/32) of patients with high EBV vs 36%(41/113) patients with low or undetectable EBV after HT(P < 0.05). CONCLUSION There is an association between persistently high EBV load during post-HT follow up and the occurrence of late-onset PTLD in pediatric HT recipients irrespective of serostatus at the time of transplant. The occurrence of allograft rejection increased in patients with high EBV load presumably due to reduction in immunosuppression. 展开更多
关键词 Pediatric heart transplantation EPSTEIN-BARR virus post-transplant LYMPHOPROLIFERATIVE disorder Immunosuppression ALLOGRAFT rejection
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Renal Transplant Artery Stenosis: Clinical Manifestations, Diagnosis and Treatment
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作者 Rihab Dkhissi Latifa Driouch +2 位作者 Naima Ouzeddoun Loubna Benamar Tarik Bouattar 《Open Journal of Nephrology》 2024年第2期262-274,共13页
Introduction: Renal transplant artery stenosis (RTAS) is a common and early complication of renal transplantation, which can lead to severe post-transplant hypertension, as well as significant morbidity and mortality,... Introduction: Renal transplant artery stenosis (RTAS) is a common and early complication of renal transplantation, which can lead to severe post-transplant hypertension, as well as significant morbidity and mortality, particulary graft loss. The aim of this study is to determine the prevalence, clinico-radiological characteristics and evaluate the outcomes of luminal angioplasty as a first-line treatment for RTAS, through the analysis of medical records of 27 kidney transplant patients. Material and Methods: This is a retrospective, single-center, and descriptive study conducted at the Nephrology department of the Ibn-Sina Hospital in Rabat, including 27 renal transplant patients with RTAS during the period from 1998 to 2023. All patients with clinically suspected RTAS and confirmed by Doppler ultrasound of the transplanted renal artery were included in the study. Results: The mean age of donors was 48.66 ± 13.55 years, with a female predominance (65%). The donor was deceased in 15% of cases. The mean age of the recipients was 39 ± 16 years with a male-to-female ratio of 4.4. The median onset of RTAS was 3.6 ± 3.4 months after renal transplantation. Seven patients (26%) had high blood pressure (HBP) before their transplantation. Six patients (22%) had hypertriglyceridemia and 7 patients (26%) had pure hypercholesterolemia. The main clinical signs were worsening of preexisting HBP, de novo HBP and acute renal failure (ARF). Stenosis was confirmed by renal Doppler ultrasound in all patients. It was severe in 63%, with a stenosis degree greater than 70%. Six patients underwent angioplasty, resulting in the stabilization of graft function with a nadir of 15 mg/l creatinine and blood pressure control with dual therapy in 5 patients. No graft loss cases were noted. Conclusion: RTAS is a significant vascular complication of renal transplantation that predicts unfavorable outcomes for both the patient and the graft. Early diagnosis is crucial to successfully restore graft function and prevent complications. 展开更多
关键词 RTAS post transplant Hypertension Graft Function Luminal Angioplasty
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Treatment of Severe Post-kidney-transplant Lung Infection by Integrative Chinese and Western Medicine 被引量:1
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作者 姚全 张淑文 +3 位作者 王红 任爱民 李昂 王宝恩 《Chinese Journal of Integrated Traditional and Western Medicine》 2006年第1期55-58,共4页
Objective: To explore treatments of severe post-kidney-transplant lung infection by integrative Chinese and Western medicine (ICWM), in order to elevate the curing rate as well as to lower the death rate. Methods:... Objective: To explore treatments of severe post-kidney-transplant lung infection by integrative Chinese and Western medicine (ICWM), in order to elevate the curing rate as well as to lower the death rate. Methods: Based on conventional ways of Western medical treatments of 18 cases of severe post-kidney-transplant lung infection, such as putting the patients in single individual ward, antibiotics to prevent infection, respiratory machines, blood filtration, nutritional support, steroids, and maintaining electrolytes balance, we applied integrated Chinese medicinal treatments, like altering conventional prescription "pneumonia Ⅲ ", and conducted clinical observation of effectiveness, and indexes including white blood cell (WBC), neutrophilic granulocyte, blood urea nitrogen (BUN), blood creatinine (Or), etc. Results: Of the 18 cases studied, 7 were already cured, 8 proved the treatment effective, 3 died. All clinical indexes had statistically significant changes compared with those of before treatment (P〈0. 01 ). Cenclusien. ICWM can increase curing rate and lower death rate. 展开更多
关键词 post-kidney-transplant severe lung infection integrative Chinese and Western medicine
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Post Liver Transplantation Lympho Proliferative Disorder, Classical Hodgkins Lymphoma Type—A Case Report
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作者 Indu R. Nair Annie Jojo +1 位作者 Sudhindran Surendran Dinesh Balakrishnan 《International Journal of Clinical Medicine》 2014年第18期1142-1145,共4页
Post transplantation lymphoproliferative disorder is a lymphoid/plasmacytic proliferation that develops as a consequence of immunosuppression in a recipient of a solid organ/bone marrow/stem cell allograft. The incide... Post transplantation lymphoproliferative disorder is a lymphoid/plasmacytic proliferation that develops as a consequence of immunosuppression in a recipient of a solid organ/bone marrow/stem cell allograft. The incidence reported in literature in post liver transplant patients is 1% - 2%. This case was of a 16-year-old boy who underwent liver transplantation for fulminant hepatic failure and subsequently developed PTLD. Morphologically and immunohistochemically, it was Hodgkin’s lymphoma like PTLD, which was the least common type reported in literature. 展开更多
关键词 Liver transplant post transplant LYMPHOPROLIFERATIVE DISORDER CLASSICAL Hodgkin’s Lymphoma Like
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Management strategies for common viral infections in pediatric renal transplant recipients
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作者 Randula Ranawaka Kavinda Dayasiri +1 位作者 Erandima Sandamali Manoji Gamage 《World Journal of Transplantation》 2024年第1期62-71,共10页
Viral infections have been considered as a major cause of morbidity and mortality after kidney transplantation in pediatric cohort.Children are at high risk of acquiring virus-related complications due to immunologica... Viral infections have been considered as a major cause of morbidity and mortality after kidney transplantation in pediatric cohort.Children are at high risk of acquiring virus-related complications due to immunological immaturity and the enhanced alloreactivity risk that led to maintenance of high immunosuppressive regimes.Hence,prevention,early detection,and prompt treatment of such infections are of paramount importance.Among all viral infections,herpes viruses(herpes simplex virus,varicella zoster virus,Epstein-Barr virus,cytomegalovirus),hepatitis B and C viruses,BK polyomavirus,and respiratory viruses(respiratory syncytial virus,parainfluenza virus,influenza virus and adenovirus)are common in kidney transplant recipients.These viruses can cause systemic disease or allograft dysfunction affecting the clinical outcome.Recent advances in technology and antiviral therapy have improved management strategies in screening,monitoring,adoption of prophylactic or preemptive therapy and precise treatment in the immunocompromised host,with significant impact on the outcome.This review discusses the etiology,screening and monitoring,diagnosis,prevention,and treatment of common viral infections in pediatric renal transplant recipients. 展开更多
关键词 Viral infections post renal transplant Immunosuppressive regimes Herpes simplex virus Varicella zoster virus Epstein-Barr virus CYTOMEGALOVIRUS Hepatitis B virus BK polyomavirus Viral monitoring
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Rare presentation of post-transplant lymphoproliferative disorder isolated to gastroesophageal junction
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作者 Brad M Haverkos Veeral M Oza +2 位作者 Andrea Johnson Jon Walker Arwa Shana'ah 《World Journal of Gastrointestinal Oncology》 SCIE CAS 2013年第12期230-234,共5页
Post transplant lymphoproliferative disorder (PTLD) represents a life threatening disorder occurring after transplantation, ranging from a polyclonal mononucleo- sis like illness to a monomorphic high grade neoplasm w... Post transplant lymphoproliferative disorder (PTLD) represents a life threatening disorder occurring after transplantation, ranging from a polyclonal mononucleo- sis like illness to a monomorphic high grade neoplasm with cytologic and histopathologic evidence indica- tive of transformation to lymphoma. PTLD of diffuse large B-cell lymphoma (DLBCL) subtype, isolated to the esophagus is a rare diagnosis. We describe the first case of an immunocompromised adult patient diagnosed with DLBCL-PTLD limited to his esophagus without an associated mass or locoregional lymphade-nopathy on imaging since the institution of the revised Cheson criteria, which includes positron emission tomography-computed tomography as the standard staging modality. Even more unique to our case was the suggestion of underlying cytomegalovirus (CMV) gastritis leading to a hypothesis about a less well understood relationship between CMV and Epstein Barr virus (EBV). In the post transplant setting, im- munocompromised state, or EBV positive state, upper gastrointestinal symptoms should prompt investigation with an upper endoscopy (EGD). Additionally, specific to our case, the fact that the patients' presentation was suspicious for CMV gastritis raises the possibility that the CMV infection predated his PTLD increasing his risk of acquiring PTLD. This reemphasizes the im- portance and diagnostic utility of early screening with EGD in patients after transplantation. 展开更多
关键词 B-CELL lymphoma Esophageal Lymphopro-liferative post-transplant EPSTEIN BARR virus
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Everolimus Associated with Activated Vitamin D for Post-Transplant Increase Epstein-Barr-Virus Load Treatment. Two Case Reports
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作者 Luciano Moscarelli Giulia Antognoli 《International Journal of Clinical Medicine》 2012年第7期669-672,共4页
Post-transplant lymphoproliferative disease (PTLD) is an uncommon but life-threatening complication of solid-organ and blood stem-cell transplants. It is caused by an uncontrolled expansion of B lymphocytes infected w... Post-transplant lymphoproliferative disease (PTLD) is an uncommon but life-threatening complication of solid-organ and blood stem-cell transplants. It is caused by an uncontrolled expansion of B lymphocytes infected with Epstein-Barr virus (EBV). It responds poorly to therapy, including reduction of immunosuppression, interferon, antivirals or chemotherapy. Therefore the optimal strategy for management is currently focused on prevention. Some centers have already introduced chemoprophylaxis and/or preemptive strategies using EBV viral load as a surveillance. Some experimental studies suggest that mTOR inhibitors inhibits growth of human EBV-transformed B lymphocytes and vitamin D had an immune response to EBV. We report two cases of an increased of blood BKV viral load after renal transplantation that were successfully treated with everolimus in association with calcitriol. This report suggests that everolimus associated with calcitriol could be an effective and safe treatment for the prevention of PTLD in transplant recipients. 展开更多
关键词 CALCITRIOL EVEROLIMUS post-transplant LYMPHOPROLIFERATIVE Disease RENAL transplant
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An Evaluation of the Benefit of Cytomegalovirus Prophylaxis with Acyclovir on Post-Transplant Cytomegalovirus Infection Prevention in a Population of Renal Transplant Recipients in Nigeria
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作者 Nnamdi Chuks Menakaya 《Open Journal of Nephrology》 2021年第3期437-449,共13页
<strong>Background:</strong> Cytomegalovirus (CMV) is an important infection in renal transplant recipients and may significantly impact recipients’ long-term outcome and graft survival. <strong>Obj... <strong>Background:</strong> Cytomegalovirus (CMV) is an important infection in renal transplant recipients and may significantly impact recipients’ long-term outcome and graft survival. <strong>Objective:</strong> This study aimed to evaluate the benefit of prophylaxis with acyclovir on post-transplant CMV infection prevention in a population of renal transplant recipients in Lagos, Nigeria. <strong>Subjects and Methods:</strong> The study was a cross-sectional design involving renal transplant recipients attending post-transplant follow-up clinics in Lagos, Nigeria between October 2004 and July 2005. Data on the use of CMV prophylaxis were obtained from the hospital case records of the study subjects. Enzyme-Linked Immunosorbent Assay (ELISA) was employed to detect CMV IgM antibodies for the diagnosis of post-transplant CMV infection and Microsoft Excel and EPI-Info 2002 statistical software were used for data entry and analysis. <strong>Results:</strong> Forty (40) renal transplant recipients were studied, 32 recipients were males and 8 were females with M:F ratio of 4:1. The mean age of the recipients was 39 ± 11.6 years old. The recipients’ post-transplant duration ranged from 2 to 80 months (Mean 17.6 ± 18.6 months). Fifteen (37.5%) of the transplant recipients received acyclovir prophylaxis for six months, one recipient (2.5%) received ganciclovir prophylaxis for three weeks while 24 recipients (60%) received no prophylactic therapy. There was no significant difference in the prevalence of seropositive CMV-IgM between transplant recipients who used CMV prophylaxis and those who did not (Fisher exact p = 0.45). <strong>Conclusion:</strong> Prophylaxis with acyclovir for six months showed no significant benefit on post-transplant CMV infection prevention in renal transplant recipients. 展开更多
关键词 post-transplant Cytomegalovirus Infection PROPHYLAXIS ACYCLOVIR Renal transplant Recipients NIGERIA
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Content Validity of a Self-Management Behavior Assessment Tool for Adult Post-Renal Transplant Recipients Using a Modified Delphi Method
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作者 Takahiro Ohashi Chiharu Akazawa 《Health》 2022年第1期70-95,共26页
<strong>Background:</strong> Self-management is important for post-renal transplant recipients to resolve renal dysfunction, heart failure, and post-transplant psychosocial issues, and to maintain transpla... <strong>Background:</strong> Self-management is important for post-renal transplant recipients to resolve renal dysfunction, heart failure, and post-transplant psychosocial issues, and to maintain transplant kidney function, etc. However, because recipients may be unable to adequately self-manage, healthcare providers need to provide self-management support for recipients to improve their skills and confidence in managing their disease. However, it is difficult to comprehensively assess the self-management behaviors in a busy outpatient support setting. Furthermore, since there are no uniform standards for assessment, it is based on the experience and abilities of medical personnel. Therefore, self-management behavior of post-renal transplant recipients is not sufficiently evaluated. <strong>Objective:</strong> This study aimed to evaluate content validity of a tool that can assess self-management behaviors of adult post-renal transplant recipients, consisting of consensus components from experts familiar with the follow-up of adult post-renal transplant recipients. <strong>Methods:</strong> A three-round modified Delphi method was used to assess the self-management behaviors of adult post-renal transplant recipients by a panel of experts consisting of certified transplant recipient coordinators, physicians, outpatient nurses, and researchers familiar with the follow-up of post-renal transplant recipients. Regarding management behaviors of adult post-renal transplant recipients, the experts rated the appropriateness and validity of each item using a Likert scale. Consensus ratings from the experts were made by calculating the median, interquartile range, and interquartile range percentage. In the third round, an item-level content validity index was calculated to assess content validity. <strong>Conclusions: </strong>The 41-item self-management behavior scale for kidney transplant recipients assessed self-management behaviors in five domains: medication, exercise, fluids and diet, disease and symptom prevention and management, and psychosocial adjustment. The content validity of this tool was confirmed, and it can be used to more easily assess the recipients’ self-management behaviors in the post-renal transplant follow-up. This tool can potentially contribute to the maintenance of transplant kidney function and high QOL in recipients. 展开更多
关键词 post-Renal transplant RECIPIENT SELF-MANAGEMENT Modified Delphi Method
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Long-Term Management of Post-Transplant Ureteral Stricture with Surgical Reconstruction: A Case Series and Literature Review
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作者 Jenna Reisler Brendan Gorman +1 位作者 Joseph Sonstein Luca Cicalese 《Open Journal of Urology》 2022年第9期478-491,共14页
Introduction: Ureteral stricture is the most common complication after kidney transplant and is largely responsible for graft dysfunction. Surgical intervention is the definitive treatment if conservative management w... Introduction: Ureteral stricture is the most common complication after kidney transplant and is largely responsible for graft dysfunction. Surgical intervention is the definitive treatment if conservative management with stenting and percutaneous nephrostomy tube placement fails and has been shown to have comparable long-term survival rates and limited post-operative complications. Methods: This is a single-center retrospective study following seven patients who received a kidney or a kidney and pancreas transplant between August 2012 and January 2021. These patients underwent surgical ureteral reconstruction after failed conservative management of a ureteral stricture. The reconstruction procedures performed were native ureter to transplanted kidney ureteropyelostomy, native bladder to transplanted renal pelvis vesicopyelostomy, non-transecting side-to-side ureteroneocystostomy, and a Boari flap creation. Data collected from electronic medical records included recipient age, gender, delayed post-transplant complications, ureteral reconstruction technique, and post-reconstruction outcomes. Renal ultrasound (RUS), renogram, nephrostogram, serum creatinine (Cr), and graft biopsy were used to assess for severity of hydronephrosis, ureteral stricture, and graft dysfunction. Serum Cr and RUS were used to assess renal function after the ureteral reconstruction. Results: Six out of seven cases resulted in reduced or resolved hydronephrosis and preserved graft function without future nephrostomy or ureteral stenting. One case required immediate revision due to persistent obstruction, and this patient had concomitant rejection leading to intrarenal stricture requiring ureterocalycostomy. Conclusions: Formal ureteral reconstruction is the definitive treatment for many cases of ureteral strictures after transplant. The surgical technique chosen for these procedures must consider the physical and functional state of the bladder, ureter, and kidney. Our series outlines multiple surgical approaches that should be considered early in the management of post-transplant ureteral strictures to limit graft dysfunction. 展开更多
关键词 Ureteral Stricture Ureteral Reconstruction post-transplant Complications
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