Hedegaardmcfadden8804

Twenty-one patients (0.21%) did not know that they had implanted stents. None of these 21 patients were urological patients, and they had stents placed during urological consultation in an operating room. CONCLUSION Our study showed that the ARMS reduced the manpower in tracking stent removal by 85.07% and that it was useful for detecting and preventing forgotten stents.BACKGROUND Portopulmonary hypertension is present in an estimated 5.3-8.5% of liver transplant candidates. Untreated, 5-year survival is estimated between 14-28%. Moderate-severe disease is a contraindication to liver transplant due to the high perioperative mortality, but patients optimized with pulmonary vasodilator therapy can become eligible for transplant. There is minimal data regarding posttransplant outcomes and ability to discontinue pulmonary vasodilator therapy posttransplant. METHODS We performed a single-center retrospective analysis to evaluate long term outcomes of patients with moderate-severe POPH who were optimized with pulmonary vasodilator therapy, became eligible for liver transplant, and subsequently underwent transplant. We identified 24 patients optimized with pulmonary vasodilator therapy who underwent subsequent liver transplantation and 25 patients who were treated with pulmonary vasodilator therapy alone. RESULTS In the transplanted cohort; 1-year survival from POPH diagnosis date 95.8%, 3-year survival 90.9%, and 5-year survival 90.9%. Posttransplant; 1-year, 3-year, and 5-year survival was 86.9%. Among transplanted patients, 41.6% (10/24) were optimized with nonparenteral therapy. Following transplantation, 100% (14/14) of the surviving patients were able to discontinue parenteral therapy; median time 7.2 months (IQR 5.1, 8.9 months), while 61.9% (13/21) were able to discontinue pulmonary vasodilator therapy altogether; median time 13.9 months (IQR 5.1, 17.6 months). CONCLUSION Patients who are optimized with pulmonary vasodilator therapy prior to liver transplant can have excellent long-term outcomes posttransplant. Oral pulmonary vasodilator therapy can be effective treatment to qualify a patient for transplant, and the majority are able to wean from pulmonary vasodilator therapy entirely posttransplant.BACKGROUND Histologic criteria for diagnosing acute rejection in vascularized composite tissue allograft (VCA) have been established by the Banff 2007 Working Classification of Skin-Containing Composite Tissue Allograft, but the role of early vascular lesions in graft rejection warrants additional analysis. METHODS We performed a retrospective study of 34 skin biopsies performed over 430 days for rejection surveillance, in Canada's first face allotransplant recipient. Three observers reviewed all biopsies to assess the nature and intensity of the inflammatory skin infiltrate. A complete histological and immunohistochemical review of the vascular components was performed with a focus on lymphocytic vasculitis, intravascular fibrin, vessel caliber, extent of injury, C4d positivity and inflammatory cell phenotyping. We then correlated these data points to clinical and immunosuppression parameters. RESULTS Acute vascular damage in biopsies that would be classified as mild acute rejection correlates with troughs in immunosuppression and subside when immunosuppressive Tacrolimus doses are increased. Grade 0 Banff rejection and Grade I without lymphocytic vasculitis were almost indistinguishable, whilst Grade I with lymphocytic vasculitis was an easy and reproducible histologic finding. CONCLUSIONS Our results highlight the possible relevance of vascular injury in the context of VCA, as its presence might underlie a more aggressive form of immune rejection. If these findings are validated in other VCA patients, vascular injury in mild rejection might warrant a different clinical approach.BACKGROUND Late antibody-mediated rejection (AMR) is a major cause of transplant failure. Potential therapeutic targets are plasma cells (PC) and/or natural killer (NK) cells, both expressing high levels of CD38. METHODS Here, we report the use of CD38 monoclonal antibody daratumumab (9-month course) in a kidney allograft recipient diagnosed with smoldering myeloma and anti-HLA class II donor-specific antibody (DSA)-positive chronic active AMR 13 years after transplantation. SF1670 in vitro Patient monitoring included serial HLA single antigen testing, peripheral blood immune cell phenotyping, as well as follow-up allograft and bone marrow biopsies at 3 and 9 months, including analyses of rejection-related gene expression patterns. RESULTS Daratumumab led to persistent CD138 cell depletion in the bone marrow and blood, and substantially decreased NK cells counts in blood and graft tissue. At the same time, DSA in serum disappeared, and in vitro alloantibody production by CD138 cells enriched from bone marrow aspirates was abrogated. A 3-month follow-up biopsy revealed a complete resolution of microcirculation inflammation (g+ptc 3 to 0) and molecular AMR activity (AMR score 0.79 to less then 0.2). The same biopsy showed (subclinical) tubulo-interstitial inflammation, which prompted steroid treatment. Over an observation period of 12 months, graft function stabilized. CONCLUSIONS Targeting CD38 for PC and NK cell depletion may be an effective strategy to counteract AMR. Our results may encourage the design of future trials to clarify the role of this innovative treatment concept in organ transplantation.BACKGROUND Desensitization protocols for HLA-incompatible living donor kidney transplantation (ILDKT) vary across centers. The impact of these, as well as other practice variations, on ILDKT outcomes remain unknown. METHODS We sought to quantify center-level variation in mortality and graft loss following ILDKT using a 25-center cohort of 1358 ILDKT recipients with linkage to SRTR for accurate outcome ascertainment. We used multilevel Cox regression with shared frailty to determine the variation in post-ILDKT outcomes attributable to between-center differences, and to identify any center-level characteristics associated with improved post-ILDKT outcomes. RESULTS After adjusting for patient-level characteristics, only 6 centers (24%) had lower mortality and 1 (4%) had higher mortality than average. Similarly, only 5 centers (20%) had higher graft loss and 2 had lower graft loss than average. Only 4.7% of the differences in mortality (p less then 0.01) and 4.4% of the differences in graft loss (p less then 0.01) were attributable to between-center variation.