Ovesensharp0487

OBJECTIVES Overall, 25% to 33% of patients on kidney transplant wait lists present with prior graft loss. In addition, the number of patients who require a retransplant seems to be increasing. Here, we describe our experience with patients who had a second kidney transplant after a previous pancreas-kidney transplant or a third or fourth kidney transplant. We focused specifically on the technical aspects and outcomes related to this patient group. selleck compound MATERIALS AND METHODS A single-center retrospective study was performed. The cohortincluded 15 patients > 18 years old who had received a second kidney graft after pancreas-kidney transplant or a second or greater kidney graft between 2013 and 2019. RESULTS Median age of recipients was 45 years (range, 20-58 y). In 10 patients, the transperitoneal approach was selected. In 5 patients, the retroperitoneal heterotopic kidney retransplant technique was used. Early surgical complications (≤ 30 days posttransplant) were reported in 4 patients. Three patients had late ureteral stenosis (> 90 days posttransplant). All grafts were functioning at time of patient discharge. Mean creatinine level was 2.69 mg/dL (range, 1.23-6.26 mg/dL). The 1-year and 2-year graft survivalrates were 85% and 75%, respectively. No grafts were lost because of surgical complications. CONCLUSIONS Retransplant of a second graft after pancreas-kidney transplant or retransplant of a third or fourth renal graft is challenging but feasible, with evidence of reasonably positive outcomes after retransplant.OBJECTIVES This study investigated the efficacy of ledipasvir-sofosbuvir, a newly developed direct-acting antiviral drug combination for hepatitis C virus infection recurrence in patients who have developed cirrhosis secondary to hepatitis C virus and who have undergone liver transplant. MATERIALS AND METHODS We retrospectively analyzed 27 patients who underwent liver transplant due to hepatitis C virus-related cirrhosis and who received ledipasvir-sofosbuvirfor 12 weeks between January 1, 2016 and December 31, 2017 following transplant procedures conducted at the Inonu University Turgut Ozal Medical Center Gastroenterology Department between January 1, 2008 and December 31, 2017. None of the donors had hepatitis C virus infection. Most donor grafts used in transplants were from children of recipients, with the remaining donated grafts from husbands (7%), nephews (4%), wives (7%), and deceased donors (7%). RESULTS Twenty patients were ultimately included in the study. Hepatitis C virus genotypes, hepatitis C virus RNA, blood counts, and liver enzyme levels of patients before and at 1, 2, and 6 months after treatment were evaluated. At the end of month 6, in addition to hepatitis C virus RNA levels of all patients decreased to unmeasurable levels, levels of alanine and aspartate aminotransferase and gamma-glutamyltransferase had also significantly decreased (all P less then .001). None of the patients experienced a complication that led to cessation of treatment. CONCLUSIONS With its reliability and high success rate, the ledipasvir-sofosbuvir combination is a strongly preferable treatment for patients who have undergone liver transplant due to chronic hepatitis C virus-related cirrhosis and who have virus recurrence posttransplant.The management of portosystemic shunts in liver transplant recipients relies on appropriate perioperative study. There are several strategies for shunt handling, ranging from preoperative interventional procedures to intraoperative surgical interruption or embolization. Appropriate management often results in a successful outcome, although wrong decisions could lead to serious consequences. Here, we report a liver transplant recipient with grade 2 portal vein thrombosis associated with 2 large portosystemic shunts (coronary and mesocaval), which were managed intraoperatively via thrombectomy without shunt ligation. Acute portal vein thrombosis developed early after transplant due to portal steal syndrome. The patient underwent a successful endovascular shunt embolization, with prompt restoration of hepatopetal portal flow and resolution of the portal steal. Use of interventional radiology in perioperative management of transplant patients has recently gained wider importance; our case reported here is particularly suggestive of the good outcomes of a multidisciplinary approach to a threatening complication such as postoperative acute portal vein thrombosis.The treatment of multiple myeloma (MM) continues to evolve with the approval of numerous agents over the past decade. Advances in treatment have led to the incorporation of these newer therapies into the treatment paradigm, with improvements in overall survival and the possibility of deep responses including a minimal residual disease-negative state. The strategy of triplet therapies for patients with newly diagnosed MM, followed by high-dose chemotherapy and autologous stem-cell transplantation for eligible patients, and subsequently consolidation and maintenance therapy, is the current treatment roadmap for patients. However, patients with MM will ultimately develop refractoriness to antimyeloma therapies. In this article, we summarize our current practice of managing patients with MM. We highlight our approach to patients with newly diagnosed MM who are transplantation eligible and ineligible and highlight risk-adapted strategies for these patients. In addition, we discuss our approach to the management of patients with relapsed or refractory MM. Last, we review standard therapies and emerging strategies such as targeted approaches, immune-based therapies, and drugs with novel mechanisms of action. Trials evaluating chimeric antigen receptor T cells targeting B-cell maturation antigen are ongoing and are only one of several novel approaches targeting cell maturation antigen, which include the use of bispecific T-cell engager antibodies and antibody drug conjugates. Emerging therapies offer the promise of more individualized approaches in the management of patients with MM and ultimately may result in the possibility of being one step closer to curing patients with MM.