Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation
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Exp Clin Transplant · Aug 2016
Preoperative Clinical Characteristics That Identify Potential Low-Volume Transfusion Candidates Among Orthotopic Liver Transplant Patients.
The primary aim of this study was to determine whether specific preoperative clinical characteristics were associated with low-volume transfusion in liver transplant recipients. Low-volume transfusion was defined as transfusion of < 2100 mL of packed red blood cells intraoperatively during liver transplant. The ability to accurately predict low-volume transfusion could increase patient safety, decrease complications associated with transfusion, improve blood management, and decrease transplant case cost. ⋯ Multiple studies have shown increased morbidity and mortality after orthotopic liver transplant when more than 6 U of packed red blood cells are administered within 24 hours of surgical incision. A method to identify low-volume transfusion candidates could help predict patient outcomes, decrease blood handling, and reduce costs. If patients with low-volume transfusion could be identified, fewer blood products would need to be prepared in advance. Although elevated preoperative coagulation parameters decrease the probability of low-volume transfusion, a definitive profile of a low-volume transfusion liver transplant recipient was not established.
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Exp Clin Transplant · Jun 2016
Comparative StudyOutcomes of Early Steroid Withdrawal in Recipients of Deceased-Donor Expanded Criteria Kidney Transplants in the Era of Induction Therapy.
This study explored the safety of early steroid withdrawal in recipients of expanded criteria deceased-donor kidney transplants. ⋯ Our study showed safety of early steroid withdrawal in recipients of expanded criteria deceased-donor kidney transplants who underwent perioperative induction followed by calcineurin inhibitor and mycophenolate mofetil maintenance. Among rabbit-antithymocyte globulin-induced patients, chronic steroid maintenance was associated with inferior graft and patient outcomes, an effect limited to older recipients.
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Exp Clin Transplant · Apr 2016
Lessons Learned From Review of a Single Center Experience With 500 Consecutive Liver Transplants in a Region With Insufficient Deceased-Donor Support.
We present here the outcomes of our first 500 liver transplants and discuss the lessons learned during this time. ⋯ In regions without a sufficient number of deceased donors, living-donor liver transplant, with its associated problems, is the only alternative to deceased-donor liver transplant. Liver transplant requires teamwork, with all players working well together for a successful outcome. The important keys to success in liver transplant include decision-making, timing, surgical skills, experience, and close follow-up.
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Exp Clin Transplant · Apr 2016
Case ReportsDe Novo Thrombotic Microangiopathy Immediately After Kidney Transplant in Patients Without Apparent Risk Factors.
Thrombotic microangiopathy refers to a spectrum of conditions that share a common underlying pathologic mechanism that result in endothelial damage and microangiopathic hemolytic anemia. De novo thrombotic microangiopathy after kidney transplant is often triggered by immunosuppressive drugs, and studies most often implicate calcineurin inhibitors and/or mammalian target of rapamycin inhibitors; however, muromonab and alemtuzumab also reportedly cause thrombotic microangiopathy. ⋯ Here, we present a case series of 3 patients without any apparent risk factors (eg, acute antibody-mediated rejection) who developed de novo thrombotic microangiopathy immediately following kidney transplant, but before the introduction of calcineurin inhibitors. Two of these 3 patients were successfully managed with plasma exchange, and calcineurin inhibitors were successfully introduced without the recurrence of thrombotic microangiopathy.
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Exp Clin Transplant · Feb 2016
Comparative StudyFrequency of Cardiovascular Events and Effect on Survival in Liver Transplant Recipients for Cirrhosis Due to Alcoholic or Nonalcoholic Steatohepatitis.
Frequency of liver transplants because of nonalcoholic steatohepatitis is increasing. Data are conflicting on nonalcoholic steatohepatitis as a risk factor for cardiovascular events after transplant. ⋯ Cardiovascular events occurred with similar frequency in transplant recipients for nonalcoholic steatohepatitis or alcoholic cirrhosis. Patient survival was affected in both groups, but male patients with concomitant hepatitis C virus infection remained at higher risk for a cardiovascular event after liver transplant. Development of a cardiac evaluation protocol for liver transplant recipients could help monitor these patients.