Transplantation proceedings
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There is a global tendency to justify transplanting extended criteria organs (ECD; Donor Risk Index [DRI] ≥ 1.7) into recipients with a lower Model for End-Stage Liver Disease (MELD) score and to transplant standard criteria organs (DRI < 1.7) into recipients with a higher MELD scores. There is a lack of evidence in the current literature to justify this assumption. ⋯ These results suggest that contrary to common belief it is not justified to preferentially allocate organs with higher DRI to recipients with lower MELD scores.
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We present a retrospective study describing the perioperative use of continuous renal replacement therapy (CRRT) for orthotopic liver transplantation (OLT). ⋯ Perioperative and especially intraoperative use of CRRT therapy can potentially improve the outcomes of patients undergoing OLT.
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Case Reports
Peritoneovenous shunt for chylous ascites after lung transplantation for lymphangioleiomyomatosis.
A 37-year-old woman with lymphangioleiomyomatosis (LAM) who underwent right single-lung transplantation from a cadaveric donor developed persistent chylous ascites. Despite use of diuretics and sirolimus to reduce ascites-associated symptoms and to prevent gastroesophageal reflex triggered by increased abdominal pressure, the ascites were refractory, and periodic paracenteses were required. With placement of a peritoneovenous shunt (Denver shunt), the patient's abdominal circumference decreased, and her symptoms abated. Thus, placement of a peritoneovenous shunt can be an effective management strategy for refractory chylous ascites in patients with LAM, even after lung transplantation.
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Prolongation of renal allograft survival a considerable challenge. The primary cause of renal graft failure is recipient death and cardiovascular disease is the leading cause of mortality. We assessed the management of hypertension, dyslipidemia and diabetes mellitus (DM) in a protocol-driven renal transplant clinic. ⋯ Even in a university-based clinic with protocols designed to improve compliance, treatment goals for BP, LDL, and HbAlC were not achieved in a substantial number of patients, especially in the first year posttransplantation. Better strategies are needed to meet treatment objectives and prevent untoward outcomes.
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To evaluate the clinical value of serum cystatin C (ScysC) for the diagnosis of an acute rejection episode after renal transplantation. ⋯ ScysC was a more sensitive marker to detect changes in renal function than Scr, BUN, β(2)-MG or UA; therefore it can be used to predict an acute rejection episode after transplantation.