Transplantation proceedings
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In living donor liver transplantation, the right lobe has many anatomic variations in the vascular tree, which could lead to surgical complications. We need to define surgical technique according to anatomy. ⋯ Living donor liver transplantation using the right lobe can be performed safely, but there is a potential operative risk because of various anatomic variations. To minimize operative complications, anatomic variations should be kept in mind to ensure a safe and successful operation.
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Hypoxic pulmonary vasoconstriction (HPV) is a well-known phenomenon to temporarily offset a ventilation/perfusion mismatch. Sustained HPV may lead to pulmonary hypertension. In this protocol, we studied the relationships between the HPV response and oxygen radical release after hypoxia/reoxygenation (H/R) challenge in an isolated perfused lung model. ⋯ H/R induced increases in the expressions of SOD and catalase in lung tissues. DMTU, DMSO, and allopurinol antioxidants attenuated the HPV responses by reducing the oxygen radical release.
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Renal transplantation is an established treatment for end-stage renal disease. Most renal transplant patients take multiple medications for a long period of time to maintain immunosuppression as well as to treat concomitant chronic diseases. Since some medications prescribed for these patients have narrow therapeutic ranges, optimal pharmacotherapy is vital. ⋯ Physician acceptance rates of recommendation types and drug classes were 96.0% and 97.1%, respectively. Among the cases in which the recommendations were accepted, 94.2% of patients showed improved conditions. We concluded that clinical pharmacists joined to renal transplant clinics provide pharmaceutical care with a positive potential impact on physician prescriptions and patient outcomes.
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Lung transplantation (LT) is the only effective form of therapy for cystic fibrosis (CF) associated with end-stage pulmonary failure. In Italy, the management of CF is regulated by national law, which has instituted regional centers for care and follow-up of all CF patients. LT has been performed since 1992 in only nine LT certified centers. ⋯ The most frequent cause of death is bronchiolitis obliterans syndrome (BOS). Our nationwide database indicates the excellent results obtained by LT in FC. Still, mortality on the waiting list remains a challenge and long-term outcome is limited by BOS.
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Lung transplantation recipients are at high risk for herpesvirus infections. We evaluated the effect of combined cytomegalovirus (CMV) prophylaxis on CMV pneumonia, acute rejection episodes (ARE), lymphocytic bronchitis/bronchiolitis (LB), and obliterans bronchiolitis (OB) diagnosed in 180 transbronchial biopsies (TBB) of lung transplant recipients. At our center, 25 patients (control group; 1999-2002) received acyclovir for 12 months and 21 recipients (study group; 2003-2007) received combined CMV prophylaxis consisting of CMV-IG (Cytotect Biotest) for 12 months and ganciclovir or valganciclovir from postoperative day 21 for 3 weeks. ⋯ Logistic regression analysis showed a relationship between prophylaxis and a reduced prevalence of ARE (odds ratio [OR] 3.25, confidence interval [CI] 1.12-9.40; P= .03). Finally, in the study group, BAL EBV-DNA positivity and EBV-CMV coinfections were low (6% and 0%, respectively) compared with other herpesviruses and with the literature. Our data suggested the efficacy of combined CMV prophylaxis to prevent ARE and LB, 2 risk factors for chronic rejection, and a possible role to reduce the trend toward CMV pneumonia and EBV infections.