فهرست مطالب

International Journal of Organ Transplantation Medicine
Volume:5 Issue: 2, Spring 2014

  • تاریخ انتشار: 1393/02/12
  • تعداد عناوین: 7
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  • Rf Saidi, N. Jabbour, Y. Li, Sa Shah Page 43
    Background
    Live donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) creates several technical challenges due to severe pre-operative condition and extensive collaterals. Although deceased donor liver transplantation in patients with PVT is now routinely performed at most centers, the impact of PVT on LDLT outcomes is still controversial.
    Objective
    To determine the outcome of patients with PVT who underwent LDLT.
    Methods
    We reviewed the outcome of adult patients with PVT who underwent LDLT in the USA from 1998 to 2009.
    Results
    68 (2.9%) of 2402 patients who underwent LDLT had PVT. Comparing patients with and without PVT who underwent LDLT, those with PVT were older (53 vs 50 yrs), more likely to be male, had longer length of stay (25 vs 18 days) and higher retransplantation rate (19% vs 10.7%). The allograft and patient survival was lower in patients with PVT. In Cox regression analysis, PVT was associated with worse allograft survival (HR=1.7, 95% CI: 1.1–2.5, p<0.001) and patient survival (HR=1.6, 95% CI: 1.2–2.4, p<0.001) than patients without PVT.
    Conclusions
    Patients with PVT who underwent LDLT had a worse prognosis than those without PVT
  • J. Haines, Kc Spadaro, J. Choi, La Hoffman, Am Blazeck Page 50
    Background
    Caregivers are a vital resource in the care of transplant candidates or recipients. However, few strategies have been tested that attempt to decrease the stress and anxiety they commonly encounter.
    Objective
    To test the feasibility of using mindfulness-based stress reduction (MBSR) techniques to decrease stress and anxiety in caregivers of lung transplant candidates/recipients who required admission to an acute care facility.
    Methods
    30 caregivers of lung transplant candidates/recipients were recruited during hospitalization of their significant other. Each completed the perceived stress scale (PSS) and state trait anxiety inventory (STAI) before and 4 weeks after receiving a DVD that demonstrated MBSR techniques. Participants were asked to practice MBSR techniques for 5–15 min a day for 4 weeks.
    Results
    The participants had a mean±SD age of 55.6±13.6 years; 77% of participants were female and 93% Caucasian. The mean PSS and STAI (trait and anxiety) scores of caregivers were higher than population norms pre- and post-intervention. Scores for caregivers who stated they watched the entire DVD and practiced MBSR techniques as requested (n=15) decreased significantly from pre- to post-testing for perceived stress (p=0.001), state anxiety (p=0.003) and trait anxiety (p=0.006). Scores for those who watched some or none of the DVD (n=15) did not change significantly.
    Conclusion
    Caregivers can benefit from stress reduction techniques using MBSR.
  • S. Nikeghbalian, Sh Mehdi, M. Aliakbarian, K. Kazemi, A. Shamsaeefar, A. Bahreini, Mr Mansoorian, Sa Malekhosseini Page 59
    Background
    Multivisceral transplantations were initially done in animal models to understand the immunological effects. Later on, in human beings, it has been considered a salvage procedure for unresectable complex abdominal malignancies. With advancement in surgical techniques, availability of better immunosuppressive drugs, and development of better post-operative management protocols, outcomes have been improved after these complex surgical procedures.
    Objective
    To analyze and report results of multivisceral, modified multivisceral, and small bowel transplantations done at Shiraz Organ Transplant Center, Shiraz, southern Iran.
    Methods
    Medical records of all patients who underwent multivisceral, modified multivisceral, and small bowel transplants were retrospectively analyzed.
    Results
    There were 18 patients. The most common indications for the procedure in our series were unresectable carcinoma of pancreas followed by short bowel syndrome. 10 patients were alive after a median follow-up of 8.7 (range: 3–32) months. The remaining 8 patients died post-operatively, mostly from septicemia.
    Conclusion
    Multivisceral and small bowel transplantations are promising treatments for complex abdominal pathologies.
  • M. Salmani Nadoushan, B. Nozary Heshmati, A. Shabanzadeh Pirsaraee, I. Salmani Nodoushan, R. Jafari Nadoushan, F. Yazdi Page 66
    Background
    Nowadays, organ transplantation is the treatment of choice for end-stage organ failure, which increases the importance of organ procurement. It seems that the attitude towards organ donation and transplantation affects people’s satisfaction. Moreover, health care personnel, especially physicians, should be familiar with transplantation rules and standards. It seems that understanding the knowledge and attitude of this group can affect the transplantation center policies.
    Objective
    To assess knowledge and attitude of a group of Iranian physicians towards organ and tissue donation.
    Methods
    In a cross-sectional study, 560 Iranian physicians including nephrologists, urologists and internists were asked to fill out a validated questionnaire containing their demographics, knowledge and attitude towards organ and tissue donation and transplantation.
    Results
    Of 560 participants, 435 (78%) agreed with organ donation after death and 285 (51%) agreed with living kidney donation. The most common reason provided by those who agreed with donation was “helping people” whereas the most common cause of disagreement was “to honor the body.” Only 32 (6%) physicians had no knowledge about transplantation rules. Complete awareness about theoretical basis and financial issues of transplantation was observed in 265 (47%) and 221 (40%) participants, respectively.
    Conclusion
    Physicians had a good attitude towards organ and tissue transplantation although less than half of them had knowledge of transplantation rules and its theoretical basis and financial issues; therefore, additional awareness and education of physicians is needed in all areas of the organ donation process in Iran.
  • Gh Naderi, M. Sotoudeh, D. Mehraban, S. Nategh Page 71
    Background
    Biopsy from deceased donors is of great value in predicting the efficacy and mid-term and long-term outcome of kidney transplantation.
    Objective
    To determine the prevalence of pathological changes in live donors’ kidneys and their association with the graft outcome.
    Methods
    This cohort study was performed among a group of renal transplant recipients. Biopsy was taken from donor’s kidney. The functionality of the grafted kidney was then evaluated by measuring serum creatinine, based on which, the patients were categorized into “successful” and “unsuccessful” groups. The results were compared based on biopsy results.
    Result
    We studied 58 kidneys from live donors. The mean±SD urine volume on the first day after transplantation was 10,052±3286 mL. Absence of allograft dysfunction was seen in 55 (95%) patients during a month, 51 (88%) patients in 6 months, and 53 (91%) within a year. Glomerulosclerosis was seen in 20 (35%) patients, fibrosis in 9 (16%), tubular atrophy in 5 (9%), and intimal fibrosis in 3 (5%). The mean±SD serum creatinine in patients within 1-month survival was 1.15±0.19, within 3-month survival was 1.17±0.20, within 6-month survival was 1.21±0.20, within 9-month survival was 1.43±1.28, and within 1-year survival was 1.14±0.22.
    Conclusion
    Kidney biopsy from live donors can show us a general status of kidney. Serum creatinine is the test of choice for evaluating the grafted kidney function.
  • A. Bahador, B. Geramizadeh, M. Rezazadeh Kermani, S. Moslemi Page 78
    Mesenchymal hamartoma and hepatoblastoma are common causes of hepatic masses in pediatric population; they have similar radiologic and pathologic features. Herein, we present a case of mesenchymal hamartoma that was preoperatively diagnosed as hepatoblastoma. The mass was completely resected instead of being treated with preoperative chemotherapy. Postoperative pathological evaluation revealed mesenchymal hamartoma with free margins; the patient incidentally received the standard treatment. If we would have measured serum AFP in our patient, we could make the correct diagnosis preoperatively, because AFP increases largely in hepatoblastoma. When suspicious exists, serum AFP is a good guide in differentiating hepatoblastoma from mesenchymal hamartoma.
  • V. Velagic, J. Samardzic, Z. Baricevic, B. Skoric, M. Cikes, H. Gasparovic, B. Biocina, D. Milicic Page 83
    Heparin-induced thrombocytopenia is an immune-mediated serious adverse effect of heparin therapy. It is a relatively frequent complication among patients with mechanical circulatory support. Herein, we present a patient with severe heart failure and sepsis who developed heparin- induced thrombocytopenia shortly after implantation of left ventricular assist device as a bridge to transplantation and who was successfully treated with fondaparinux.