International Journal of Organ Transplantation Medicine
Volume:12 Issue: 1, Winter 2021

Mouse orthotopic lung transplantation (MOLTx) models are extremely useful. However, there are only few studies on non-invasive monitoring methods for lung rejection in these models. Additionally, a model of chronic rejection has so far been difficult to reproduce consistently with MOLTx.

To determine if CT scan of the lung graft can be considered a useful noninvasive monitoring method of evaluation of graft rejection in an animal lung transplantation model.

Left MOLTx was performed from B10 donors into B6 recipients (from B6 donors for syngeneic controls). Following transplantation, 3 different doses of cyclosporine—5, 15, and 25 mg/kg daily—were administered in the first week to suppress acute rejection. Positive controls did not receive cyclosporine. 8 weeks after transplantation, CT and histological rejection grading were performed.

The negative controls did not show any inflammation. Positive controls revealed moderate acute rejection (A3). A3 was also detected in the 5-mg/kg group (100%). The 15-mg/kg group (n=7) demonstrated A3 in 4 mice and mild acute rejection (A2) in the remaining 3 mice. In this group, 4 mice had bronchiolitis obliterans (BO; C1, 57%). The 25-mg/kg group (n=3) showed A3 changes in 1 and A2 in 2 mice. On CT scan, lungs without BO (C0) had radiodensities of ‑278.1±110.7 Hounsfield units (HU). C1 lungs had ground-glass opacity or atelectasis with ‑83.4±46.8 HU (C0 vs. C1, p<0.001). On grouping with A2 or A3 in C0, significant differences were detected: ‑375.3±41.2 vs. ‑185.0±38.4 HU (A2+C0 vs. A3+C0, respectively), p=0.01.

BO can be modeled using this MOLTx model by administration of subtherapeutic doses of cyclosporine. CT scans are a valid tool for monitoring of rejection following MOLTx.

Ischemia-reperfusion injury during transplantation can cause post-operative graft dysfunction.

To assess the efficacy of N-acetylcysteine in preventing hepatic ischemia-reperfusion injury and post-transplant outcomes.

In this retrospective study on pediatrics undergoing living-donor (from one of their parents) liver transplantation, N-acetylcysteine was administered to one group (n=20) after induction in the donors until graft harvest, and in the recipients during implantation, which was maintained for 19 hours. The second group (n=20) did not receive NAC. Early allograft dysfunction was determined in the presence of alanine aminotransferase or aspartate aminotransferase ≥2000 IU/L and bilirubin ≥10 mg/dL within the first 7 days, and an international normalized ratio ≥1.6 on day 7. Data were collected from a retrospectively maintained database.

The incidence of post-reperfusion syndrome was lower in N-acetylcysteine group compared with the other group (5% vs. 30%, p=0.037). Serum creatinine level was significantly (p=0.04) different in the N-acetylcysteine group during the second post-operative week (0.14 vs. 0.15 mg/dL). There was no significant difference in the incidence of early allograft dysfunction (21% vs. 14%, p=0.327), and the survival rate (p=0.409).

Peri-operative infusion of N-acetylcysteine in both donor and recipient would effectively prevent post-reperfusion syndrome and renal insufficiency. However, it might not affect the early allograft dysfunction, ICU stay, and mortality. NAC increases the chance of re-operation due to non-surgical bleeding in the first post-operative day.

Laparoscopic live donor nephrectomy (LLDN) has become the standard of care and is popular among most of the transplant centers across the globe. Despite proven advantages of LLDN, some transplantation centers hesitate to start the program because of issues concerning donor safety and allograft function.

To discusses the main barriers for creating a successful LLDN program, strategies that allowed us to start a successful LLDN program along with the study results.

The donors undergoing LLDN from December 2016 to February 2018 were enrolled in the study and prospectively evaluated. LLDN were performed by two senior surgeons alternately with assistance by the laparoscopic urologist in all cases. Also, in the present study, two technical alterations were done in the standard surgical technique of transperitoneal LDN. The first important modification made was the use of two additional ports for use by laparoscopic urologists. The second modification involved dissection on both poles of the kidney before hilar dissection.

A total of 112 transperitoneal LLDN were performed during the study period. The mean (range) of operation time was 117.5 (81–158) min; the ischemia time was 194 (171–553) sec. Only one patient needed conversion to open surgery. No other major peri-operative or posto-perative complications occurred. All kidney grafts were functioning well.

With proper planning, team approach, and few technical modifications, introduction of LLDN is safe and effective.

Despite the high regenerative capacity of skeletal muscle, volumetric muscle loss (VML) is an irrecoverable injury. One therapeutic approach is the implantation of engineered biologic scaffolds.

To investigate the simultaneous effect of high intensity interval training (HIIT) and the use of decellularized human amniotic membrane (dHAM) scaffolds on vascularization, growth factor, and neurotrophic factor gene expression, and muscle force generation in the tibialis anterior (TA) of rats after VML injury.

VML injury was created in the TA of 24 rats, which were randomly divided into two groups—12 animals with and 12 without the use of a dHAM scaffold. After injury, each group was further divided into two groups of 6 animals each—sedentary and HIIT. Blood vessels were visualized and counted by hematoxylin and eosin staining. The PowerLab converter assay was used to evaluate isometric contraction force. The relative expression of neurotrophic factors and growth factor genes was measured with reverse transcription PCR (RT-PCR).

The number of blood vessels in the whole regenerating areas showed a significant difference in the dHAM-HIIT and dHAM-sedentary groups compared to the sedentary group without dHAM (p=0.001 and p=0.003, respectively). BDNF and GDNF mRNA levels in the dHAM-HIIT group were significantly (p<0.05) higher than those in other groups; NGF mRNA levels did not differ significantly among groups. Isometric contraction force in the dHAM-HIIT group was significantly (p=0.001) greater compared to the sedentary group without dHAM.

Combined use of dHAM scaffoldsand HIIT would improve the structure of the injured muscle during regeneration after VML by better vascular perfusion. HIIT leads to greater force generation and innervation by modulating neurotrophic factor synthesis in regenerating muscles.

Use of AlloDerm™ is highly suggested for the treatment of deep burns and burn sequela reconstruction. Scar formation and contracture are recognized as long-term consequences of split-thickness skin autografting, which is applied for full-thickness burn injuries. Mature fibroblasts, in the absence of dermis, seem to secrete collagen in the reformed scar pattern.

To process AlloDerm™ from fresh allograft and use it as a dermal substitute for covering deep wounds in burn patients and evaluate its effectiveness.

In this case-series, 7 patients with deep burn wounds involving different locations on the body surface were exposed to combined AlloDerm™ (processed from fresh human allograft) with thin split thickness skin autograft on it. On the 5th post-operative day, wound dressings were changed to evaluate the graft survival with the human acellular dermal matrix scaffold. To determine the skin profiles, followups continued for at least 6 months.

The results showed excellent graft take, good elasticity, acceptable thickness, and little contracture and scarring according to fix surgeon assessment in 6 patients. Graft rejection happened only in one patient with chronic electrical injury.

AlloDerm™ derived from cadaver skin and combination of it with thin split thickness skin auto grafting constitute a cost-effective and favorable option for the treatment of deep burn wounds in our center, considering the increased tendency of the population towards organ donation in the event of brain death.

The inferior vena cava is the main organ of venous return from the lower extremities and abdominal organs to the right atrium. Congenital atresia of inferior vena cava is very rare. This anomaly can be surprising for transplant surgeons. The anomaly, if unknown, can cause procedural complications during interventional procedures or organ harvesting

Increased mortality of COVID-19 has been reported in older patients with diabetes, high blood pressure, lung disease and immunocompromised people such as kidney transplant recipients. Both the behavior of the viral infection and the treatments proposed so far interact with the state of immunosuppression and immunosuppressants. Herein, we report two cases of kidney transplant recipients with COVID-19 infection. The first patient presented with gastrointestinal symptoms and progressively advanced to multilobar pneumonia. The second case presented with fever accompanied by gastrointestinal and urinary symptoms and dry cough. Both patients responded appropriately to treatment.