International Journal of Organ Transplantation Medicine
Volume:12 Issue: 4, Autumn 2021

Background: Optimizing anesthetic management for the best possible outcome is essential in kidney transplantation (KT). Objective: To evaluate the difference in grafted kidney function and early kidney transplant outcome when the pairs of donor-recipient were anesthetized with isoflurane compared to propofol. Methods: Thirty-eight pairs of kidney transplant donor-recipient were anesthetized with isoflurane, and 22 pairs were anesthetized with propofol. Blood urea nitrogen (BUN), serum creatinine (SCr), estimated glomerular filtration rate (eGFR) were assessed in the preoperative period, on the first postoperative day, before discharge from the hospital, and 6 months after KT. Short-term (6 months) outcomes of KT were assessed by the incidence of delayed graft function, acute rejection episodes, and graft failure. Results: There was no statistically significant difference between the two groups in the serial measurements of SCr, BUN, eGFR, and the early outcomes (6 months) after surgery. Interestingly, donor warm ischemic time in the propofol group was significantly longer than in the isoflurane group (4.05±1.02, 2.93±0.87 minutes, respectively) (p=0.001). Moreover, postoperative hospital stay in the propofol group were significantly shorter compared to the isoflurane group (9.63±2.96, 11.78±4.91 days, respectively) (p=0.02). Conclusion: There were no significant differences in transplanted kidney function and the early outcome of kidney transplantation between the two study groups. However, earlier hospital discharge after surgery in the propofol group suggests that propofol may be a more appropriate anesthetic choice in these patients.

Giardiasis is one of the opportunistic infections in immunocompromised patients, especially among organ transplant recipients.

This study aimed to investigate the prevalence of Giardia lamblia infection in children with heart transplantation.

A prospective cross-sectional study was conducted on 53 heart transplant recipients (aged 1–17 years). Transplant patients were on oral Trimethoprim/Sulfamethoxazole (TMP-SMX) from the first day of transplantation as a prophylaxis regimen. The prevalence of Giardia lamblia was evaluated on stool samples by phenotypic assay and polymerase chain reaction (PCR) method.

Out of 53 patients studied, 11 (20.75%) had gastrointestinal symptoms, and 42 (79.25%) were asymptomatic cases. No significant difference was observed between patients with and without gastrointestinal symptoms regarding type of heart disorders (p=0.13). The overall prevalence of Giardia lamblia infection among heart transplant patients was 5.7% (n=3). Moreover, the frequency was different between gastrointestinal symptomatic and asymptomatic recipients (27.27% and 0%, respectively). All three patients whose stool exams were phenotypically positive for Giardia lamblia were confirmed with PCR. Out of three, two Giardia lamblia isolates were found to have genotype B, while one isolate had genotype A. All of the Giardia positive patients suffered from chronic diarrhea and anorexia. Cryptosporidium spp., Isospora belli and Blastocysts spp. were not found in these cases.

The incidence of Giardia lamblia infection in pediatric heart transplant patients is considerable and should be noted. A comprehensive guideline for the assessment of Giardia lamblia before and after transplantation is suggested.

There are no known predictors of extracorporeal membrane oxygenation (ECMO) induction for single lung transplantation.

The purpose of the present study was to clarify the relationship between variables and ECMO requirements in single lung transplantation.

This study included adult patients who underwent cadaveric single lung transplantation between 2010 and 2019. After general anesthesia, the transplanted lungs were ventilated in all cases. The analysis included 38 patients in the ECMO required (RQ) group and 12 patients in the ECMO non-required (FR) group. Comparisons were made between the two groups for data affecting ECMO implementation, and data that were significantly different were subjected to multivariate analysis.

Prior to anesthesia, the bicarbonate (HCO3 -) value of the FR group was lower than that of the RQ group (24.6±2.7 vs. 29.7±5.3 mmol/L, p=0.005). Multivariate analysis showed that the cut-off bicarbonate value was 29.6. The area under the receiver operating characteristic curve (AUROC) of the model was 0.869 (R2 : 0.331), with a sensitivity of 79% and a specificity of 88%. The odds ratio was 1.63 for every unit increase in the bicarbonate value (95%CI: 1.11-2.39, p<0.001). Further, the FR group had higher arterial blood pressure (mean: 79.0±11.5 vs. 68.9±8.3 mmHg, p=0.030), less blood loss (432±385 vs. 1,623±1,997 g, p<0.001), shorter operation time (417±44 vs. 543±111 min, p<0.001), and shorter ICU stay (11±9 vs. 25±38 days, p=0.039).

Preoperative evaluation of bicarbonate could predict the need for ECMO for single lung transplantation.

MicroRNAs (miRNAs) are endogenous, 18-22 nucleotide non-coding RNA molecules. Human cytomegalovirus (HCMV) is a ubiquitous and particular herpes virus that encodes miRNAs, which increases gradually in the presence of infection. One of the important viral miRNAs is HCMV-miRUL-148D, which plays a role in establishing and maintaining viral latency.

The current study aimed to evaluate the expression levels of HCMV-miRUL-148D in active and inactive HCMV infected transplant patient groups compared to healthy individuals.

Total RNA was extracted from blood samples of 60 solid organ transplant patients and 30 healthy controls. In-house SYBR Green Real-Time PCR evaluated the expression levels of studied miRNA and gene.

The expression level of the UL-148D gene was significantly higher in the active HCMV infected patients (p=0.001) compared to other groups. While the miRUL-148D expression level significantly increased in the inactive HCMV-infected patients (p<0.001) compared to other groups.

Increased miRUL-148D expression level in the inactive HCMV-infected transplant patients indicates the potential role of this miRUL-148D as a biomarker of the HCMV latent stage.

Calcineurin inhibitors (CNIs) are regarded as a corner stone in immunosuppressive therapy after solid organ transplantation. However, neurotoxicity is a common side effect of CNIs, resulting in a wide range of neurological symptoms such as headache, tremor and seizures. In this case report, we describe a patient who developed severe motor and sensory neuron dysfunction related to CNIs after bilateral lung transplantation, which resolved after halting CNI and switching to a mammalian Target of Rapamycin-inhibitor.

Living donor hepatectomy is not without risks, and some complications can end up with serious morbidities if not timely diagnosed and appropriately managed. In this report, we described a very unusual but significant surgical problem in living liver donor surgery in which a significant narrowing occurred in the inferior vena cava after the closure of the stump of the right hepatic vein and inferior right hepatic vein close to the right hepatic vein together, and describe the cavoplasty technique used to repair this narrowing. To the best of our knowledge, the technique of solving this problem in living liver donors was described only once in literature, which was previously published by our team.