International Journal of Organ Transplantation Medicine
Volume:13 Issue: 3, Summer 2022

Estimation of graft weight for live donor liver transplant using portal vein diameter has not been validated widely.

To observe the accuracy of portal vein diameter based formula in predicting graft weight.

Graft weight was estimated using standard liver volume (SLV) multiplied by the ratio of portal vein branch diameter (Lee’s formula). SLV was calculated using different formulae described in the literature. The most accurate formula was compared with three dimensional computed tomography volumetry in terms of accuracy of prediction of actual graft weight. Factors which predicted percentage error of more than 15 in computed tomography were analyzed.

In 307 right hemiliver grafts, SLV calculation by Urata’s method in Lee’s formula was the most accurate (P=0.60 in Analysis of Variance) among all SLV methods. Lee’s formula with Urata and computed tomography volumetry had a good correlation with actual graft weight (r=0.77 vs. r=0.8) which was confirmed by Bland Altman analysis. On volumetry 45 patients had a percent error of more than 15. On logistic regression analysis, an estimated graft volume of greater than 800cc was a significant factor ( p=0.008, odds ratio 2.99) and, in these patients Lee’s formula was better(mean error 9.2 ±7.8 vs. 20.2±4.5, p<0.001).

Lee's formula with SLV by Urata’s method was accurate and can act as the second checkpoint after three dimensional computed tomography volumetry. Computed tomography estimate of graft weight more than 800 is associated with higher inaccuracy and in those patients portal vein diameter based formulae fared better.

Granzyme-B is a serine proteinase expressed and released mainly by the cytotoxic T and NK cell. Granules intact Granzyme-B is directly delivered into the target cell, while extracellular Granzyme-B, released in serum leads to nonspecific cleavages of extracellular matrix molecules like vitronectin, collagen, TGF-β, IL-1 and invites systemic inflammation, tissue remodeling and fibrosis leading to the development of chronic renal allograft dysfunction.

We aimed to immunophenotype the Granzyme-B positive T-lymphocyte subset and Granzyme- B role in the development of chronic renal allograft dysfunction.

We have analyzed the Granzyme-B+CD8+T/CD8neg and Granzyme-B+CD3+/CD3neg cell subset by the flowcytometry and serum Granzyme-B level by the enzyme-linked immunosorbent assay.

We have found that the frequency of Granzyme-B+ CD8neg CD3+T cell, Granzyme-B+ CD8lowCD3+T cell and Granzyme-B+ CD8high CD3+T cell subset was significantly lower and serum Granzyme-B level was significantly higher in CAD group. The frequency of CD3+T, CD3neg lymphocyte, CD8neg CD3+T, CD8lowCD3+T, CD8high CD3+T, Granzyme-B+CD3negCD8neg lymphocyte was similar between the group. The frequency of CD3+CD8negGzm-B+ cell was negatively correlated with serum creatinine and CD3+CD8highGzm-B+ cell was negatively correlated with serum Granzyme-B level. Similarly, Serum Granzyme-B level was positively correlated with serum creatinine, urine proteinuria and negatively with eGFR.

The circulating frequency of Granzyme-B+ CD8neg CD3+T cell, Granzyme-B+ CD8lowCD3+T cell and Granzyme-B+ CD8high CD3+T cell subsets were significantly lower and serum Granzyme-B level was significantly higher in renal allograft recipients with CAD.

In patients with chronic liver disease, the presence of hepatocellular failure and/or portosystemic shunting lead to structural and functional brain changes. These changes are due to an increase in substances that are efficiently metabolized by the liver under normal circumstances. These abnormalities can be detected by MRI and magnetic resonance spectroscopy (MRS).

This study aims to evaluate changes in MR brain imaging, manganese, and ammonia levels in patients with chronic liver disease. Additionally, to assess the reversibility of these changes post-living donor liver transplantation.

The study included 10 adult male patients with CLD who underwent LDLT and 10 age and sexmatched healthy control subjects. All patients were subjected to clinical examination, routine labs, MR and MRS examinations of the brain. Follow-up MRI and MRS brain examination, as well as ammonia and manganese levels, were performed 6 to 9 months post-liver transplantation.

The CHILD score ranged from 7 to 13 with a mean of 10.4±1.8, whereas the MELD score ranged from 12 to 22 with a mean of 17.5±3.4. Ammonia levels pre-transplantation (mean 60±7.8) decreased significantly post-transplantation (mean 45.8±7.0) (P<0.001). Also, manganese levels pre-transplantation (mean 2.2±0.16 decreased significantly post-transplantation (mean 1.18±0.09) (P<0.001). Pallidal T1 hyperintense signal was detected in 8 out of 10 patients and regressed in 6 of them post-transplant. Eight patients demonstrated hyperintense whiter matter lesions (WMLs) in FLIAR WI that regressed in all patients after LT (P= 0.011). MRS findings demonstrated lower Cho/Cr and MI/Cr, and higher Glx/Cr compared to controls (P<0.05). The abnormal brain metabolites returned to normal levels post-transplant. Blood levels of ammonia and manganese significantly decreased post-transplant compared to their pre-transplant levels (P<0.01).

MRI and MRS findings can be used to detect metabolic brain abnormalities in chronic liver disease patients with a correlation with ammonia and manganese levels. Moreover, they can be used to monitor the patients post-transplant.

Living organ, tissue, or cell transplantation from one species to another is known to as xenotransplantation. The history of xenotransplantation is just as ancient as that of allogeneic transplantation. Early attempts were attempted when it was uncertain exactly, on an immunologic level, causes organ rejection. With the emergence of potent immunosuppressive medicines and concurrent advancements in the field of genetic engineering, a new perspective on the role of xenotransplantation as a tactic to resolve the disparity between the number of applicants on the waitlist and the available organs has developed. Although a xenotransplantation clinical trial involving human subjects appears to be theoretically viable, it requires a stringent regulatory framework on both a national and international level to ensure both the individuals' and the public's safety. Several scientists in the United States urged the FDA to prohibit cross-species transplantation research until ethical concerns and health risks are addressed at the public conference on xenotransplantation that was held in January 1998. Clinical studies that are being conducted cautiously and with precision were approved by the FDA as suitable. ARMBA and the roles of the relevant governmental organisations and healthcare institutions are the focus of the present rules regulating the conduct of xenotransplantation clinical trials in Korea. In accordance with the standards of the international guidelines, Korea is prepared to perform a clinical experiment involving xenotransplantation on humans. In accordance with the ARMBA and other relevant laws and regulations, the appropriate governmental authorities would work together to control the xenotransplant clinical study.

The organ shortage is the main concern for kidney transplantation. Using deceased pediatric donors either as single or in an en-bloc manner is one way to solve this problem. We reviewed 21 en-bloc pediatric deceased kidney transplantations to adult recipients.

From May 2010 to May 2016, 472 deceased kidney transplantations have been performed in our hospitals. Twenty-one of these were pediatric kidney transplantations to adult recipients (age < 5 years, kidney size < 8 cm, donor weight <15 kg). Follow-up (ranging from 3 to 36 months) included clinical findings and complications plus serial creatinine levels and kidney size with ultrasonography and dimercaptosuccinic acid renal scan.

Among 21 patients, 52.4% were female. The mean age of participants was 28.85 ± 10.29 years. The preoperative mean size of the grafts was 6.94 ± 0.58 centimeters reaching 8.52 ± 0.98 and 10.20 ± 1.2 after 3 and 12 months of postoperative follow-up, respectively (P-value < 0.001). Means of serum creatinine was 1.61 ± 0.39, 1.45 ± 0.39, 1.32 ± 0.37, and 1.17 ± 0.28 mg/dl at postoperative 1, 3, and 6 and 12 months, respectively (P-value < 0.001). In a 12-month follow-up (range, 3 to 36 months), the complication- free rate was 61.9%, one-year patient survival was 90.5%, and one-year graft survival was 100%.

En-bloc pediatric deceased kidney transplantation is an acceptable alternative for adult recipients, with a great midterm patient and graft survival. Longer follow-up is recommended to assess their long-term outcomes.

Cryptococcus neoformans is an encapsulated yeast in the natural environment, and soils often contaminated with bird droppings are the most important source of contamination. In this article, a 61-year-old female recipient of renal transplantation, who was diagnosed with disseminated cryptococcal infection with skin involvement, is presented. Physical examination of the patient was found to have atypical lesions on her face. At the end of the 72-hour incubation of the scraping sampling from the patient's lesion; Crytococcosis was diagnosed by detecting encapsulated yeast fungi in staining with Indian ink. Yeast structures compatible with C.neoformans were seen. L-Amphotericin B treatment, which was started. The patient died on the 8th day of follow-up despite extensive and effective antifungal therapy. In conclusion, it should be considered that opportunistic fungal infections that may develop due to the use of immunosuppressive agents in patients undergoing solid organ transplantation.