scholarly journals Retrieval of Microencapsulated Islet Grafts for Post-transplant Evaluation

2016 ◽  
pp. 157-171 ◽  
Author(s):  
John Patrick McQuilling ◽  
Sivanandane Sittadjody ◽  
Rajesh Pareta ◽  
Samuel Pendergraft ◽  
Clancy J. Clark ◽  
...  
Keyword(s):  
Post Transplant ◽  
Transplant Evaluation

REMOTE CONTROL: OUTCOMES UTILIZING TELEMEDICINE FOR OFF-SITE PRE-TRANSPLANT EVALUATION AND POST-TRANSPLANT LONG-TERM CARE.

2000 ◽  
Vol 69 (Supplement) ◽  
pp. S369
Author(s):  
Sumodh Kalathil ◽  
David D. Douglas ◽  
David C. Mulligan ◽  
M. E. Harrison ◽  
Monte Anderson ◽  
...  
Keyword(s):  
Remote Control ◽  
Long Term Care ◽  
Term Care ◽  
Post Transplant ◽  
Transplant Evaluation

scholarly journals 569. A Multidisciplinary Approach to the Pre-evaluation Process of Pediatric Solid Organ Transplant Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S349-S349
Author(s):  
Jacquie Toia ◽  
Kevin Le ◽  
Natalia Panek ◽  
Justin Boese ◽  
Ravi Jhaveri ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Multidisciplinary Approach ◽  
Organ Transplant ◽  
Evaluation Process ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Post Transplant ◽  
Increased Risk ◽  
Transplant Evaluation ◽  
Transplant Candidates

Abstract Background Pediatric transplant recipients are at increased risk of infection-related morbidity and mortality, both from opportunistic infections and vaccine-preventable diseases. Since vaccine immunogenicity may wane with organ failure and immunosuppressive therapies, it is recommended that transplant candidates are immunized early in their disease course, prior to transplant. However, transplant candidates are often incompletely immunized due to factors including complexity of care and multiple providers. A multidisciplinary approach involving Infectious Diseases (ID) is crucial to ensure that vaccination status is optimized prior to transplant and to prevent and treat infectious complications. Methods During the solid organ transplant evaluation process, liver, intestinal, and heart transplant candidates and their families meet with Infectious Diseases, Transplant Pharmacy, and Organ Procurement clinicians. The multidisciplinary team effort ensures that transplant candidates receive appropriate vaccines prior to transplant, based on immunization history and serology results. The team helps to manage infections diagnosed during the evaluation process (active or latent), identify risk factors for infection, optimize antimicrobial dosing based on comorbid conditions and concomitant medications, and follows patients post-transplant. Transplant candidates and their families are educated on how organ donation and organ allocation function in the US. Results Since launch of our multidisciplinary solid organ transplant team, we have completed pre-transplant ID evaluations on 64 patients [Table 1]. Nearly all (97%) of pre-transplant evaluated patients received vaccine optimization (booster/new vaccine doses) [Table 2]. Forty-five patients (70%) underwent organ transplant. Many intestinal (67%), cardiac (46%), and liver (27%) transplant candidates with pre-transplant evaluations required subsequent ID consultation. Table 1 Table 2 Conclusion Multidisciplinary ID pre-transplant evaluation leads to individualized vaccine optimization and infection management. Families benefit from education and counseling as well as familiarity with the Transplant ID consult service, involved in a large percentage of these patients in their peri- and post-transplant course. Disclosures All Authors: No reported disclosures

scholarly journals Renal transplant improves pulmonary hypertension in patients with end stage renal disease

2019 ◽  
Vol 6 ◽  
Author(s):  
Serife Savas Bozbas ◽  
Suleyman Kanyilmaz ◽  
Sule Akcay ◽  
Huseyin Bozbas ◽  
Cihan Altin ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Renal Transplant ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Preoperative Assessment ◽  
Post Transplant ◽  
Transplant Evaluation ◽  
Stage Renal Disease ◽  
End Stage

Background: Pulmonary hypertension (PH) is present in a sig- nificant proportion of patients with end stage renal disease (ESRD) and is of prognostic importance. Data on the effect of renal transplant on PH is very limited. In this study, the aim was to examine the effect of renal transplant on systolic pul- monary artery pressure (SPAP) determined by Doppler echocardiography. Methods: Analysis was performed on the records of 500 con- secutive patients who underwent renal transplant at our cen- ter between the years 1999 to 2008. The prevalence of PH in the preoperative assessment period was established. Patients were diagnosed as having PH when measured SPAP values were > 35 mm Hg. Results: Pulmonary hypertension was detected in 85 of the 500 (17%) patients under pre-transplant evaluation. At post-transplant follow up Doppler echocardiographic exam- ination was performed on 50 of the 85 patients. After exclu- sion of 8 cases (1 due to massive pulmonary thromboem- boli; 7 due to graft failure requiring dialysis therapy) analy- ses were performed on 42 patients who had undergone both pre- and post-transplant echocardiographic examination. Mean SPAP at pre-transplant evaluation was 45.9 ± 8.8 mm Hg and in 6 (14.3%) cases SPAP was above 50 mm Hg. Compared to pre-transplant values, a significant decrease was observed in mean SPAP values in an average of 53 months of postoperative follow up (41.8 ± 7.4 mm Hg vs. 45.9 ± 8.8 mm Hg, p < 0.0001). Conclusion: These findings indicate that patients with ESRD accompanied by PH may benefit from renal transplant. Further research is required for more concrete conclusions to be drawn on this subject.

scholarly journals Identifying Post Transplant Atypical Hemolytic Uremic Syndrome in Small Bowel Transplant Patients: A Retrospective Analysis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4212-4212
Author(s):  
Kruti Sheth ◽  
Daniel Smith ◽  
Raffaele Girlanda ◽  
Catherine Broome
Keyword(s):  
Small Bowel ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Ischemic Bowel ◽  
Post Transplant ◽  
Transplant Patients ◽  
Small Bowel Transplant ◽  
Uremic Syndrome ◽  
Transplant Evaluation

Abstract Post transplant thrombotic microangiopathy (PT-TMA) has been recognized for over 25 years. The exact incidence of PT-TMA in small bowel transplant (SBT) patients is unknown with reports varying from 4% to greater than 30%. One of the contributors to the differences in reported occurrence rates is the continued debate regarding the definition of PT-TMA. There is a growing consensus that PT-TMA is complement mediated and therefore can be defined by the same criteria as atypical hemolytic uremic syndrome (aHUS). AHUS is a complement mediated TMA defined by microangiopathic hemolytic anemia, thrombocytopenia (TCP), and end organ damage. We have previously demonstrated that the initiation of eculizumab in post-transplant aHUS (PT-aHUS) has led to improved outcomes in these patients. We believe that establishing reliable diagnostic criteria that can be utilized in the post transplant period will lead to earlier recognition and treatment which will decrease the high mortality rate associated with PT- aHUS. METHODS: This retrospective analysis was performed to evaluate whether we could identify a set of laboratory criteria that would reliably predict patients who are at higher risk of developing of aHUS in the pre-transplant or early post transplant period. Records of the forty-eight patients who underwent SBT at our institution between 2011 and 2013 were reviewed. Laboratory values were collected at three predetermined time points: pre-transplant (during transplant evaluation), 1-month post-transplant, and 6-12 months post-transplant. The criteria we designated for establishing a diagnosis of aHUS included fulfillment of all four of the following parameters at either the 1 month or 6-12 month time point: (1) 25% or greater decrease in platelet count from pre-transplant baseline, (2) serum creatinine increase of greater than 0.3 mg/dL from pre- transplant baseline, (3) haptoglobin of less than 50 mg/dL, and (4) LDH of greater than 250 units/L. Fisher exact test was used to find any statistical difference between the development of PT-aHUS and patient demographics and recorded cause of small bowel failure. RESULTS: One patient was not included in the analysis due to immediate graft failure. Eight of the remaining 47 patients (17%) met the defined criteria for aHUS post transplant. Three of the 8 patients who met the defined aHUS criteria were diagnosed clinically with aHUS and were treated with eculizumab. The remaining 5 who met the defined laboratory criteria for aHUS but were not clinically diagnosed had the following outcomes: 2 patients died due to multi organ failure, 2 have ongoing chronic kidney disease (CKD) and TCP and 1 pediatric patient is doing well. Three patients who did not meet the defined laboratory criteria for aHUS were clinically diagnosed with aHUS and treated with eculizumab. Figure 1 There were two significant pre transplant demographic associations that were identified by Fisher exact test with developing aHUS after SBT: age > 18 (RR 2.01, 95% CI 1.29-7.29, p=. 02) and ischemic bowel event preceding small bowel failure (RR 3.90, 95% CI 1.33-14.81, p=. 02). Figure 1. There were two significant pre transplant demographic associations that were identified by Fisher exact test with developing aHUS after SBT: age > 18 (RR 2.01, 95% CI 1.29-7.29, p=. 02) and ischemic bowel event preceding small bowel failure (RR 3.90, 95% CI 1.33-14.81, p=. 02). CONCLUSIONS: Utilizing the proposed criteria for defining PT- aHUS the incidence of PT- aHUS was 17% in our series, consistent with prior reports of PT- TMA in SBT patients. This incidence is higher than reported in renal transplant patients, suggesting some unique correlation between SBT and PT-aHUS. Multiple theories can be proposed for the etiology of complement dysregulation: (1) higher doses of immunosuppression (calcineurin inhibitor (CNI) based) required in small bowel recipients may augment endothelial damage and increase complement activity, (2) the transplanted organ itself may be more immunogenic and increase complement activity, (3) CNIs may deregulate T cell-complement homeostasis. The adult patients who met our criteria for PT-aHUS, but were not clinically recognized and treated had worse outcomes indicating a need for early diagnosis and treatment. The finding that an ischemic event as the etiology for small bowel failure is associated with an increased relative risk of developing post transplant aHUS is thought provoking and suggests that in some patients, bowel ischemia may actually be the initial TMA manifestation of aHUS. Pre-transplant evaluation of this subset of patients for the presence of known mutations in complement regulatory genes may be warranted. Disclosures Broome: Alexion Pharmaceuticals: Honoraria.

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