scholarly journals Hemodynamics in renal transplant in children with various morphological changes in the long-term post-transplant period

2021 ◽  
pp. 286-293
Author(s):  
Denis B. Ektov ◽  
Mikhail I. Pykov ◽  
Alexey L. Valov ◽  
Maria S. Molchanova ◽  
Berta L. Kushnir ◽  
...  
Keyword(s):  
Renal Artery ◽  
Morphological Changes ◽  
Objective Assessment ◽  
Graft Function ◽  
Resistance Index ◽  
Calcineurin Inhibitors ◽  
Nitrogen Excretion ◽  
Post Transplantation ◽  
Morphological Studies ◽  
The Common

Introduction. Ultrasound scanning is one of the main methods of instrumental examination of patients after allogenic transplantation of kidney. The main reasons of dysfunction of the kidney transplant in long post-transplantation term are acute or chronic rejection, as well as acute and chronic nephrotoxicity of calcineurin inhibitors.Objective. Assessment of dopplerographic indicators of the blood flow throughout the transplanted kidney vessels in patients with preserved nitrogen excretion function under various morphological changes.Materials and methods. The study includes an analysis of the medical history of 98 children with end-stage chronic renal failure who underwent 98 allogeneic kidney transplants from a posthumous donor. There were analyzed the results of 185 percutaneous puncture biopsies and ultrasound studies of renal transplants. The analyzed data of morphological studies are divided into 4 groups. 1st group – there are no morphological changes affecting graft function. 2nd group – morphological signs of calcineurin toxicity. 3rd group – borderline damage of the graft. 4th group – acute and chronic graft rejection.Results and discussion. Indices of resistance and pulsation measured at the level of the renal artery and interlobular arteries tended to decrease in the kidneys with immunological influence and remained stable in other morphological groups. This means that, the higher the degree of hyalinosis of the arteries, the lower the indices of resistance and pulsation indices measured at the level of the common renal artery and interlobular arteries.Conclusions. The revealed tendency of a decrease in the values of the resistance index and the pulsation index at the level of the common renal artery of the interlobular arteries can be considered as one of the initial ultrasound signs that allow to speak of a decrease in the elasticity of the vascular wall. Normal indices of renal hemodynamics do not exclude the presence of pathological processes leading to graft dysfunction.

scholarly journals Changes in Hemodynamic Parameters in Various Morphological Changes in the Kidney Transplant in Children

2021 ◽  
pp. 76-87
Author(s):  
M. I. Pykov ◽  
D. B. Ektov
Keyword(s):  
Renal Artery ◽  
Kidney Transplant ◽  
Morphological Changes ◽  
Graft Function ◽  
Resistance Index ◽  
Calcineurin Inhibitors ◽  
Vascular Wall ◽  
Tubular Atrophy ◽  
Morphological Studies ◽  
The Common

Ultrasound scanning is one of the main methods of instrumental examination of patients after allogenic transplantation of kidney. The main reasons of dysfunction of the kidney transplant in long posttransplantation term are acute or chronic rejection, as well as acute and chronic nephrotoxicity of calcineurin inhibitors. The study includes an analysis of the medical history of 130 children with end-stage chronic renal failure who underwent 130 allogeneic kidney transplants from a posthumous donor. There were analyzed the results of 231 percutaneous puncture biopsies and ultrasound studies of renal transplants. The analyzed data of morphological studies are divided into 4 groups:1st group — there are no morphological changes affecting graft function;2nd group — morphological signs of calcineurin toxicity;3rd group — borderline damage of the graft;4th group — acute and chronic graft rejection;5th group — non-specific tubulointerstitial sclerosis and tubular atrophy.Indices of resistance and pulsation measured at the level of the renal artery and interlobular arteries tended to decrease in the kidneys with immunological influence and remained stable in other morphological groups. This means that, the higher the degree of hyalinosis of the arteries, the lower the indices of resistance and pulsation indices measured at the level of the common renal artery and interlobular arteries. The revealed tendency of a decrease in the values of the resistance index and the pulsation index at the level of the common renal artery of the interlobular arteries can be considered as one of the initial ultrasound signs that allow to speak of a decrease in the elasticity of the vascular wall. Normal indices of renal hemodynamics do not exclude the presence of pathological processes leading to graft dysfunction.

scholarly journals LONG-TERM FUNCTIONING OF KIDNEY GRAFTS

2020 ◽  
Vol 44 (1) ◽  
pp. 4-10
Author(s):  
Т. N. Nikonenko ◽  
A. V. Trailin ◽  
V. N. Nepomnyashchy ◽  
S. V. Fen’ ◽  
S. R. Vildanov ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Inflammatory Diseases ◽  
Morphological Changes ◽  
Graft Function ◽  
Early Period ◽  
Long Term Results ◽  
Humoral Rejection ◽  
Morphological Studies ◽  
Cyclosporine Nephrotoxicity

Abstract Purpose of the study. To study the morphological changes of long-functioning kidney transplants and determine the main causes of transplant dysfunction. Materials and methods. A total of 52 recipients aged 20 to 70 years were analyzed retrospectively at different times after transplant surgery (5 to 22 years).Morphological changes in the kidney transplant are comparable according to light microscopy. The morphological changes in the graft were studied in the initial and long-term period. Morphological studies were conducted in monitoring mode. Results. In the early period after transplantation, ischemic injuries, primary graft function, and episodes of acute rejection were taken into account. In the distant period, morphological changes were evaluated in accordance with the recommendations of the Banff-classification.When analyzing long-term results, antigen- dependent (immune) and antigen-independent (visible) factors that affect the renal transplant are distinguished. The main clinical and laboratory indicators of allografts dysfunction are increased creatinine and proteinuria.In antigen-dependent forms (cellular, humoral and mixed rejection), humoral rejection is the most common (25%) allografts dysfunction.Antigen-independent forms of dysfunction (streptococcal infection 25%, inflammatory diseases 19,2%, recurrent pathology 3,8%, signs of cyclosporine nephrotoxicity in combination with other forms was found in 59,2%, nephrosclerosis 65,4%). Conclusions. The data obtained suggest that antigen-dependent (immune) factors, and in particular humoral rejection, are the most common cause of allografts dysfunction, and antigen- independent factors contribute to the progression of chronic rejection and the development of nephrosclerosis. Keywords: renal transplant, antigen-dependent, antigen-independent, dysfunction.

scholarly journals Strategies to Improve Immune Suppression Post-Liver Transplantation: A Review

2021 ◽  
Vol 2 (4) ◽  
pp. 441-454
Author(s):  
Islam B Mohamed ◽  
Fuad Z Aloor ◽  
Prasun K Jalal
Keyword(s):  
Liver Transplantation ◽  
Graft Loss ◽  
Graft Function ◽  
Calcineurin Inhibitors ◽  
Neurological Complications ◽  
Immunosuppressive Agent ◽  
Post Transplantation ◽  
Immunosuppressive Medications ◽  
Medication Side ◽  
Clinical Dilemma

Since the first liver transplantation operation (LT) in 1967 by Thomas Starzl, efforts to increase survival and prevent rejection have taken place. The development of calcineurin inhibitors (CNIs) in the 1980s led to a surge in survival post-transplantation, and since then, strategies to prevent graft loss and preserve long-term graft function have been prioritized. Allograft rejection is mediated by the host immune response to donor antigens. Prevention of rejection can be achieved through either immunosuppression or induction of tolerance. This leads to a clinical dilemma, as the choice of an immunosuppressive agent is not an easy task, with considerable patient and graft-related morbidities. On the other hand, the induction of graft tolerance remains a challenge. Despite the fact that the liver exhibits less rejection than any other transplanted organs, spontaneous graft tolerance is rare. Most immunosuppressive medications have been incriminated in renal, cardiovascular, and neurological complications, relapse of viral hepatitis, and recurrence of HCC and other cancers. Efforts to minimize immunosuppression are directed toward decreasing medication side effects, increasing cost effectiveness, and decreasing economic burden without increasing the risk of rejection. In this article, we will discuss recent advances in strategies for improving immunosuppression following liver transplantation.

PROTECTIVE EFFECT OF SOME SALTS 2-AMINOETHANESULFONIC ACID IN AN EXPERIMENTAL MODEL OF DEGENERATIVE SPINAL CORD INJURY

2020 ◽  
pp. 41-47
Author(s):  
Semeleva E.V. ◽  
Blinova E.V. ◽  
Zaborovsky A.V. ◽  
Vasilkina O.V. ◽  
Shukurov A.S.
Keyword(s):  
Spinal Cord ◽  
Morphological Changes ◽  
Male Rats ◽  
Zinc Salt ◽  
Control Group ◽  
Morphological Studies ◽  
Cord Injury ◽  
The Central Nervous System ◽  
Acid Compound ◽  
Lateral Sclerosis

In this work, we studied the pharmacological activity of zinc and magnesium salts of 2-aminoethanesulfonic acid in white non-linear male rats with amyotrophic lateral sclerosis, which was modeled by neurotoxicantsimplication into the pelvic part of spinal cord. After the reproduction of the pathology in animals, the indices of motor activity were recorded in the Rotarod test, and morphological studies of spinal cord sections stained according to Nisl in the Belshovsky modification were carried out. It was shown that the magnesium salt of 2-aminoethanesulfonic acid (compound LHT-317) to a greater extent reduces the development of motor disorders in experimental animals compared with the control group on the 4th day of observation. The course of intravenous administration of the studied compounds of 2-aminoethanesulfonic acid did not inhibit morphological changes in the spinal cord that develop in degenerative-dystrophic pathology of the central nervous system: connections. Moreover, if, against the background of treatment with zinc salt, the total area of motor zones in animals of the experimental group exceeded that of control rats, then the number of motoneurons did not differ from the control.

scholarly journals The future is coming: promising perspectives regarding the use of machine learning in renal transplantation

2019 ◽  
Vol 41 (2) ◽  
pp. 284-287
Author(s):  
Pedro Guilherme Coelho Hannun ◽  
Luis Gustavo Modelli de Andrade
Keyword(s):  
Machine Learning ◽  
Prediction Models ◽  
Graft Function ◽  
Statistical Technique ◽  
Daily Routine ◽  
Learning Approaches ◽  
Post Transplantation ◽  
Chronic Allograft Rejection ◽  
Institutional Experience ◽  
Learning Principles

Abstract Introduction: The prediction of post transplantation outcomes is clinically important and involves several problems. The current prediction models based on standard statistics are very complex, difficult to validate and do not provide accurate prediction. Machine learning, a statistical technique that allows the computer to make future predictions using previous experiences, is beginning to be used in order to solve these issues. In the field of kidney transplantation, computational forecasting use has been reported in prediction of chronic allograft rejection, delayed graft function, and graft survival. This paper describes machine learning principles and steps to make a prediction and performs a brief analysis of the most recent applications of its application in literature. Discussion: There is compelling evidence that machine learning approaches based on donor and recipient data are better in providing improved prognosis of graft outcomes than traditional analysis. The immediate expectations that emerge from this new prediction modelling technique are that it will generate better clinical decisions based on dynamic and local practice data and optimize organ allocation as well as post transplantation care management. Despite the promising results, there is no substantial number of studies yet to determine feasibility of its application in a clinical setting. Conclusion: The way we deal with storage data in electronic health records will radically change in the coming years and machine learning will be part of clinical daily routine, whether to predict clinical outcomes or suggest diagnosis based on institutional experience.

scholarly journals III.—Morphological Studies on the Echinoidea Holectypoida and their Allies

1917 ◽  
Vol 4 (6) ◽  
pp. 249-256
Author(s):  
Herbert L. Hawkins
Keyword(s):  
Common Origin ◽  
Normal Type ◽  
The Third ◽  
Morphological Studies ◽  
Apical System ◽  
The Common

The characters of the apical system of a series of Holectypus hemisphæricus from the same horizon at two localities in Dorsetshire are analysed and described. It is found that the average relations of the plates of the system are different at the two localities, although certain numbers of identical forms occur at both. Out of 189 specimens (from both localities), 40 show serious departures from the normal type. These abnormalities are of three classes. One, the most prevalent, consists in the presence of madreporic pores on genital 3, in addition to the normal perforation of genital 2. This is regarded as a “progressive variant” in the direction of Discoides. The second, occurring in three specimens, consists in the interpolation of a supernumerary plate within the system. It is suggested that this may be either a “regressive variant” towards Acrosalenia, or a “progressive variant” towards Nucleolites (as illustrated by N.orlicularis). In neither case would this variation coincide with actual phyletic sequence, so that it is styled “parallel variation”. The third type of variant, seen in one specimen only, combines both the first and second types, and in addition shows an absence of genital 5 and a corresponding increase in the size of the posterior oculars, which meet round the back of the system. The variation in this specimen is interpreted as being “progressive” towards Discoides, “parallel progressive” or “regressive” towards Nucleolites or Acrosalenia respectively, and “progressive” towards Conulus. There are indications of a different series of variants in the Holectypus depressus from the Cornbrash. The high percentage of variation in the composition of the apical system of Holectypus is regarded as an indication of the evolutional activity of the genus, and of its near approximation in time and phylogeny to the common origin of many of the groups of Irregular Echinoids.

scholarly journals SP723INTRA ABDOMINAL PRESSURE AND RENAL ARTERY BLOOD FLOW IN THE EARLY POST TRANSPLANTATION PERIOD

2018 ◽  
Vol 33 (suppl_1) ◽  
pp. i589-i590
Author(s):  
Armando Coca ◽  
Ana Lucia Valencia ◽  
Cristina Ferrer ◽  
Pablo Gonzalez ◽  
Miriam Martinez ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Artery ◽  
Abdominal Pressure ◽  
Artery Blood Flow ◽  
Post Transplantation

scholarly journals B-cell activating factor BAFF as a novel alert marker for the immunological risk stratification after kidney transplantation

2021 ◽  
Author(s):  
Antonia Margarete Schuster ◽  
N. Miesgang ◽  
L. Steines ◽  
C. Bach ◽  
B. Banas ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
B Cell ◽  
Graft Function ◽  
Risk Profile ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Antibody Mediated Rejection ◽  
B Cell Activating Factor ◽  
Medium Risk ◽  
Patients At Risk

AbstractThe B cell activating factor BAFF has gained importance in the context of kidney transplantation due to its role in B cell survival. Studies have shown that BAFF correlates with an increased incidence of antibody-mediated rejection and the development of donor-specific antibodies. In this study, we analyzed a defined cohort of kidney transplant recipients who were treated with standardized immunosuppressive regimens according to their immunological risk profile. The aim was to add BAFF as an awareness marker in the course after transplantation to consider patient’s individual immunological risk profile. Included patients were transplanted between 2016 and 2018. Baseline data, graft function, the occurrence of rejection episodes, signs of microvascular infiltration, and DSA kinetics were recorded over 3 years. BAFF levels were determined 14 d, 3 and 12 months post transplantation. Although no difference in graft function could be observed, medium-risk patients showed a clear dynamic in their BAFF levels with low levels shortly after transplantation and an increase in values of 123% over the course of 1 year. Patients with high BAFF values were more susceptible to rejection, especially antibody-mediated rejection and displayed intensified microvascular inflammation; the combination of high BAFF + DSA puts patients at risk. The changing BAFF kinetics of the medium risk group as well as the increased occurrence of rejections at high BAFF values enables BAFF to be seen as an awareness factor. To compensate the changing immunological risk, a switch from a weaker induction therapy to an intensified maintenance therapy is required.

Low Graft Function and Ongoing Hyperparathyroidism Are Closely Related to Post-Transplantation Osteoporosis

2013 ◽  
Vol 45 (4) ◽  
pp. 1562-1566 ◽  
Author(s):  
E. Tutal ◽  
M.E. Uyar ◽  
T. Colak ◽  
Z. Bal ◽  
B.G. Demirci ◽  
...  
Keyword(s):  
Graft Function ◽  
Post Transplantation

scholarly journals Conversion from calcineurin inhibitors to sirolimus of recipients with chronic kidney graft disease grade iii for a period 2003-2011

2013 ◽  
Vol 70 (9) ◽  
pp. 848-853 ◽  
Author(s):  
Ljiljana Ignjatovic ◽  
Rajko Hrvacevic ◽  
Dragan Jovanovic ◽  
Zoran Kovacevic ◽  
Neven Vavic ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Immunosuppressive Therapy ◽  
Graft Function ◽  
Solid Organ Transplantation ◽  
Calcineurin Inhibitors ◽  
Solid Organ ◽  
Kidney Graft ◽  
Group I ◽  
Grade Iii

Background/Aim. Tremendous breakthrough in solid organ transplantation was made with the introduction of calcineurin inhibitors (CNI). At the same time, they are potentially nephrotoxic drugs with influence on onset and progression of renal graft failure. The aim of this study was to evaluate the outcome of a conversion from CNIbased immunosuppressive protocol to sirolimus (SRL) in recipients with graft in chronic kidney disease (CKD) grade III and proteinuria below 500 mg/day. Methods. In the period 2003-2011 24 patients (6 famale and 18 male), mean age 41 ? 12.2 years, on triple immunosuppressive therapy: steroids, antiproliferative drug [mycophenolate mofetil (MMF) or azathiopirine (AZA)] and CNI were switched from CNI to SRL and followe-up for 76 ? 13 months. Nine patients (the group I) had early postransplant conversion after 4 ? 3 months and 15 patients (the group II) late conversion after 46 ? 29 months. During the regular outpatient controls we followed graft function through the serum creatinine and glomerular filtration rate (GFR), proteinuria, lipidemia and side effects. Results. Thirty days after conversion, in all the patients GFR, proteinuria and lipidemia were insignificantly increased. In the first two post-conversion months all the patients had at least one urinary or respiratory infection, and 10 patients reactivated cytomegalovirus (CMV) infection or disease, and they were successfully treated with standard therapy. After 21 ? 11 months 15 patients from both groups discontinued SRL therapy due to reconversion to CNI (10 patients) and double immunosuppressive therapy (3 patients), return to hemodialysis (1 patient) and death (1 patient). Nine patients were still on SRL therapy. By the end of the follow-up they significantly improved GFR (from 53.2 ? 12.7 to 69 ? 15 mL/min), while the increase in proteinuria (from 265 ? 239 to 530.6 ? 416.7 mg/day) and lipidemia (cholesterol from 4.71 ? 0.98 to 5.61 ? 1.6 mmol/L and triglycerides from 2.04 ? 1.18 to 2.1 ? 0.72 mmol/L) were not significant. They were stable during the whole follow-up period. Ten patients were reconverted from SRL to CNI due to the abrupt increase of proteinuria (from 298 ? 232 to 1639 ? 1641/mg day in 7 patients), rapid growth of multiple ovarian cysts (2 patients) and operative treatment of persisted hematoma (1 patient). Thirty days after reconversion they were stable with an insignificant decrease in GFR (from 56.10 ? 28.09 to 47 ? 21 mL/min) and significantly improved proteinuria (from 1639 ? 1641 to 529 ? 688 mg/day). By the end of the follow-up these patients showed nonsignificant increase in the serum creatinine (from 172 ? 88 to 202 ? 91 mmol/L), decrease in GFR (from 56.10 ? 28.09 to 47 ? 21 mL/day) and increased proteinuria (from 528.9 ? 688 to 850 ? 1083 mg/min). Conclusion. In this small descriptive study, conversion from CNI to SRL was followed by an increased incidence of infections and consecutive 25-50% dose reduction in the second antiproliferative agent (AZA, MMF), with a possible influence on the development of glomerulopathy in some patients, which was the major reason for discontinuation of SRL therapy in the 7 (29%) patients. Nine (37.5%) of the patients experienced the greatest benefit of CIN to SRL conversion without serious post-conversion complications.

Sign in / Sign up

Export Citation Format

Share Document