transplanted organs
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Author(s):  
Hindustan Abdul Ahad ◽  
Haranath Chinthaginjala ◽  
Abdalrahman Mohammed Salih Karar ◽  
Musab Idris Mohammed Ali Saeed ◽  
Aladin Khalaf Alla Elhaj Eltahir Alawad

The authors aimed to extend the discharge of Sirolimus from the tablets with a blend of herbal and synthetic polymers. In this study, Sirolimus was taken as a model drug, Hydroxy Propyl Methyl Cellulose as a synthetic polymer and mucilage from Hibiscus rosa sinensis leaves as a natural polymer. Sirolimus is an orphan drug used to treat Lymphangioleiomyomatosis damage and to suppress body refuse towards the transplanted organs. Sirolimus matrix tablets made with the blend of Hibiscus rosa sinensis leaves mucilage and Hydroxy Propyl Methyl Cellulose. The blend was assessed for flow possessions and the designed tablets were categorized for official and non-official tests including Sirolimus discharge. The Sirolimus matrix tablets possess good Sirolimus content with passible pre and post-formulation parameters. The study concludes that there were no chemical interactions between Sirolimus with polymers used. The study also revealed that Hibiscus rosa sinensis leaves mucilage can be a good polymer in grouping with other polymers for prolonged drug discharge.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jana Smalcova ◽  
Katerina Rusinova ◽  
Iván Ortega-Deballon ◽  
Eva Pokorna ◽  
Ondrej Franek ◽  
...  

Introduction: In refractory cardiac arrest, extracorporeal cardiopulmonary resuscitation (ECPR) may increase the chance of survival. However, in brain death or donation after cardiac death scenario, ECPR may also become an important organ donor source. Hypothesis: We hypothesized that 1/ the implementation of ECPR into the daily routine of a high volume cardiac arrest centre might increase the availability of organ donors, and 2/ ECPR might assure the same long-term function of donated organs as non-ECPR care. Methods: We retrospectively evaluated pre-ECPR (2007-2011) and ECPR (2012-2020) periods in terms of donors recruited from the out-of-hospital and in-hospital cardiac arrest population. We assessed the number of donors referred, the number of organs harvested and their one- and five-year survival. Results: In the pre-ECPR period, 11 donors were referred, of which 7 were accepted. During the ECPR period, the number of donors increased to 80, of which 42 were accepted. The number of donated organs in respective periods were 18 and 119, corresponding to 3,6 vs 13,2 (p =0.033) organs per year harvested. One-year survival of transplanted organs was 94.4% vs 100%, and five-year survival was 94.4% vs 87,5%, in relevant periods. Survival of organs obtained from donors after CPR and ECPR at one year (98.9% vs 100%) and five years (90,2% vs 88.9%) was the same. Graft failure was not the cause of death in any single case. Conclusions: Establishing a high volume cardiac arrest/ECPR centre may lead to a higher number of potential and subsequently accepted organ donors. The length of survival of donated organs is high and comparable between ECPR vs non-ECPR cardiac arrest donors.


Uro ◽  
2021 ◽  
Vol 1 (4) ◽  
pp. 222-227
Author(s):  
Dai D. Nghiem

Tacrolimus is the cornerstone component of all immunosuppressive regimens. Despite its long record of use, very little is known about its acute toxicity syndrome. We describe five patients with acute organ failure, involving both native and transplanted organs, which was reversed by inducing the cytochrome P450-3A system. In all patients, the causative drug was stopped and phenytoin was given intravenously to accelerate tacrolimus metabolism. Within 24 h, tacrolimus trough levels fell daily at a significant level (p < 0.05) and all failed organs recovered their normal function within 48–72 h. Therefore, phenytoin metabolic induction appears to be a safe therapeutic option for patients with acute tacrolimus toxicity.


2021 ◽  
Vol 2 (3) ◽  
pp. 348-361
Author(s):  
Naveen Kumar ◽  
Rashmi Rana ◽  
Devender Singh Rana ◽  
Anurag Gupta ◽  
Mohinder Pal Sachdeva

Donor-derived cell-free DNA (dd-cfDNA) is a non-invasive biomarker that is more sensitive and specific towards diagnosing any graft injury or rejection. Due to its applicability over all transplanted organs irrespective of age, sex, race, ethnicity, and the non-requirement of a donor sample, it emerges as a new gold standard for graft health and rejection monitoring. Published research articles describing the role and efficiency of dd-cfDNA were identified and scrutinized to acquire a brief understanding of the history, evolution, emergence, role, efficiency, and applicability of dd-cfDNA in the field of transplantation. The dd-cfDNA can be quantified using quantitative PCR, next-generation sequencing, and droplet digital PCR, and there is a commendatory outcome in terms of diagnosing graft injury and monitoring graft health. The increased levels of dd-cfDNA can diagnose the rejection prior to any other presently used biochemistry or immunological assay methods. Biopsies are performed when these tests show any signs of injury and/or rejection. Therefore, by the time these tests predict and show any unusual or improper activity of the graft, the graft is already damaged by almost 50%. This review elucidates the evolution, physiology, techniques, limitations, and prospects of dd-cfDNA as a biomarker for post-transplant graft damage and rejection.


2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Zahra Sheikhalipour ◽  
Vahid Zaman Zadeh ◽  
Leili Borimnejad ◽  
Stephen R Large ◽  
Leila Vahedi

Background: While organ transplantation is a common surgical procedure worldwide, it is yet well-examined how the recipients of newly-transplanted organs adapt and accept a new organ from another body. Adaptation and acceptance of a vital organ from another person is a complex phenomenon, and medical staff needs to delve into this issue to provide appropriate care. Objectives: The present study aimed to explore the transplant recipients' experiences of adaptation to the transplanted organ. Method: A qualitative research design with a hermeneutic phenomenological approach was adopted in this study. In-depth unstructured interviews were conducted by one of the authors (Z. S.) in different locations across Iran. The purposive sampling method was used to select 20 transplant recipients (n = 4 kidney transplantation; n = 10 heart transplantation; n = 4 liver transplantations; and n= 2 blood transfusion). Results: The constitutive pattern emerged from the data was ‘Psychological adaptation to transplanted organ’, with three themes (namely ‘Alien organ,’ ‘Ensure of being the patch of togetherness,’ and ‘Durability of new organ in body’) and several sub-themes. Conclusions: According to the organ recipients' experiences, it takes time for the recipients to accept another person's organ as their own. The transplant team members need to openly and proactively discuss the many psychological and spiritual issues to which the newly-transplanted organ recipients are exposed to facilitate the adaptation and acceptance of the new organs.


2021 ◽  
Vol 12 ◽  
Author(s):  
Jin-Yu Sun ◽  
Rui Wu ◽  
Jiang Xu ◽  
Hui-Ying Xue ◽  
Xiao-Jie Lu ◽  
...  

The immune system recognizes and attacks non-self antigens, making up the cornerstone of immunity activity against infection. However, during organ transplantation, the immune system also attacks transplanted organs and leads to immune rejection and transplantation failure. Interestingly, although the embryo and placenta are semi-allografts, like transplanted organs, they can induce maternal tolerance and be free of a vigorous immune response. Also, embryo or placenta-related antibodies might adversely affect subsequent organ transplantation despite the immune tolerance during pregnancy. Therefore, the balance between the immune tolerance in maternal-fetal interface and normal infection defense provides a possible desensitization and tolerance strategy to improve transplantation outcomes. A few studies on mechanisms and clinical applications have been performed to explore the relationship between maternal-fetal immune tolerance and organ transplantation. However, up to now, the mechanisms underlying maternal-fetal immune tolerance remain vague. In this review, we provide an overview on the current understanding of immune tolerance mechanisms underlying the maternal-fetal interface, summarize the interconnection between immune tolerance and organ transplantation, and describe the adverse effect of pregnancy alloimmunization on organ transplantation.


2021 ◽  
Vol 9 ◽  
Author(s):  
Majda Sahman ◽  
Snezana Mugosa ◽  
Nemanja Rancic

Background: Organ transplantations are difficult, complicated and very expensive interventions. In order to preserve the transplanted organs, it is necessary to provide medical care to the patients in terms of immunosuppression. According to the guidelines, the first-line therapy choices for achieving immunosuppression after transplantation are tacrolimus, cyclosporine, mycophenolic acid, azathioprine, sirolimus, everolimus„ and corticosteroids. The aim of our study was to examine the utilization of this drugs in Montenegro and to compare the results with the ones from Finland, Croatia, and Serbia.Methods: In our investigation we used Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Prices per DDD of drugs are presented in euros (€).Results: In all observed countries, there is a positive trend in the consumption of all 6 drugs during the analyzed period. The prices per DDD of these drugs generally show a negative trend. Tacrolimus and mycophenolic acid in Montenegro recorded the largest reduction in the price per DDD. Price per one DDD of tacrolimus decreased from €13.28 in 2009 to €5.11 in 2019, thus by about 260%, and as regards mycophenolic acid, the price per one DDD decreased from €9.59 in 2009 to € 3.36 in 2019, thus by almost 300%.Conclusion: Despite the reduction in the price per DDD, drugs that are used as immunosuppressants are showing increasing costs from year to year. Since these drugs are expensive, they participate in a significant percentage in the budget for medicines in each country.


2021 ◽  
Vol 74 (1) ◽  
Author(s):  
Fernanda Gatez Trevisan dos Santos ◽  
Vanessa Aparecida Martim Mezzavila ◽  
Thamires Fernandes Cardoso da Silva Rodrigues ◽  
Luana Cristina Bellini Cardoso ◽  
Marcelo da Silva ◽  
...  

ABSTRACT Objectives: to indentify the time trend of rates of organs and tissues effective donors, of reports and types of transplanted organs per million people of the Brazilian population. Methods: ecological study, of time series, about reports of organ donations and on transplants. The data were provided by the Registro Brasileiro de Transplantes and analyzed using polynomial regression. Results an increasing trend was found for potential donors and effective donors, with an average increase of 2.33 and 0.92 per year, respectively. The South Region had the highest rate of potential donors (83.8) and effective donors (34.1) and the North Region, the lowest rate (20.2 and 3.9). The family refusal was the main obstacle to accomplish the donation. Conclusions the results show an increasing trend of potential donors and effective donors throughout Brazil, with emphasis on the southern region of the country. Among the main reasons for non-donation, it is worth emphasizing family refusal and medical contraindication prescription.


2020 ◽  
Vol 21 (24) ◽  
pp. 9669
Author(s):  
Malgorzata Kloc ◽  
Ahmed Uosef ◽  
Jacek Z. Kubiak ◽  
Rafik M. Ghobrial

Tissue-resident macrophages and those conscripted from the blood/bone marrow are professional phagocytes. They play a role in tissue homeostasis, replacement, and healing, and are the first-line responders to microbial (viral, bacterial, and fungi) infections. Intrinsic ameboid-type motility allows non-resident macrophages to move to the site of inflammation or injury, where, in response to the inflammatory milieu they perform the anti-microbial and/or tissue repair functions. Depending on the need and the signaling from the surrounding tissue and other immune cells, macrophages acquire morphologically and functionally different phenotypes, which allow them to play either pro-inflammatory or anti-inflammatory functions. As such, the macrophages are also the major players in the rejection of the transplanted organs making an excellent target for the novel anti-rejection therapies in clinical transplantation. In this review, we describe some of the less covered aspects of macrophage response to microbial infection and organ transplantation.


BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038340
Author(s):  
Aki Uutela ◽  
Ilkka Helanterä ◽  
Karl Lemström ◽  
Arie Passov ◽  
Simo Syrjälä ◽  
...  

IntroductionRemote ischaemic preconditioning (RIPC) using a non-invasive pneumatic tourniquet is a potential method for reducing ischaemia-reperfusion injury. RIPC has been extensively studied in animal models and cardiac surgery, but scarcely in solid organ transplantation. RIPC could be an inexpensive and simple method to improve function of transplanted organs. Accordingly, we aim to study whether RIPC performed in brain-dead organ donors improves function and longevity of transplanted organs.Methods and analysesRIPTRANS is a multicentre, sham-controlled, parallel group, randomised superiority trial comparing RIPC intervention versus sham-intervention in brain-dead organ donors scheduled to donate at least one kidney. Recipients of the organs (kidney, liver, pancreas, heart, lungs) from a randomised donor will be included provided that they give written informed consent. The RIPC intervention is performed by inflating a thigh tourniquet to 300 mm Hg 4 times for 5 min. The intervention is done two times: first right after the declaration of brain death and second immediately before transferring the donor to the operating theatre. The sham group receives the tourniquet, but it is not inflated. The primary endpoint is delayed graft function (DGF) in kidney allografts. Secondary endpoints include short-term functional outcomes of transplanted organs, rejections and graft survival in various time points up to 20 years. We aim to show that RIPC reduces the incidence of DGF from 25% to 15%. According to this, the sample size is set to 500 kidney transplant recipients.Ethics and disseminationThis study has been approved by Helsinki University Hospital Ethics Committee and Helsinki University Hospital’s Institutional Review Board. The study protocol was be presented at the European Society of Organ Transplantation congress in Copenhagen 14−15 September 2019. The study results will be submitted to an international peer-reviewed scientific journal for publication.Trial registration numberNCT03855722.


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