Assessment of the Glomerular Filtration Rate in Living and Cadaver Donor Recipients Within 12 Months of Kidney Transplant

Background: Among patients with urologic disease, end-stage renal disease (ESRD) have the highest mortality rate. The choice of treatment for patients with ESRD is transplantation. The primary objective of this study was to assess the trend of renal function test in cadaver and living donor groups within a year after the surgery. Method: We included ESRD patients who were admitted to our hospital’s clinic from 2001 to 2014. The glomerular filtration rate (GFR) was the outcome of interest. Results: A total of 381 individuals were included in this study, of whom 246 (64.6%) were males. the mean age was 40.8 years (SD=13.2). In this study, 291 (76.4%) patients received a transplant from a live donor. In the cadaver group, the GFR decreased by 3.8 mL/min (95% confidence interval [CI], 1.2-5.0) per six months, while in the living donor group, it decreased by 1.4 mL/min (95% CI, 0.3–2.5). These trends were not significantly different. The GFR of the living donor group was 0.4 mL/min (95% CI, -1.6-2.3, p=0.72) higher than that of the cadaver donor group per six months, which was not significantly different. The rejection rate was lower in the live donor group (odds ratio=0.54 [95% CI, -0.39-0.74], p<0.001). The rejection rate decreased over the study period by 71% every six months, and this decrease did not significantly differ between the study groups. Conclusions: Although the total GFR in the live donor group was higher, given the higher GFR at the time of surgery in the live donor group, the decrease rate in GFR seemed identical in the study groups.

Challenges of Kidney transplantation: Cadaver Donor

Not Available Bangladesh Journal of Urology, Vol. 14, No. 2, July 2011 p.42-43

A New Human-Derived Acellular Dermal Matrix for 1-Stage Coverage of Exposed Tendons in the Foot

The closure of wounds associated with soft tissue defects is surgically challenging, frequently requiring extensive plastic surgery and free flaps. The combination of ADM and STSG is an innovative method used to cover such wounds. The human-derived ADMs (H-ADMs) are the most described in the literature but according to European legislations, Companies H-ADMs outside the EC are not allowed to commercialize them in Europe, H-ADMs being “human products” and not “medical devices”, so being ruled by European legislations on transplants. The Skin Bank of the Bufalini Hospital (Cesena, Italy) obtained in 2009 the approval for the production and distribution of the first human cadaver-donor derived ADM from the Italian National Transplant Center and National Health Institute, we called with the Italian acronym M.O.D.A. (Matrice Omologa Dermica Acellulata). We present here the first use of a new H-ADM for treatment of distal lower extremity wounds with exposed tendons managed in one-stage pocedure with STSG. The excellent performance suggests that in cases where autologous tissue is unavailable or undesirable, the use of M.O.D.A. in one-stage procedure represents a promising alternative for covering wounds associated with tendons exposition.

Methods of cadaver donor cornea evaluation for keratoplasty (literature review)

At present time, a large amount of patients with corneal diseases require keratoplasty, therefore there is a quite high demand of constant donor cornea stock. In present article, methods of cadaver donor corneal material analysis are described in a sequence that is necessary for its qualitative assessment before surgery or for the choice of the optimal method of preservation in the Eye Bank conditions. It is known that corneal endothelial cells and their viability play a main role in the maintenance of transparency of transplanted corneal flap after penetrating keratoplasty or endothelial keratoplasty. It is for these types of keratoplasty that the highest quality of donor material with preservation of a large number of viable corneal endothelial cells is needed. Corneal flaps with poorer quality of corneal endothelial layer could be successfully used for different types of anterior lamellar keratoplasty and interlamellar keratoplasty. Therefore the adequate evaluation of donor corneal material before surgery allows reducing the risk of postoperative complications associated with failure of the corneal endothelial layer, and increasing graft survival in patients after surgery. In addition, the choice of the optimal type of preservation is of great relevance for maintaining the corneal material as viable in the long run for various types of transplantations.

Fibrolamellar Hepatocellular Carcinoma and Noncirrhotic Hyperammonemic Encephalopathy

Fibrolamellar hepatocarcinoma is an infrequent liver tumor, currently considered to be a variant different from hepatocarcinoma. The differences lie in genomic alterations, a greater prevalence of fibrolamellar hepatocarcinoma in young patients, and its lack of association with underlying liver disease. The clinical presentation is unspecific, with symptoms ranging from abdominal pain, malaise, and weight loss to atypical manifestation which include hyperammonemic encephalopathy. We present the case of a 33-year-old woman with no prior medical history who presented with a coma and a diagnosis of inoperable fibrolamellar hepatocarcinoma requiring a cadaver donor transplant. While she was on the waiting list, she received hemofiltration and ammonium benzoate treatment, with progressive improvement in her state of consciousness.