We analyzed the results of 55 patients who underwent split liver transplantation at our center be... more We analyzed the results of 55 patients who underwent split liver transplantation at our center between September 1996 and December 2008, 30 adults (54.5%) and 25 children (45.5%). Median follow-up was 12 years. Overall patient survival was 71%, adult 70% and pediatric 72%. Mean patient survival was 61.58 months, and mean graft survival was 44.35 months. Pediatric survival and pediatric
Progress in transplantation (Aliso Viejo, Calif.), 2002
Cannulation of the abdominal aorta in organ donors with advanced arteriosclerotic disease or exte... more Cannulation of the abdominal aorta in organ donors with advanced arteriosclerotic disease or extensive trauma may be problematic owing to difficulty in securing a watertight tie around the diseased aorta, the danger of creating a false passageway in the aorta, and the risk of breaking off plaque particles that can advance into the arteries of donated organs. Cannulation problems can be avoided in these challenging donors by using a simplified technique for cannulation of the thoracic aorta in which a Foley catheter is passed down around the aortic arch, the balloon is inflated, and cool flushing is initiated.
Natural killer (NK) cells are innate immune lymphocytes. NK cells contribute to host antimicrobia... more Natural killer (NK) cells are innate immune lymphocytes. NK cells contribute to host antimicrobial and antitumor immunity. Liver transplantation in patients with hepatocellular carcinoma (HCC) has increased recently. The possibility of NK cell immunotherapy for liver cancer has been studied. Adoptive transfer of interleukin-2 (IL-2)-stimulated NK cells extracted from donor liver perfusate could increase an antitumor response without causing toxicity against 1-haplotype identical recipient intact tissues in patients with live donor liver transplant. Donor liver NK cells showed the most vigorous cytotoxicity against an HCC after in-vitro IL-2 stimulation, compared with donor and recipient peripheral blood NK cells and recipient liver NK cells. IL-2 stimulation led to an increased expression of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) on liver NK cells. T-cell contamination and risk of graft-versus-host disease can be minimized with a T-cell depleting agent such ...
Posttransplant lymphoproliferative disorders (PTLD) are a frequent complication in bowel transpla... more Posttransplant lymphoproliferative disorders (PTLD) are a frequent complication in bowel transplant recipients. Histological changes in PTLD range from expansile lymphoplasmacytic (LP) hyperplasia to frank lymphoma. Small bowel allograft biopsies obtained in the first 250 days posttransplant were retrospectively graded after patients had received induction immunosuppression with either anti-CD52 (Campath) or anti-CD25 (Zenapax) monoclonal antibodies. The biopsies were analyzed with respect to the onset intensity of lymphoplasmacytic infiltrates and presence of in situ EBV hybridization (EBER) positivity. We observed that lymphoplasmacytic infiltrates were a frequent change in all bowel transplant patients over the examined period. Campath-treated patients developed earlier LP infiltrates of mild to moderate intensity between day 1 and 100 posttransplant, thereafter decreasing to mild. No EBER positivity was detected in this group. Zenapax-treated patients presented with LP infiltrat...
Background: Some trauma victims who survive acute illness develop lingering, debilitating syndrom... more Background: Some trauma victims who survive acute illness develop lingering, debilitating syndromes that are incompatible with any semblance of normalcy. Intestinal failure, in particular, exacts a high price in terms of quality of life. Total parenteral nutrition (TPN) has served these patients well, but complications limit its long-term therapeutic effect. Consequently, transplantation is emerging as a life-saving therapy for some patients with the short gut syndrome.
Background: The distal splenorenal shunt (DSRS) is de- signed to maintain hepatopetal portal vein... more Background: The distal splenorenal shunt (DSRS) is de- signed to maintain hepatopetal portal vein flow while de- compressing gastroesophageal varices. However, over time, as the underlying liver disease progresses, the DSRS loses its selectivity. The most common method of addressing this issue during orthotopic liver transplantation is shunt ligation with or without splenectomy. Dismantling the shunt increases the complexity of
Campath-1H is being used as induction immunosuppression for intestinal/multivisceral transplantat... more Campath-1H is being used as induction immunosuppression for intestinal/multivisceral transplantation. Patient and graft survival in this preliminary experience is similar to previous studies but there has been a significant decrease in the incidence and severity of acute rejections without increase of opportunistic infections. Collage of the abdominal wall (transplantation of a composite graft of the abdominal wall) can provide biologic
... Induction therapy for adult small bowel transplant with campath-1H. Auteur(s) / Author(s). NI... more ... Induction therapy for adult small bowel transplant with campath-1H. Auteur(s) / Author(s). NISHIDA S. (1) ; LEVI D. (1) ; KATO T. (1) ; MADARIAGA J. (1) ; NERY J. (1) ; TZAKIS A. (1) ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s). ... Intestino delgado. ; Homotrasplante. ; ...
Results: The incidence of HAT was 10.4% (10 of 96 transplantations) in group 1 and 7.0% (3 of 43 ... more Results: The incidence of HAT was 10.4% (10 of 96 transplantations) in group 1 and 7.0% (3 of 43 trans- plantations) in group 2. The incidence of biliary com- plications after HAT was 100% in group 1 and 0% in group 2 (P=.02). The incidence of retransplantation af- ter HAT was 90.0% (9 of 10 patients) in group 1 and
Introduction. In a prospective protocol we studied whether serum citrulline level within 30 days ... more Introduction. In a prospective protocol we studied whether serum citrulline level within 30 days of an acute rejection was predictive of the episode.
BackgroundAlemtuzumab (Campath-1H [C1H]) is a humanized monoclonal antibody directed against the ... more BackgroundAlemtuzumab (Campath-1H [C1H]) is a humanized monoclonal antibody directed against the CD 52 antigen that is present on the surface of T cells, B cells, natural killer cells and monocytes. We studied its application in intestinal transplantation.
Closure of the abdomen in patients undergoing intestinal transplantation can be extremely difficu... more Closure of the abdomen in patients undergoing intestinal transplantation can be extremely difficult, if not impossible. We describe our initial experience with abdominal wall allotransplantation to facilitate abdominal closure. We undertook nine cadaveric abdominal wall composite allograft transplants in eight patients. The graft's blood supply was based on the inferior epigastric vessels left in continuity with the donor femoral and iliac vessels. Skin biopsies were undertaken randomly and when rejection was suspected. Vessel patency was monitored by doppler ultrasound. Six patients have survived, five of whom have intact, viable abdominal wall grafts. Two patients have had a clinically mild episode of acute rejection of the skin of the abdominal wall that resolved with corticosteroid therapy. No clinically apparent graft-versus-host disease has been noted. Transplantation of an abdominal wall composite allograft can facilitate reconstruction and closure of the abdominal compartment in intestinal transplant recipients with complex abdominal wall defects.
Subclinical rejection (SCR) is a known entity in various solid organ transplants but not in intes... more Subclinical rejection (SCR) is a known entity in various solid organ transplants but not in intestinal transplantation. The purpose of this study is to characterize the presence and effect of SCR in small intestinal transplantation (Itx). A total of 151 patients who underwent Itx and maintained a functioning graft for at least 3 months after Itx were investigated. The clinicopathological characteristics associated with a SCR episode within 3 months after Itx were analyzed. Cox regression with the landmark method (the landmark time being 3 months after Itx) was used for the analyses of overall graft survival and cause-specific hazard rate of SCR. A total of 2744 small intestinal transplant biopsies within 3 months after Itx were available for retrospective evaluation; 171 cases (6.2%) were determined as SCR and 78 patients (51.7%) experienced SCR episode within 3 months after Itx. Adult patients were associated with a significantly higher occurrence of a SCR episode (P=0.001). Overal...
Journal of Hepato-Biliary-Pancreatic Sciences, 2010
Background/Purpose In living donor liver transplantation (LDLT), matching of liver volume between... more Background/Purpose In living donor liver transplantation (LDLT), matching of liver volume between donor and recipient is critical to the success of the procedure; mismatch can result in 'small-or large-for-size syndrome'. In orthotopic liver transplantation (OLT), matching criteria are less stringent and non-uniform. We sought to determine whether a new parameter, the ratio of donor to recipient body surface area (BSAi), is predictive of size mismatch and/or post-transplant morbidity or mortality. Methods We reviewed data on 1228 OLT recipients and stratified this data according to three categories: small-forsize (BSAi\0.6), control (BSAi = 0.6-1.4), and large-forsize (BSAi [1.4) donors. Results We found that: (1) matching of grafts at the upper and lower extremes of BSAi had significantly reduced graft survival; (2) matches with lower BSAi sustained a less severe form of intraoperative post-reperfusion syndrome, and the incidence of hepatic artery thrombosis was high postoperatively in these grafts; (3) BSAi and donor age correlated well with the severity of intraoperative postreperfusion hypotension; and (4) small-for-size (BSAi \0.6) and large-for-size (BSAi [1.4) grafts, as well as preoperative total bilirubin, were significant risk factors for decreased graft survival. Conclusion We conclude that the BSAi can predict clinically significant size mismatch and adverse outcomes in cadaveric whole OLT.
Since March 2002, the United Network for Organ Sharing liver allocation policy has given extra pr... more Since March 2002, the United Network for Organ Sharing liver allocation policy has given extra priority to patients with hepatocellular carcinoma (HCC) who meet specific medical criteria. This study reviews our experience with liver transplantation for HCC under this system. Between March 2002 and April 2009, 244 patients with HCC underwent primary liver or liver-kidney transplantation under the current allocation system at the University of Miami. Outcomes including HCC recurrence-free survival (RFS) and patient survival (PS) were assessed retrospectively. Clinical variables that predicted outcomes were analyzed. The median time from listing to transplantation was 48 days. The median follow-up was 27.4 months, with an observed recurrence rate of 10.7%. The RFS rates at 1, 3, and 5 years after transplantation were 96.0%, 89.0%, and 83.6%, respectively. The PS rates at 1, 3, and 5 years after transplantation were 86.3%, 71.5%, and 61.7%, respectively. Among patients diagnosed with T2 HCC, a trend toward improved RFS was observed for those who received preoperative ablative therapy; PS was similar (p > 0.05). Outcomes (RFS and PS) for patients with T3 HCC were similar to those in patients with T2 HCC (p > 0.05). Patients with an alpha-fetoprotein >100 ng/mL had an RFS that was inferior to that in patients with an alpha-fetoprotein…
The objective of this study was to summarize the evolution of multivisceral transplantation over ... more The objective of this study was to summarize the evolution of multivisceral transplantation over a decade of experience and evaluate its current status. Multivisceral transplantation can be valuable for the treatment of patients with massive abdominal catastrophes. Its major limitations have been technical and rejection of the intestinal graft. This study consisted of an outcome analysis of 98 consecutive patients who received multivisceral transplantation at our institution. This represents the largest single center experience to date. The most common diseases in our population before transplant were intestinal gastroschisis and intestinal dysmotility syndromes in children, and mesenteric thrombosis and trauma in adults. Kaplan Meier estimated patient and graft survivals for all cases were 65% and 63% at 1 year, 49% and 47% at 3 years, and 49% and 47% at 5 years. Factors that adversely influenced patient survival included transplant before 1998 (P = 0.01), being hospitalized at the...
Campath-1H therapy is directed to CD52, a small mw protein that has a glycosylphosphatidylinosito... more Campath-1H therapy is directed to CD52, a small mw protein that has a glycosylphosphatidylinositol (GPI) anchor, which has a conventional structure similar to other GPI anchors such as CD55 and CD59. Paroxysmal nocturnal hemoglobinuria (PNH) results when cells have a somatic defect in the synthesis of GPI anchors and lack CD55 and CD59, as well as CD52. Several patients treated with Campath developed PNH-like symptoms with hemolysis and thrombosis. These patients were followed after therapy by measurement of peripheral CD55 and CD59 levels and showed an increased number of cells deficient in the expression of these molecules. Thereafter we instituted a screening program for the presence of CD55/59 levels in all pretransplant patients. Our results show that 17.3% of all pretransplant samples contained abnormal (9.7% of samples) or slightly abnormal (7.6% of samples) levels of granulocytes deficient in CD55 or CD59. This high prevalence of CD55/59 deficiency in Campath-treated patients with PNH-like symptoms suggests that a lack of these molecules (including CD52) could predispose to a complication of this immunosuppressive therapy.
Protocol endoscopy with biopsy is currently the gold standard of small bowel transplantation (SBT... more Protocol endoscopy with biopsy is currently the gold standard of small bowel transplantation (SBTx) monitoring, however it is invasive, costly, needs skilled operator, may require anesthesia and may cause complications. We investigated fecal calprotectin level (FCL) as a candidate noninvasive marker for monitoring patients after SBTx. A pilot study was performed to test the use of FCL measurement in following up SBTx patients. Ileostomy effluents were collected at various postoperative days before endoscopy and biopsy. FCLs were measured by enzyme-linked immunosorbent assay and a cut-off level of 100 ng/mg was considered positive. The results were retrospectively evaluated in combination with clinical, endoscopic, and histopathological findings. FCLs are presented as median nanogram per milligram. FCLs were measured in 122 samples that were obtained from 29 patients after SBTx. Only 1 of 69 positive FCL did not accompany abnormal findings. Retrospective evaluation showed that 11 samples from six patients (FCL: 217) coincided with rejection episodes, six samples from three patients (FCL: 125) coincided with viral enteritis, 51 samples from 21 patients (FCL: 207) coincided with nonspecific inflammation, 11 samples from two patients (FCL: 998) coincided with chronic intestinal ulceration, and finally 50 samples from 19 patients (FCL: 43) coincided with normal findings. No significant FCL difference was found between rejection, infection, and inflammation. FCL evolution in individuals showed that FCL can predict rejection days before histopathological diagnosis. FCL is a sensitive test for ongoing organic intestinal allograft pathologies. It might be useful as prescreening marker to avoid unnecessary endoscopies.
We analyzed the results of 55 patients who underwent split liver transplantation at our center be... more We analyzed the results of 55 patients who underwent split liver transplantation at our center between September 1996 and December 2008, 30 adults (54.5%) and 25 children (45.5%). Median follow-up was 12 years. Overall patient survival was 71%, adult 70% and pediatric 72%. Mean patient survival was 61.58 months, and mean graft survival was 44.35 months. Pediatric survival and pediatric
Progress in transplantation (Aliso Viejo, Calif.), 2002
Cannulation of the abdominal aorta in organ donors with advanced arteriosclerotic disease or exte... more Cannulation of the abdominal aorta in organ donors with advanced arteriosclerotic disease or extensive trauma may be problematic owing to difficulty in securing a watertight tie around the diseased aorta, the danger of creating a false passageway in the aorta, and the risk of breaking off plaque particles that can advance into the arteries of donated organs. Cannulation problems can be avoided in these challenging donors by using a simplified technique for cannulation of the thoracic aorta in which a Foley catheter is passed down around the aortic arch, the balloon is inflated, and cool flushing is initiated.
Natural killer (NK) cells are innate immune lymphocytes. NK cells contribute to host antimicrobia... more Natural killer (NK) cells are innate immune lymphocytes. NK cells contribute to host antimicrobial and antitumor immunity. Liver transplantation in patients with hepatocellular carcinoma (HCC) has increased recently. The possibility of NK cell immunotherapy for liver cancer has been studied. Adoptive transfer of interleukin-2 (IL-2)-stimulated NK cells extracted from donor liver perfusate could increase an antitumor response without causing toxicity against 1-haplotype identical recipient intact tissues in patients with live donor liver transplant. Donor liver NK cells showed the most vigorous cytotoxicity against an HCC after in-vitro IL-2 stimulation, compared with donor and recipient peripheral blood NK cells and recipient liver NK cells. IL-2 stimulation led to an increased expression of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) on liver NK cells. T-cell contamination and risk of graft-versus-host disease can be minimized with a T-cell depleting agent such ...
Posttransplant lymphoproliferative disorders (PTLD) are a frequent complication in bowel transpla... more Posttransplant lymphoproliferative disorders (PTLD) are a frequent complication in bowel transplant recipients. Histological changes in PTLD range from expansile lymphoplasmacytic (LP) hyperplasia to frank lymphoma. Small bowel allograft biopsies obtained in the first 250 days posttransplant were retrospectively graded after patients had received induction immunosuppression with either anti-CD52 (Campath) or anti-CD25 (Zenapax) monoclonal antibodies. The biopsies were analyzed with respect to the onset intensity of lymphoplasmacytic infiltrates and presence of in situ EBV hybridization (EBER) positivity. We observed that lymphoplasmacytic infiltrates were a frequent change in all bowel transplant patients over the examined period. Campath-treated patients developed earlier LP infiltrates of mild to moderate intensity between day 1 and 100 posttransplant, thereafter decreasing to mild. No EBER positivity was detected in this group. Zenapax-treated patients presented with LP infiltrat...
Background: Some trauma victims who survive acute illness develop lingering, debilitating syndrom... more Background: Some trauma victims who survive acute illness develop lingering, debilitating syndromes that are incompatible with any semblance of normalcy. Intestinal failure, in particular, exacts a high price in terms of quality of life. Total parenteral nutrition (TPN) has served these patients well, but complications limit its long-term therapeutic effect. Consequently, transplantation is emerging as a life-saving therapy for some patients with the short gut syndrome.
Background: The distal splenorenal shunt (DSRS) is de- signed to maintain hepatopetal portal vein... more Background: The distal splenorenal shunt (DSRS) is de- signed to maintain hepatopetal portal vein flow while de- compressing gastroesophageal varices. However, over time, as the underlying liver disease progresses, the DSRS loses its selectivity. The most common method of addressing this issue during orthotopic liver transplantation is shunt ligation with or without splenectomy. Dismantling the shunt increases the complexity of
Campath-1H is being used as induction immunosuppression for intestinal/multivisceral transplantat... more Campath-1H is being used as induction immunosuppression for intestinal/multivisceral transplantation. Patient and graft survival in this preliminary experience is similar to previous studies but there has been a significant decrease in the incidence and severity of acute rejections without increase of opportunistic infections. Collage of the abdominal wall (transplantation of a composite graft of the abdominal wall) can provide biologic
... Induction therapy for adult small bowel transplant with campath-1H. Auteur(s) / Author(s). NI... more ... Induction therapy for adult small bowel transplant with campath-1H. Auteur(s) / Author(s). NISHIDA S. (1) ; LEVI D. (1) ; KATO T. (1) ; MADARIAGA J. (1) ; NERY J. (1) ; TZAKIS A. (1) ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s). ... Intestino delgado. ; Homotrasplante. ; ...
Results: The incidence of HAT was 10.4% (10 of 96 transplantations) in group 1 and 7.0% (3 of 43 ... more Results: The incidence of HAT was 10.4% (10 of 96 transplantations) in group 1 and 7.0% (3 of 43 trans- plantations) in group 2. The incidence of biliary com- plications after HAT was 100% in group 1 and 0% in group 2 (P=.02). The incidence of retransplantation af- ter HAT was 90.0% (9 of 10 patients) in group 1 and
Introduction. In a prospective protocol we studied whether serum citrulline level within 30 days ... more Introduction. In a prospective protocol we studied whether serum citrulline level within 30 days of an acute rejection was predictive of the episode.
BackgroundAlemtuzumab (Campath-1H [C1H]) is a humanized monoclonal antibody directed against the ... more BackgroundAlemtuzumab (Campath-1H [C1H]) is a humanized monoclonal antibody directed against the CD 52 antigen that is present on the surface of T cells, B cells, natural killer cells and monocytes. We studied its application in intestinal transplantation.
Closure of the abdomen in patients undergoing intestinal transplantation can be extremely difficu... more Closure of the abdomen in patients undergoing intestinal transplantation can be extremely difficult, if not impossible. We describe our initial experience with abdominal wall allotransplantation to facilitate abdominal closure. We undertook nine cadaveric abdominal wall composite allograft transplants in eight patients. The graft's blood supply was based on the inferior epigastric vessels left in continuity with the donor femoral and iliac vessels. Skin biopsies were undertaken randomly and when rejection was suspected. Vessel patency was monitored by doppler ultrasound. Six patients have survived, five of whom have intact, viable abdominal wall grafts. Two patients have had a clinically mild episode of acute rejection of the skin of the abdominal wall that resolved with corticosteroid therapy. No clinically apparent graft-versus-host disease has been noted. Transplantation of an abdominal wall composite allograft can facilitate reconstruction and closure of the abdominal compartment in intestinal transplant recipients with complex abdominal wall defects.
Subclinical rejection (SCR) is a known entity in various solid organ transplants but not in intes... more Subclinical rejection (SCR) is a known entity in various solid organ transplants but not in intestinal transplantation. The purpose of this study is to characterize the presence and effect of SCR in small intestinal transplantation (Itx). A total of 151 patients who underwent Itx and maintained a functioning graft for at least 3 months after Itx were investigated. The clinicopathological characteristics associated with a SCR episode within 3 months after Itx were analyzed. Cox regression with the landmark method (the landmark time being 3 months after Itx) was used for the analyses of overall graft survival and cause-specific hazard rate of SCR. A total of 2744 small intestinal transplant biopsies within 3 months after Itx were available for retrospective evaluation; 171 cases (6.2%) were determined as SCR and 78 patients (51.7%) experienced SCR episode within 3 months after Itx. Adult patients were associated with a significantly higher occurrence of a SCR episode (P=0.001). Overal...
Journal of Hepato-Biliary-Pancreatic Sciences, 2010
Background/Purpose In living donor liver transplantation (LDLT), matching of liver volume between... more Background/Purpose In living donor liver transplantation (LDLT), matching of liver volume between donor and recipient is critical to the success of the procedure; mismatch can result in 'small-or large-for-size syndrome'. In orthotopic liver transplantation (OLT), matching criteria are less stringent and non-uniform. We sought to determine whether a new parameter, the ratio of donor to recipient body surface area (BSAi), is predictive of size mismatch and/or post-transplant morbidity or mortality. Methods We reviewed data on 1228 OLT recipients and stratified this data according to three categories: small-forsize (BSAi\0.6), control (BSAi = 0.6-1.4), and large-forsize (BSAi [1.4) donors. Results We found that: (1) matching of grafts at the upper and lower extremes of BSAi had significantly reduced graft survival; (2) matches with lower BSAi sustained a less severe form of intraoperative post-reperfusion syndrome, and the incidence of hepatic artery thrombosis was high postoperatively in these grafts; (3) BSAi and donor age correlated well with the severity of intraoperative postreperfusion hypotension; and (4) small-for-size (BSAi \0.6) and large-for-size (BSAi [1.4) grafts, as well as preoperative total bilirubin, were significant risk factors for decreased graft survival. Conclusion We conclude that the BSAi can predict clinically significant size mismatch and adverse outcomes in cadaveric whole OLT.
Since March 2002, the United Network for Organ Sharing liver allocation policy has given extra pr... more Since March 2002, the United Network for Organ Sharing liver allocation policy has given extra priority to patients with hepatocellular carcinoma (HCC) who meet specific medical criteria. This study reviews our experience with liver transplantation for HCC under this system. Between March 2002 and April 2009, 244 patients with HCC underwent primary liver or liver-kidney transplantation under the current allocation system at the University of Miami. Outcomes including HCC recurrence-free survival (RFS) and patient survival (PS) were assessed retrospectively. Clinical variables that predicted outcomes were analyzed. The median time from listing to transplantation was 48 days. The median follow-up was 27.4 months, with an observed recurrence rate of 10.7%. The RFS rates at 1, 3, and 5 years after transplantation were 96.0%, 89.0%, and 83.6%, respectively. The PS rates at 1, 3, and 5 years after transplantation were 86.3%, 71.5%, and 61.7%, respectively. Among patients diagnosed with T2 HCC, a trend toward improved RFS was observed for those who received preoperative ablative therapy; PS was similar (p > 0.05). Outcomes (RFS and PS) for patients with T3 HCC were similar to those in patients with T2 HCC (p > 0.05). Patients with an alpha-fetoprotein >100 ng/mL had an RFS that was inferior to that in patients with an alpha-fetoprotein…
The objective of this study was to summarize the evolution of multivisceral transplantation over ... more The objective of this study was to summarize the evolution of multivisceral transplantation over a decade of experience and evaluate its current status. Multivisceral transplantation can be valuable for the treatment of patients with massive abdominal catastrophes. Its major limitations have been technical and rejection of the intestinal graft. This study consisted of an outcome analysis of 98 consecutive patients who received multivisceral transplantation at our institution. This represents the largest single center experience to date. The most common diseases in our population before transplant were intestinal gastroschisis and intestinal dysmotility syndromes in children, and mesenteric thrombosis and trauma in adults. Kaplan Meier estimated patient and graft survivals for all cases were 65% and 63% at 1 year, 49% and 47% at 3 years, and 49% and 47% at 5 years. Factors that adversely influenced patient survival included transplant before 1998 (P = 0.01), being hospitalized at the...
Campath-1H therapy is directed to CD52, a small mw protein that has a glycosylphosphatidylinosito... more Campath-1H therapy is directed to CD52, a small mw protein that has a glycosylphosphatidylinositol (GPI) anchor, which has a conventional structure similar to other GPI anchors such as CD55 and CD59. Paroxysmal nocturnal hemoglobinuria (PNH) results when cells have a somatic defect in the synthesis of GPI anchors and lack CD55 and CD59, as well as CD52. Several patients treated with Campath developed PNH-like symptoms with hemolysis and thrombosis. These patients were followed after therapy by measurement of peripheral CD55 and CD59 levels and showed an increased number of cells deficient in the expression of these molecules. Thereafter we instituted a screening program for the presence of CD55/59 levels in all pretransplant patients. Our results show that 17.3% of all pretransplant samples contained abnormal (9.7% of samples) or slightly abnormal (7.6% of samples) levels of granulocytes deficient in CD55 or CD59. This high prevalence of CD55/59 deficiency in Campath-treated patients with PNH-like symptoms suggests that a lack of these molecules (including CD52) could predispose to a complication of this immunosuppressive therapy.
Protocol endoscopy with biopsy is currently the gold standard of small bowel transplantation (SBT... more Protocol endoscopy with biopsy is currently the gold standard of small bowel transplantation (SBTx) monitoring, however it is invasive, costly, needs skilled operator, may require anesthesia and may cause complications. We investigated fecal calprotectin level (FCL) as a candidate noninvasive marker for monitoring patients after SBTx. A pilot study was performed to test the use of FCL measurement in following up SBTx patients. Ileostomy effluents were collected at various postoperative days before endoscopy and biopsy. FCLs were measured by enzyme-linked immunosorbent assay and a cut-off level of 100 ng/mg was considered positive. The results were retrospectively evaluated in combination with clinical, endoscopic, and histopathological findings. FCLs are presented as median nanogram per milligram. FCLs were measured in 122 samples that were obtained from 29 patients after SBTx. Only 1 of 69 positive FCL did not accompany abnormal findings. Retrospective evaluation showed that 11 samples from six patients (FCL: 217) coincided with rejection episodes, six samples from three patients (FCL: 125) coincided with viral enteritis, 51 samples from 21 patients (FCL: 207) coincided with nonspecific inflammation, 11 samples from two patients (FCL: 998) coincided with chronic intestinal ulceration, and finally 50 samples from 19 patients (FCL: 43) coincided with normal findings. No significant FCL difference was found between rejection, infection, and inflammation. FCL evolution in individuals showed that FCL can predict rejection days before histopathological diagnosis. FCL is a sensitive test for ongoing organic intestinal allograft pathologies. It might be useful as prescreening marker to avoid unnecessary endoscopies.
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Papers by Seigo Nishida