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Open Access

ISSN 2577-5820

© 2019 by the authors; CC BY 4.0 licence

OBM Transplantation , Volume 3 , Issue 4 (2019)

Pages: 114

Published: January 2020

(This book is a printed edition that was published in OBM Transplantation)

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Cover story: Bronchiolitis Obliterans Syndrome (BOS) or Chronic Lung Allograft Dysfunction (CLAD) after Lung Transplantation, are dramatically common in their prevalence and detrimental effects on long term survival. Indeed data from International Society of Heart and Lung Transplantation report a median BOS-free survival of only 3.16 and 3.58 years after Single and Bilateral Lung Transplant while for 5-year survival, a sobering 55.8% and 66.2%, respectively. Therefore, novel innovative therapies which target the pathobiology of CLAD are critical. In our pilot study in OBM Transplantation, we have yet scratched the surface regarding the potential therapeutic effects of IL-6 receptor blockade and the complex detrimental interactions of IL-6 and TH-17 in contributing to CLAD, based on our original observations from rodent models. Herein we report an amelioration for the decrement in Slope for Forced Expiratory Volume (FEV)-1 sec in nine lung transplant recipients with CLAD who received combination immune modulation therapies that included TOCILIZUMAB, a humanized monoclonal antibody to the IL-6 receptor alpha (FEV-1 Slope PRE: -0.132+0.0148 versus POST: -0.012+0.049 L/month. To our knowledge, these represent the first human data after lung transplant and suggest prospective, multi-center, RCT which target the pathologic increase in cytokines / chemokines in CLAD would be appropriate for additional investigation for this devastating complication of clinical lung transplantation. View this paper.

Volume 3,Issue 4

Open Access Research Article

Long-Term Exposure to Fine Particulate Matter (PM2.5) and Cardiovascular Disease Mortality among Renal Transplant Recipients

Received: 11 August 2019;  Published: 17 December 2019;  doi: 10.21926/obm.transplant.1904095

Abstract

Background: Substantial evidence has been used to establish links between air pollution and increased risks of overall health morbidity and mortality, especially for respiratory and cardiovascular diseases. However, very few investigations have explored these relationships among highly sensitive populations, such as renal transplant recipients. Despite the quality improvement of life after renal transplantation, cardiovascular diseases (CVD) are still the major causes of graft loss and mortality [...]

Open Access Review

Modelling Recurrent Primary Biliary Cholangitis and Primary Sclerosing Cholangitis as Infectious Diseases Following Liver Transplantation

Received: 19 November 2019;  Published: 13 December 2019;  doi: 10.21926/obm.transplant.1904094

Abstract

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are idiopathic and progressive autoimmune hepatobiliary disorders that lead to liver failure and a need for liver transplantation in a proportion of individuals with poorly controlled disease. It is currently thought that an environmental agent triggers disease in a genetically susceptible host and to date, xenobiotics, bacteria and a human betaretrovirus have all been linked with PBC. However, there is no consensus on w [...]

Open Access Review

Therapeutic Apheresis in Prevention and Treatment of Antibody-Mediated Rejection of Renal Allografts

Received: 13 October 2019;  Published: 02 December 2019;  doi: 10.21926/obm.transplant.1904093

Abstract

Antibody-mediated rejection represents a significant barrier to favourable long-term outcomes after kidney transplantation and is the most common cause of allograft failure. Therapeutic apheresis techniques associated with other treatments, such as immunosuppressive drugs, are commonly used in the prevention and treatment of antibody-mediated injury in pre- and post-transplant protocols. The rationale is related to the removal of donor-specific antibodies as well as other inflammatory mediators, [...]

Open Access Research Article

Incidence, Location, and Natural History of Perihepatic Fluid Collections after Orthotopic Liver Transplantation

Received: 18 February 2019;  Published: 18 November 2019;  doi: 10.21926/obm.transplant.1904092

Abstract

Objective: The purpose of this study was to evaluate the common locations of perihepatic fluid collections after liver transplantation, assess their complexity, and understand their natural history and clinical significance. Materials and Methods: A retrospective analysis of 189 postoperative orthotopic liver transplant patients was performed using serial CT or MRI to characterize perihepatic fluid collections. Location, size, complexity of the collections, and clinical course were evaluated. [...]

Open Access Case Report

Toxoplasmosis: “An Often Forgotten Cause for Fever of Unknown Origin in Liver Transplant Recipients”. Case Report and Review of Literature

Received: 24 October 2019;  Published: 18 November 2019;  doi: 10.21926/obm.transplant.1904091

Abstract

Toxoplasmosis in liver transplantation (LT) is uncommon, especially in the current era of universal prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis jirovecii pneumonia (PJP). Here we present a case of a 55-year-old woman LT recipient, on dapsone or PJP prophylaxis due to sulfa allergy, who presented on day 25 after LT with fever, diarrhea and abdominal pain. Initially she was diagnosed with cytomegalovirus-associated colitis and was treated with intravenous ganciclovir, [...]

Open Access Original Research

Combination, Sequential Therapies Incorporating Tocilizumab Decrease the Progression of Chronic Lung Allograft Dysfunction (CLAD) after Lung Transplantation: Initial Clinical Experience

Received: 19 September 2019;  Published: 07 November 2019;  doi: 10.21926/obm.transplant.1904090

Abstract

INTRODUCTION: TH-17 and IL-6 interactions and detrimental biologic effects have been shown in rodent models of Chronic Lung Allograft Dysfunction (CLAD). Similarly, these pathways have been found to be upregulated in human CLAD. Tocilizumab (TCZ), a humanized monoclonal antibody targets the IL-6 receptor subunit alpha and prevents binding of IL-6. We herein report our preliminary experience with adjunctive TCZ therapy for human CLAD. METHODS: We retrospectively reviewed our initial experien [...]

Open Access Case Report

A Silent and Very Early Post-Liver Transplant Death by Candida Arteritis

Received: 29 August 2019;  Published: 28 October 2019;  doi: 10.21926/obm.transplant.1904089

Abstract

Background: Graft site candidiasis is a serious complication after solid organ transplantation, often presenting as invasive arteritis leading to graft loss or even death. Case Report: We report a case of anastomotic site candidiasis leading to arterial rupture and death at postoperative day 10 with no clinical warning signs. Preservation fluid cultures were negative and postoperative doppler ultrasonography did not show vascular compromise. Postmortem examination revealed microscopic arterial w [...]

Open Access Original Research

Oral Management in Pre-HSCT Patients: An Evaluation of Oral and Systemic Complications

Received: 14 June 2019;  Published: 21 October 2019;  doi: 10.21926/obm.transplant.1904088

Abstract

Objective Hematopoietic stem cell transplant has to be preceded by chemotherapy and radiotherapy. The following neutropenia and thrombocytopenia could be the cause of post transplant complications. Patient undergoing transplantation need to be eradicated of any possible infectious focus. Nowadays there is not a uniformed protocol to manage these patients oral cavity. Study Design The dental management was decided for each patient according to a more selective protocol, based on: type and size [...]

Open Access Case Report

The Surgical Approach for Obtaining Abdominal Wall Closure in Renal Transplant Recipients with Temporary or Permanent Loss of Fascial Integrity Following Emergency Reoperative Surgery

Received: 01 July 2019;  Published: 08 October 2019;  doi: 10.21926/obm.transplant.1904087

Abstract

A range of corrective surgical procedures may be required in adult renal transplant recipients who sustain loss of integrity of the abdominal wall in the first month postoperatively. Where this involves the fascia, such as in acute fascial dehiscence or in renal allograft compartment syndrome, more sophisticated reconstructive procedures may also be required, particularly in the setting of surgical site infection. There is limited data on the use of prosthetic or biologic mesh for this type of s [...]
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