DOI: 10.4172/2161-0991.1000108e
It has been long time before a new medicine introduced to the forefront of immunosuppressant therapies. It has come after long extended studies, enrolling hundreds of patients, from different countries, in the phase III of the widely known BENEFIT, and BENEFIT-EXT trials. It sounds like a new hope for the transplantation community, which is still striving to overcome the hurdles of the older regimens of immunosuppressant’s, with its critical side effects, in particular the nonspecificity of the immunosuppression with the consequent issues of the opportunistic infections, the lymphoproliferative and the neoplastic complications. And the other common nonspecific complications like hypertension, diabetes, and the hyperlipidemia with its subsequent mounting cardiovascular mortality and morbidity (the most common cause of mortality in transplant recipients). And most importantly,the ever challenging chronic allograft nephropathy which is partly attributed to the direct Calcineurin inhibitors (CNI) toxicity.
Sara Hewitt, Elisa J. Gordon, Marla L. Clayman, Murad Alam, Simon Yoo, John Friedewald, Alfred W. Rademaker and June K. Robinson
Background: Solid-organ transplant recipients (OTRs) have an increased risk of developing nonmelanoma skin cancer.
Objective: This study explored the longitudinal history of sun exposure in OTRs from a few months after transplantation to two-three years later.
Methods: OTRs, who previously completed a telephone survey in 2007 to 2009 were re-surveyed in summer 2011 about their skin cancer history and habits of sun exposure. The two sets of data were compared to assess change in sun exposure.
Results: OTRs were enrolled (baseline) a mean of 8 months (range of 6 to 17.0 months) after transplantation. The interval between enrollment and the follow-up survey was a mean of 14 months (range of 2 to 21.8 months).
Duration of self-reported weekday and weekend exposure increased from a mean of 2.05 hrs at baseline to a mean of 2.52 hours at follow-up. The mean difference in weekday exposure was 0.31 hrs (range -5.25 to 5.05 hrs) (t-test, p= 0.02, rank sum test, p =0.017) and in weekend exposure was 0.47 hrs (range-5.25 to 0.05) (t-test, p = 0.0007, rank sum test, = =0.004). Kidney transplant recipients increased the duration of weekday and weekend exposure significantly more than liver transplant recipients. (p=0.05) The number of sunburns experienced at baseline and follow-up remained consistent (p=0.58) with about 13% experiencing 1-5 sunburns each year.
Conclusion: OTRs did not limit outdoor sun exposure or experience fewer sunburns in the 14 months after their transplant. Research is needed to ascertain the impact of educational programs on skin protection behaviors.
Afaneh C, Ramasamy R, Aull MJ, Leeser DB, Sosa RE, Kapur S and Del Pizzo JJ
Background: Laparoscopic donor nephrectomy represents a significant source of allografts to patients with endstage renal disease. Given the increasing wait-list and limited number of deceased donors, utilization of the right kidney is necessary to maximize the donor pool.
Materials: We retrospectively reviewed 122 right-sided kidney donors; 73 hand-assisted laparoscopic donor nephrectomies (R-HAL-DN), 36 standard laparoscopic donor nephrectomies (R-LAP-DN), and 13 laparoendoscopic single site donor nephrectomies (R-LESS-DN). We compared these groups to matched left donors and each other, analyzing various parameters including operative times, warm ischemia time (WIT), estimated blood loss (EBL), incision length, length of stay (LOS), convalescence data and complications.
Results: Right and left donors demonstrated no difference in analysis parameters in all 3 procurement techniques. When comparing all right donors total operative time and allograft extraction time were lowest in the R-LAP-DN group (p=0.003 & p=0.04, respectively). The R-LESS-DN group had the lowest EBL (p=0.06) and shortest incision length (p<0.0001). The LOS was shortest in the R-LAP-DN group (p=0.03). WIT, donor convalescence, and recipient allograft function were similar in all 3 groups.
Conclusion: Our data demonstrates the safety and reproducibility of procuring the right kidney. Donor safety and allograft function have continued through evolution of the technique.
Nhu Thao T Nguyen, Theresa R Harring, Jacfranz J Guiteau, Ron T Cotton, Ismael Salas de Armas, Hao Liu, John A Goss and Christine A O’Mahony
Aim: Liver transplantations (LT) have proven to be a successful treatment for many tumors of the liver. The goal of this study was to evaluate the outcomes of liver transplantations in patients with primary liver tumors with a focus on rarer malignancies. Methods: The UNOS database catalogues all adult patients who underwent LT for a primary liver tumor from 1992-2008. Of the 73, 231 liver transplantations, 5,682 patients with liver tumors were identified and categorized by indication for LT: hepatocellular carcinoma (HCC, n=5272), hepatic epithelioid hemangioendothelioma (HEH, n=85), cholangiocarcinoma (n=249), sarcomas (n= 11) and combined HCC-Cholangiocarcinomas (HCC-CC, n=12). Survivals were calculated using Kaplan-Meier and log rank tests. Results: 5,629 patients received LT for solid liver tumors. HCC patients and their allografts survived longer than those transplanted for cholangiocarcinomas (p=0.001, 0.002) or for HCC-CC (p=0.025, 0.004). Overall survival rates of HCC patients were 86.4%, 71.3%, and 61.2% at 1, 3 and 5 years, respectively. Cholangiocarcinoma patients had survival rates of 79.7%, 60.3% and 45.5% at 1-, 3- and 5-years from transplant. HCC-CC patients had the worst overall survival of 72.9%, 39.1% and 39.1% at 1, 3 and 5 years. Allograft survival in HCC-CC patients was comparatively low, averaging 65.6%, 35.2% and 0% at 1-, 3- and 5-years. HEH patients and their allografts survived the longest with overall survival of 83.9%, 77.8% and 73.5% at 1, 3 and 5 years, respectively, and allograft survival at 76.8%, 69.8% and 64.3%. Conclusion: Our data reveals overall survival was significantly better in HEH patients when compared to HCC, cholangiocarcinoma and HCC-CC patients after LT. In fact, HCC-CC patients fared the worst, both in patient and allograft survival, as compared to HCC and HEH. Results of cholangiocarcinoma patients show worse survival after LT compared to HCC and HEH, though recent evidence suggests adjuvant therapy will change outcomes for the future. Our findings suggest transplantation for HCC-CC may not be sufficient treatment. Other forms of adjuvant and neoadjuvant therapy may be indicated, warranting further research.
