Delayed construction of the bilio-digestive anastomosis in right living donor liver transplantation.

We describe a two-step procedure in the transplantation of a right lobe liver graft obtained from a living donor, in which the biliary anastomosis is delayed until the day after the actual implantation of the graft. The purpose of the two-step procedure is to minimize the factors that might contribute to biliary complications in living donor liver transplantation (LDLT). Three patients who received a graft with two hepatic ducts underwent Roux-en-Y hepatico-jejunostomies during a separate procedure the day after the implantation of the graft.

Early intra-abdominal infections associated with orthotopic liver transplantation.

Background: Postoperative infections remain a significant problem among liver transplant recipients (LTRs). An early cause of morbidity after liver transplantation is intra-abdominal infection (IAI) about which there are limited data.

Methods: We report a retrospective review of 169 adult LTRs from January 1, 2002 to June 9, 2006, comparing those who developed early postoperative IAI (peritonitis, biliary tract infection, abdominal abscess, or enteritis) with those who did not to identify clinical features and risk factors, analyze epidemiology, and assess graft and patient survival.

Lessons learned in pediatric small bowel and liver transplantation from living-related donors.

Background: Children are the primary candidates for intestinal transplant with more than 70% requiring a combined liver-bowel transplant. We report our single-center experience with living donor intestinal transplantation (LDITx) and combined living donor intestinal and liver transplant (CLDILTx) in pediatric patients.

Patients And Methods: Between October 2002 and June 2006, 13 living donor intestinal grafts were transplanted in 10 recipients.

Living donor kidney transplantation across positive crossmatch: the University of Illinois at Chicago experience.

Background: To increase living donation for kidney transplantation, we investigated desensitization of recipients with positive crossmatch against a potential living donor.

Methods: Between June 2001 and March 2007, 57 consecutive sensitized candidates for kidney transplantation, with crossmatch positive potential living donors, were treated with various desensitization protocols. All patients received plasmapheresis every other day with intravenous immune globulin 100 mg/kg starting 1 week before the scheduled transplant.

Reported isolated pancreas rejection is associated with poor kidney outcomes in recipients of a simultaneous pancreas kidney transplant.

Background: We hypothesized that many reported and presumed isolated pancreas acute rejection episodes in simultaneous pancreas kidney patients may in fact be missed concordant kidney acute rejection episodes.

Methods: To test this hypothesis, we undertook an analysis of the Organ Procurement and Transplant Network database from 1995 to 2006 to assess the impact of reported isolated pancreas rejection on kidney allograft outcomes. The primary outcome of interest was kidney graft status beyond the first posttransplant year.

Living donor liver graft salvage after rupture of hepatic artery pseudoaneurysm.

Hepatic artery pseudoaneurysm (HAP) is an uncommon but life-threatening complication of liver transplantation (LTx). It is often associated with a local infection. Prompt diagnosis and intervention are necessary.

Reconstruction of two bile ducts in a cloaca fashion in living donor liver transplantation.

The presence of two or more hepatic ducts for biliary anastomosis in adult-to-adult right liver transplantation is not uncommon. In the case described here, the graft had two hepatic ducts: one corresponded anatomically to a normal right hepatic duct and the other ran parallel to the proper hepatic duct and drained into its distal to the cystic duct. Because of the small diameter of both duct orifices and the favorable length of the ducts, a cloaca type reconstruction was performed.

Combined living-related segmental liver and bowel transplantation for megacystis-microcolon-intestinal hypoperistalsis syndrome.

Background: Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is the most severe form of functional intestinal obstruction in the newborn. To date, multivisceral transplantation has been the only accepted treatment modality for these patients, and the results have met with marginal success. We report the first case of a patient affected by MMIHS and cholestatic liver failure treated by a combined living-related liver and intestinal transplant (CLRLITx).

Infectious complications associated with the use of rituximab for ABO-incompatible and positive cross-match renal transplant recipients.

Immunosuppressive protocols for ABO-incompatible (ABOI) and positive cross-match (PCM) solid organ transplant (SOT) recipients have included the use of rituximab (RTX). Infectious complications (IC) have been reported after the use of RTX for other indications, but have not been well studied in the SOT population. We performed a retrospective review of IC occurring within six months of ABOI and PCM renal transplantation (RT) in recipients receiving RTX.

Successful rescue of refractory, severe antibody mediated rejection with splenectomy.

Antibody-mediated rejection (AMR) commonly occurs after transplantation of ABO-incompatible and sensitized renal transplant. Treatment regimens commonly include a combination of plasmapheresis (PL) and intravenous immunoglobulin (IVIG). However, some cases of AMR remain refractory to treatment.

'Prope' tolerance in a noncompliant living related small bowel transplant recipient after severe rejection.

Advances in immunosuppression and surgical technique have greatly improved patient outcomes after intestinal transplantation. However, the procedure remains one of the most challenging among solid organ transplantation as a result of the high rate of acute rejection, sepsis, and posttransplantation lymphoproliferative disorder. Recently, clinical trials to explore tolerance protocols in humans have been initiated, including small bowel transplant recipients, with results not always reproducible.

Living related segmental bowel transplantation: from experimental to standardized procedure.

Introduction: Living donor bowel transplantation has recently emerged as a valuable alternative to cadaver bowel transplant. We herein present our single-center experience with this procedure.

Materials And Methods: From April 1998 to October 2004, 12 living donor intestinal transplants were performed in 11 patients (7 males, 4 females; average age, 26 years).

Hilar early division of the hepatic duct in living donor right hepatectomy: the probe-and-clamp technique.

The division of the hepatic duct is one of the most challenging passages of the donor hepatectomy. We report our experience with the early division, prior to the liver parenchyma resection, of the hepatic duct and the definition of the biliary anatomy with a probe inserted in the proper hepatic duct. From February 2002 to December 2004, 40 donors (25 male, 15 female; mean age 34, range 20-57) underwent right hepatectomy.

Routine left robotic-assisted laparoscopic donor nephrectomy is safe and effective regardless of the presence of vascular anomalies.

The classic approach to donor nephrectomy consists of preferential procurement of the kidney without vascular anomalies. We studied the effect of routine procurement of the left kidney regardless the presence of multiple arteries on the outcomes of robotic-assisted laparoscopic living donor nephrectomy (LLDN) with particular reference to the incidence of urological complications. From August 2000 to July 2005, 209 left LLDNs were performed.

Peliosis hepatis in a living related liver transplantation donor candidate.

Peliosis hepatis is a rare benign condition histologically characterized by multiple cystic blood-filled spaces distributed throughout the liver parenchyma. Peliosis hepatis has been associated with malignancies, immunosuppression, infections and medications. We report a case of peliosis hepatis in a candidate for living liver donation, which regressed with restitutio ad integrum, after the noxious stimulus was stopped.

Kidney transplantation at the University of Illinois at Chicago from 1988-2004.

The Division of Transplantation at the University of Illinois at Chicago (UIC) was established in 1968 by Dr. Olga M. Jonasson, who performed the first living related kidney transplant in Illinois.

Delayed construction of the bilio-digestive anastomosis in right living donor liver transplantation.

We describe a two-step procedure in the transplantation of a right lobe liver graft obtained from a living donor, in which the biliary anastomosis is delayed until the day after the actual implantation of the graft. The purpose of the two-step procedure is to minimize the factors that might contribute to biliary complications in living donor liver transplantation (LDLT). Three patients who received a graft with two hepatic ducts underwent Roux-en-Y hepatico-jejunostomies during a separate procedure the day after the implantation of the graft.

Early discontinuation of steroids is safe and effective in pediatric kidney transplant recipients.

In pediatric kidney transplantation, steroid induced growth retardation and cushingoid features are of particular concern. In children, gradual steroid withdrawal late after kidney transplantation increases the risk of rejection. In this pilot study, we investigated the outcome of pediatric renal transplantation with an early steroid withdrawal protocol.

Increased risk of post-transplant diabetes mellitus despite early steroid discontinuation in Hispanic kidney transplant recipients.

Early steroid discontinuation (ESD) has been associated with a lower incidence of post-transplant diabetes mellitus (PTDM). We retrospectively reviewed the incidence of PTDM in relation to racial groups in kidney transplant recipients treated with ESD. Between January 2002 and September 2003, 125 consecutive primary adult kidney transplants were performed.

Thymoglobulin induction protects liver allografts from ischemia/reperfusion injury.

Background: Interventions that minimize hepatic ischemia/reperfusion injury (IRI) can expand the donor organ pool. Thymoglobulin (TG) induction therapy has been shown to ameliorate delayed graft function and possibly decrease IRI in cadaver renal transplants recipients. This controlled randomized trial was designated to assess the ability of TG to protect against IRI in liver transplant recipients.

Long-term results of a prospective randomized trial comparing tacrolimus versus cyclosporine in African-American recipients of primary cadaver renal transplant.

The ideal immunosuppressive treatment for African-American kidney transplant recipients has not been established. We performed a long-term prospective randomized trial comparing the results of tacrolimus (TAC) and cyclosporine (CSA) in the African-American population. Thirty-five African-American primary cadaveric renal transplant (CRT) recipients were enrolled in the study.

Reversal of tacrolimus-related hypertrophic obstructive cardiomyopathy 5 years after kidney transplant in a 6-year-old recipient.

Hypertrophic obstructive cardiomyopathy (HOCM) is an unusual but serious side-effect of tacrolimus (TAC) based immunosuppression primarily affecting pediatric patients after solid organ transplant. TAC-induced HOCM has already been described in patients after liver, bowel and heart transplant shortly after the procedure. Herein, we present the first case report of TAC-induced HOCM in a young renal transplant recipient 5 yr after renal transplant.

Standard chronic immunosuppression after kidney transplantation for systemic lupus erythematosus eliminates recurrence of disease.

Background: There is only limited experience in patients with systemic lupus erythematosus (SLE) with drugs that have developed for immunosuppression after organ transplantation, namely calcineurin inhibitors (CI). The aim of this study is to determine the effect of these drugs on disease activity after kidney transplant in patients affected by SLE.

Methods: Between January 1990 to March 2003, 13 patients with end- stage renal disease secondary to SLE received 14 kidney transplants.