Cytomegalovirus (CMV) glycoprotein B genotypes and response to antiviral therapy, in solid-organ-transplant recipients with CMV disease.

Cytomegalovirus (CMV) can be classified into 4 glycoprotein B (gB) genotypes, on the basis of sequence variation in the UL55 gene. We assessed the effect that CMV gB genotype has on virologic and clinical response to therapy, in 50 solid-organ-transplant recipients with CMV disease. CMV loads were determined at regular intervals after the start of therapy.

Radiofrequency ablation causes 'thermal fixation' of hepatocellular carcinoma: a post-liver transplant histopathologic study.

Radiofrequency ablation (RFA) is increasingly used to treat hepatocellular carcinoma (HCC) in patients awaiting a liver transplant. Despite its increasing use, detailed histologic information is scarce regarding the nature of RFA-treated lesions. We identified four chronic hepatitis C patients who had RFA of their HCC before their liver transplant.

Severe Acute Respiratory Syndrome (SARS) in a liver transplant recipient and guidelines for donor SARS screening.

Severe acute respiratory syndrome (SARS) is a recently described infectious entity with salient features of fever, headache and malaise, with rapid progression to pneumonitis. The etiology of SARS is likely a novel coronavirus. During the winter of 2003, an outbreak of SARS involving several hospitals occurred in Toronto, Canada.

Changes in the spectrum and risk factors for invasive candidiasis in liver transplant recipients: prospective, multicenter, case-controlled study.

Background: This study determines whether the spectrum, risk factors, and outcome of invasive candidiasis in liver transplant recipients have changed.

Methods: Thirty-five consecutive liver transplant recipients with invasive candidiasis were prospectively studied in a case-controlled, multicenter study. One control was matched with the case for duration of hospitalization and the other for antibiotic use so that risk factors unique in liver transplantation could be elicited.

Pancreas transplantation in crossmatch-positive recipients.

Background: Prolonged cold preservation time can unfavorably affect outcome in pancreas transplantation. To reduce this ischemic time, cadaver pancreas grafts, in selected cases, are sometimes transplanted before crossmatch results are known. We report our experience with pancreas transplants in recipients with either current or historically positive T- or B-cell crossmatches.

West Nile virus infection in 2002: morbidity and mortality among patients admitted to hospital in southcentral Ontario.

Background: In August and September 2002 an outbreak of West Nile virus (WNV) infection occurred in southern Ontario. We encountered a number of seriously ill patients at our hospitals. In this article we document the clinical characteristics of these cases.

Kidney transplants for children under 1 year of age - a single-center experience.

From September 20, 1970 to October 24, 2001, we performed 46 kidney transplants in infants under 1 yr old at the University of Minnesota. This article reviews the preoperative care, surgical technique, and immunosuppression. Recipients included 16 females and 30 males; the youngest recipient was 6 wk old.

Randomized, double-blind, controlled trial of pneumococcal vaccination in renal transplant recipients.

Renal transplant recipients are at increased risk for developing invasive pneumococcal disease but may have a poor response to pneumococcal polysaccharide vaccine (PPV23). For them, pneumococcal conjugate vaccine (PCV7) may be more immunogenic. Patients were given a single dose of PPV23 or PCV7 in our randomized, controlled, double-blind trial.

Predicting long-term kidney graft survival: can new trials be performed?

Background: As short-term transplant results improve, it has become difficult to use patient or graft survival or acute rejection as clinical trial endpoints, except in large, multicenter studies. Despite better outcomes, graft failure continues over time.

Methods: We studied 6- and 12-month creatinine (Cr) level and change in creatinine (deltaCr) level (3-12 months, 6-12 months) as predictors of graft survival for 1,389 primary kidney transplants (minimum graft survival 1 year).

Outbreak of pseudomonas aeruginosa by multiple organ transplantation from a common donor.

Transmission of bacterial infections from donor to recipient may occur with donor bacteremia. We describe a novel mechanism for transmission of Pseudomonas to multiple recipients through direct contamination of a donor innominate artery graft. Patient data were collected by chart review from the donor and the kidney, kidney-pancreas, heart, lung, and liver recipients.

Polyomavirus infection and acute vascular rejection in a kidney allograft: coincidence or mimicry?

During the past decade, polyoma virus (PV) infection has emerged as an important cause of graft dysfunction and failure in kidney transplant recipients. Establishing the correct diagnosis can be difficult, however, because the histologic appearance of PV infection can resemble acute cellular rejection. We report a kidney-pancreas transplant recipient with PV infection, in whom both vascular and cellular rejection were dominant histologic features in a renal biopsy specimen.

Is surveillance for multidrug-resistant enterobacteriaceae an effective infection control strategy in the absence of an outbreak?

Multidrug-resistant enterobacteriaceae (MDRE) are an important cause of nosocomial infections. The effectiveness of screening for MDRE in the nonoutbreak setting in an attempt to prevent transmission is unknown. Patients admitted for new organ transplantation were screened for MDRE colonization.

Risk factors for slow graft function after kidney transplants: a multivariate analysis.

Background: We previously defined an intermediate group of cadaver kidney transplant recipients who do not have immediate graft function (IGF), but do not have sufficient graft dysfunction to be classified as having delayed graft function (DGF). We showed that this group with slow graft function (SGF) had an increased risk of rejection and inferior long-term results vs. recipients with IGF.

Low-virulence Citrobacter species encode resistance to multiple antimicrobials.

Citrobacter spp. are gram-negative commensal bacteria that infrequently cause serious nosocomial infections in compromised hosts. They are often resistant to cephalosporins due to overexpression of their chromosomal beta-lactamase.

Cytomegalovirus (CMV) virus load kinetics to predict recurrent disease in solid-organ transplant patients with CMV disease.

Despite standard therapy, cytomegalovirus (CMV) disease recurs in a significant proportion of organ transplant recipients. The kinetics of CMV load in response to therapy may allow early prediction of recurrence. CMV loads were obtained at regular intervals after starting ganciclovir therapy in 52 transplant recipients with CMV disease.

Interactions between cytomegalovirus, human herpesvirus-6, and the recurrence of hepatitis C after liver transplantation.

Recurrence of hepatitis C (HCV) following liver transplantation is common. Herpesvirus reactivation following transplant may have an immunomodulatory effect resulting in increased HCV replication. We studied whether cytomegalovirus (CMV) and human herpesvirus-6 (HHV-6) may be associated with HCV recurrence and viral load after transplant.

Five preventable causes of kidney graft loss in the 1990s: a single-center analysis.

Background: Despite improvements in immunosuppressive protocols and patient care, kidney allografts continue to fail. We studied causes of graft loss for primary kidney transplants in the 1990s to determine major causes and potential interventions.

Methods: Causes of graft loss were reviewed for 1467 primary kidney transplants done at our institution between January 1, 1990, and December 31, 1999.

Rapid discontinuation of steroids in living donor kidney transplantation: a pilot study.

Unlabelled: Steroids are associated with significant postoperative complications (hypertension, cosmetic changes, bone loss, hyperlipidemia, diabetes, and cataracts). Most develop early; in addition, late post-transplant steroid withdrawal in kidney transplant recipients has been associated with increased acute rejection (AR). To obviate these problems, we studied outcome of a protocol of rapid discontinuation of prednisone (RDS) (steroids stopped on POD6).

Split liver transplantation for two adult recipients: an initial experience.

The shortage of cadaver donor livers has been most severe for adult patients. Split liver transplantation is one method to expand the donor pool, but to have a significant impact on the waiting list, it needs to be applied for 2 adult recipients. We split livers from 6 cadaver donors, and transplanted 12 adult recipients.

Living related liver transplantation for recurrent hepatocellular carcinoma in a normal liver.

The role of liver transplantation for hepatocellular carcinoma (HCC) is evolving. In patients with advanced liver disease and early stage HCC, transplantation offers the best hope for cure. A living donor offers the optimal approach to a timely transplant, before disease progression obviates the potential benefit.

Biliary stricture in living-related donor liver transplantation: management with balloon dilation.

Biliary stricture is a recipient graft complication, occurring late in the post-operative period, which appears to occur with increased frequency in living-related donor liver transplantation (LRD LTx). We reviewed the experience at the University of Minnesota in managing a biliary complication of LRD LTx. Since January 1997, 13 LRD transplants have been performed using the technique of transplantation of the left lateral segments with a small portion of segment IV.