UCTx: a multi-agent system to assist a transplant coordination unit

We present a system called UCTx, designed to model and automate some of the tasks performed by a Transplant Coordination Unit (UCTx) inside a Hospital. The aim of this work is to show how a multi-agent approach allows us to describe and implement the model, and how UCTx is capable of dealing with another multi-agent (Carrel, an Agent Mediated Institution for the exchange of Human Tissues among Hospitals for Transplantation) in order to meet its own goals, acting as the representative of the hospital in the negotiation. As an example we introduce the use of this Agency in the case of Cornea Transplantation.Postprint (published version

Extending the Carrel system to mediate in the organ and tissue allocation processes: a first approach

In this paper we extend the formalization of Carrel, a virtual organization for the procurement of tissues for transplantation purposes, in order to model also the procurement of human organs for transplants. We will focus in the organ allocation process to show how it can be formalized with the ISLANDER formalism. Also we present a first mechanism to federate the institution in several geographically-distributed platforms.Postprint (published version

Computational Models for Transplant Biomarker Discovery.

Translational medicine offers a rich promise for improved diagnostics and drug discovery for biomedical research in the field of transplantation, where continued unmet diagnostic and therapeutic needs persist. Current advent of genomics and proteomics profiling called "omics" provides new resources to develop novel biomarkers for clinical routine. Establishing such a marker system heavily depends on appropriate applications of computational algorithms and software, which are basically based on mathematical theories and models. Understanding these theories would help to apply appropriate algorithms to ensure biomarker systems successful. Here, we review the key advances in theories and mathematical models relevant to transplant biomarker developments. Advantages and limitations inherent inside these models are discussed. The principles of key -computational approaches for selecting efficiently the best subset of biomarkers from high--dimensional omics data are highlighted. Prediction models are also introduced, and the integration of multi-microarray data is also discussed. Appreciating these key advances would help to accelerate the development of clinically reliable biomarker systems

Provenance-based trust for grid computing: Position Paper

Current evolutions of Internet technology such as Web Services, ebXML, peer-to-peer and Grid computing all point to the development of large-scale open networks of diverse computing systems interacting with one another to perform tasks. Grid systems (and Web Services) are exemplary in this respect and are perhaps some of the first large-scale open computing systems to see widespread use - making them an important testing ground for problems in trust management which are likely to arise. From this perspective, today's grid architectures suffer from limitations, such as lack of a mechanism to trace results and lack of infrastructure to build up trust networks. These are important concerns in open grids, in which "community resources" are owned and managed by multiple stakeholders, and are dynamically organised in virtual organisations. Provenance enables users to trace how a particular result has been arrived at by identifying the individual services and the aggregation of services that produced such a particular output. Against this background, we present a research agenda to design, conceive and implement an industrial-strength open provenance architecture for grid systems. We motivate its use with three complex grid applications, namely aerospace engineering, organ transplant management and bioinformatics. Industrial-strength provenance support includes a scalable and secure architecture, an open proposal for standardising the protocols and data structures, a set of tools for configuring and using the provenance architecture, an open source reference implementation, and a deployment and validation in industrial context. The provision of such facilities will enrich grid capabilities by including new functionalities required for solving complex problems such as provenance data to provide complete audit trails of process execution and third-party analysis and auditing. As a result, we anticipate that a larger uptake of grid technology is likely to occur, since unprecedented possibilities will be offered to users and will give them a competitive edge

Specific issues concerning the management of patients on the waiting list and after liver transplantation

The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system

Outcome analysis of 71 clinical intestinal transplantations

Objective: The aim of the study was to determine risk factors associated with graft failure and mortality after transplantation of the intestine alone or as pad of an organ complex. Summary Background Data: Even with modern immunosuppressive therapies, clinical intestinal transplantation remains a difficult and unreliable procedure. Causes for this and solutions are needed. Methods: Between May 1990 and February 1995, 71 intestinal transplantations were performed in 66 patients using tacrolimus and low-dose steroids. The first 63 patients, all but one treated 1 to 5 years ago, received either isolated grafts (n = 22), liver and intestinal grafts (n = 30), or multivisceral grafts (n = 11). Three mere recipients of allografts who recently underwent surgery and one undergoing retransplantation were given unaltered donor bone marrow cells perioperatively as a biologic adjuvant. Results: Of the first 63 recipients, 32 are alive: 28 have functioning primary grafts and 4 have resumed total parenteral nutrition after graft enterectomy. Thirty-five primary grafts were lost to technical and management errors (n = 10), rejection (n = 6), and infection (n = 19). Regression analysis revealed that duration of surgery, positive donor cytomegalovirus (CMV) serology, inclusion of graft colon, OKT3 use, steroid recycle, and high tacrolimus blood levels contributed to graft loss. All four intestine and bone marrow recipients are alive for 2-3 months without evidence of graft- versus-host disease. Conclusion: To improve outcome after intestinal transplantation with previous management protocols, it will be necessary to avoid predictably difficult patients, CMV seropositive donors, and inclusion of the graft colon. Bone marrow transplantation may further improve outcome by ameliorating the biologic barriers of rejection and infection and allowing less restrictive selection criteria

‘Back to Life’—Using knowledge exchange processes to enhance lifestyle interventions for liver transplant recipients: A qualitative study

Interventions to prevent excessive weight gain after liver transplant are needed. The purpose of the present study was to enhance a specialist post-transplant well-being program through knowledge exchange with end-users.The study used an interactive process of knowledge exchange between researchers, clinicians and health system users. Data were collected as focus groups or telephone interviews and underwent applied thematic analysis.There were 28 participants (age 24-68 years; 64% male). The results identified experiences that may influence decisions around health behaviours during the course of transplant recovery. Three over-arching themes were identified that impact on liver transplant recipients post-transplant health behaviours. These include (i) Finding a coping mechanism which highlighted the need to acknowledge the significant emotional burden of transplant prior to addressing long-term physical wellness; (ii) Back to Life encompassing the desire to return to employment and prioritise family, while co-ordinating the burden of ongoing medical monitoring and self-management and (iii) Tailored, Personalised Care with a preference for health care delivery by transplant specialists via a range of flexible eHealth modalities.This person-centred process of knowledge exchange incorporated experiences of recipients into service design and identified life priorities most likely to influence health behaviours post-transplant. Patient co-creation of services has the potential to improve the integration of knowledge into health systems and future directions will require evaluation of effectiveness and sustainability of patient-centred multidisciplinary service development

Thyroid Hormone as a Method of Reducing Damage to Donor Hearts after Circulatory Arrest

There is a chronic lack of donor hearts to meet the need for heart transplant both in the US and worldwide. Further, the use of available hearts is limited by the short period between collection and implantation during which the heart can be safely preserved ex vivo. Using mid-thermic Langendorff machine perfusion, we have been able to preserve the metabolic function of a healthy heart for up to 8 hours, twice the limit for current static cold storage. We have also been able to preserve the metabolic function of a damaged DCD Heart collected 30 minutes after cardiac arrest for a period of 8 hours. We further investigated whether it was possible to improve the preservation of DCD heart using treatment with 10 μM Triiodothyronine to stimulate the tissue metabolism and we did find a reduction in damage markers in the treated DCD hearts as compared to the untreated group