Is left lobe adult-to-adult living donor liver transplantation ready for widespread use? The US experience (1998–2010)

AbstractObjectivesLiving donor liver transplantation (LDLT) is an accepted treatment for patients with end-stage liver disease. To minimize risk to the donor, left lobe (LL) LDLT may be an ideal option in adult LDLT.MethodsThis study assessed the outcomes of LL-LDLT compared with right lobe (RL) LDLT in adults (1998–2010) as reported to the United Network for Organ Sharing (UNOS) Organ Procurement and Transplantation Network (OPTN).ResultsA total of 2844 recipients of LDLT were identified. Of these, 2690 (94.6%) underwent RL-LDLT and 154 (5.4%) underwent LL-LDLT. A recent increase in the number of LL-LDLTs was noted: average numbers of LL-LDLTs per year were 5.2 during 1998–2003 and 19.4 during 2004–2010. Compared with RL-LDLT recipients, LL-LDLT recipients were younger (mean age: 50.5years vs. 47.0years), had a lower body mass index (BMI) (mean BMI: 24.5kg/m2 vs. 26.8kg/m2), and were more likely to be female (64.6% vs. 41.9%). Donors in LL-LDLT had a higher BMI (mean BMI: 29.4kg/m2 vs. 26.5kg/m2) and were less likely to be female (30.9% vs. 48.1%). Recipients of LL-LDLT had a longer mean length of stay (24.9days vs. 18.2days) and higher retransplantation rates (20.3% vs. 10.9%). Allograft survival in LL-LDLT was significantly lower than in RL-LDLT and there was a trend towards inferior patient survival. In Cox regression analysis, LL-LDLT was found to be associated with an increased risk for allograft failure [hazard ratio (HR): 2.39)] and inferior patient survival (HR: 1.86).ConclusionsThe number of LL-LDLTs has increased in recent years

Impact of recipient functional status on 1-year liver transplant outcomes

BACKGROUND: The Karnofsky Performance Status (KPS) scale has been widely validated for clinical practice for over 60 years.AIM: To examine the extent to which poor pre-transplant functional status, assessed using the KPS scale, is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.METHODS: This study included 38278 United States adults who underwent first, non-urgent, liver-only transplantation from 2005 to 2014 (Scientific Registry of Transplant Recipients). Functional impairment/disability was categorized as severe, moderate, or none/normal. Analyses were conducted using multivariable-adjusted Cox survival regression models.RESULTS: The median age was 56 years, 31% were women, median pre-transplant Model for End-Stage for Liver Disease score was 18. Functional impairment was present in 70%; one-quarter of the sample was severely disabled. After controlling for key recipient and donor factors, moderately and severely disabled patients had a 1-year mortality rate of 1.32 [confidence interval (CI): 1.21-1.44] and 1.73 (95%CI: 1.56-1.91) compared to patients with no impairment, respectively. Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13 (CI: 1.02-1.24) and 1.16 (CI: 1.02-1.31), respectively.CONCLUSION: Pre-transplant functional status is a useful prognostic indicator for 1-year post-transplant patient and graft survival.</p

Donor Diabetes and Prolonged Cold Ischemia Time Synergistically Increase the Risk of Graft Failure After Liver Transplantation

BACKGROUND: Both prolonged cold ischemia time (CIT) and donor history of diabetes mellitus (DM) are associated with reduced graft survival after liver transplantation. However, it is unknown whether the adverse effect of prolonged CIT on posttransplant graft survival is more pronounced after transplant with DM versus non-DM donor grafts. METHODS: The study sample included 58 226 liver transplant recipients (2002-2015) from the Scientific Registry of Transplant Recipients. Multivariable Cox survival regression with interaction analysis was used to quantify the extent to which history of donor DM (n = 6478) potentiates the adverse effect of prolonged ( \u3e /=8 hours) CIT (n = 18 287) on graft survival. RESULTS: Donor DM and CIT 8 hours or longer were each associated with increased risk of graft failure (GF) (adjusted hazard ratio [aHR], 1.19; 95% confidence interval [CI], 1.06-1.35 and aHR, 1.42; 95% CI, 1.32-1.53, respectively) compared with transplanted grafts without either risk factor. However, the combination of DM and CIT 8 hours or longer was associated with a higher risk of GF than either factor alone (aHR, 1.79; 95% CI, 1.55-2.06) and had a synergy index of 1.30. The interaction was significant on a multiplicative scale in the later postoperative period, days 31 to 365 (P = 0.047). CONCLUSIONS: These results suggest that liver grafts from DM donors are more susceptible to the adverse effects of prolonged CIT than livers from non-DM donors. We need to be cognizant that they are more susceptible to ischemic injury, and this may be considered during the allocation process

Single-Center Experience With Liver Transplant Using Donors With Very High Transaminase Levels

OBJECTIVES: Elevation of transaminases has been used as a marker of hepatic ischemic injury and as a crucial parameter for liver graft assessment. However, analysis of serum transaminases has limitations regarding the quantitative assessment of liver necrosis and is not a reliable predictor of outcomes. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all liver transplants (N = 238) performed at the UMass Memorial Medical Center from 2009 to 2013. RESULTS: Fourteen liver grafts showed high peak aminotransferases alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at \u3e 1000 U/L. This high aminotransferase group was compared with 224 donors with low transaminase levels (ALT/AST \u3c 1000 U/L). The high transaminase donors had a median peak AST level of 3216 U/L (range, 1823-13?030 U/L) and ALT level of 2677 U/L (range, 812-7080 U/L). The high transaminase donors showed higher levels of lactate dehydrogenase, international normalized ratio, total bilirubin, and gamma-glutamyltransferase compared with low transaminase donors; however, only lactate dehydrogenase results reached statistical significance. None of the grafts from the high transaminase donors showed primary nonfunction. Three-year graft and patient survival rates were similar in both groups (75% vs 80% [P = .48] and 72% vs 82% [P = .33], respectively). In an analysis of the discard rate of livers over a 10-year period in the United States using the Scientific Registry of Transplant Recipients database, the discard rate of livers with high aminotransferase levels was 69.14% compared with 22.23% for livers with low transaminase levels. CONCLUSIONS: Liver grafts from donors with high transaminase levels can lead to clinical results that are similar to liver grafts from donors who had lower peak transaminase levels

Original Article

Abstract Background: Mosquitoes transmit several diseases to human. There are several measures for control of larvae. As part of Integrated Vector Management (IVM) program, the utility of floating layers of polystyrene beads (EPS) is a potential alternative in habitats of mosquito larva. EPS beads prevent oviposition of mosquito as well as killing the immature stages by forming a tick layer on the water surface. They are cheap, environmentally safe and do not need frequent application and remain on the surface of water for long time. The objective of the current study was to asses the effectiveness of two types of polystyrene beads of (EPS) and (SWAP) for control of mosquito larvae under laboratory conditions. Methods: Anopheles stephensi and Culex quinquefasciatus were used for experimental purposes. In each tray 250 larvae of late 3 rd and early 4 th instars were introduced. The experiment was conducted on 4 replicates for An. stephensi, Cu. quinquefasciatus and combination of both. Emerging of adult mosquitoes were calculated every day until the end of experiments. Results: Mortality rate and Inhibition of Emerge (IE) for Cu. quinquefasciatus, An. stephensi and combination of both species was 97.8%, 100% and 99.07%, respectively using EPS. In average, EPS was able to kill 98.9% of larvae. The figures with SWAP were 63%, 91.05% and 72.65%, respectively. The average mortality for mosquitoes was 75.57% Conclusion: EPS and SWAP beads can be very effective and practical for elimination of An. stephensi and Cx. quinquefasciatus under the laboratory conditions

Optimal Integer Delay Budgeting on Directed Acyclic Graphs

Delay budget is an excess delay each component of a design can tolerate under a given timing constraint. Delay budgeting has been widely exploited to improve the design quality. We present an optimal integer delay budgeting algorithm. Due to numerical instability and discreteness of libraries of components during library mapping in design optimization flow, integer solution for delay budgeting is essential. We prove that integer budgeting problem - a 20-year old open problem in design optimization [7]- can be solved optimally in polynomial time. We applied optimal delay budgeting in mapping applications on FPGA platform using pre-optimized cores of FPGA libraries. For each application we go through synthesis and place and route stages in order to obtain accurate results. Our optimal algorithm outperforms ZSA algorithm [3] in terms of area by 10% on average for all applications. In some applications, optimal delay budgeting can speedup runtime of place and route up to 2 times