Nylon filters, a new technique for the pancreas islet isolation in a canine research model, a technical standardization

El trasplante de islotes de páncreas es un campo en desarrollo para el tratamiento de la Diabetes Mellitus. En la actualidad, la técnica de aislamiento es un proceso complejo que todavía tiene algunos problemas. Dos de los problemas que encontramos son el alto costo del procedimiento y la toxicidad celular por el uso de Ficoll durante la purificación de islotes pancreáticos de Langerhans. Hemos centrado nuestros esfuerzos en reducir el costo del procedimiento y la lesión celular mediante el uso de filtros de nylon como una alternativa al gradiente de Ficoll para mejorar los resultados de aislamiento de islotes en un modelo animal.Artículo original452-467Pancreas islet transplantation is a developing field for the treatment of diabetes mellitus. Currently the isolation technique is a complex process that still has some problems to overcome. Two of the problems we addressed were the high cost of the procedure and the cellular toxicity derived from Ficoll use during purification of pancreatic islets of Langerhans during the isolation procedure. We focused our efforts in reducing both the cost of the procedure and cellular injury by using nylon filters as an alternative to Ficoll gradient purification and improving the outcome of islet isolation in a large animal model

The Charlson comorbidity index as a predictor of outcomes in liver transplantation: single-center experience.

Several comorbidity indices, such as the Child-Turcotte-Pugh (CTP) score and the Model for End-Stage Liver Disease (MELD) score, have been used to optimize available organ resources and adjust priorities in diagnosis and allocation of grafts for patients who are candidates for liver transplantation. There have also been various attempts to create instruments to accurately predict outcomes after liver transplantation, but none has proved to be truly applicable, with the exception of the Charlson comorbidity index (CCI). We retrospectively reviewed data of 221 liver recipients, including living-related liver transplantation and multiple organ transplantation performed between January 2006 and September 2009. Survival analysis revealed a significant association of the CCI with decreased posttransplantation patient survival (P = .003). Furthermore, Kaplan-Meier plots and log-rank test showed a significant association between graft survival and the score (P = .039). Our data suggest that the CCI is a simple tool for the evaluation of comorbidity and that increased preoperative patient comorbidity increases the risk of graft loss and patient death after liver transplantation. The CCI should be considered an important tool for improving patient care because of its potential applications for patient management

A Syndrome of Severe Hypoglycemia and Acidosis in Young Immunosuppressed Diabetic Monkeys and Pigs—Association With Sepsis

Background: Large animals treated with immunosuppressive drugs for preclinical experiments of transplantation have increased risks of infection, which can be compounded by the induction of diabetes if islet transplantation is planned. Methods: We report our experience with severe sepsis in two young cynomolgus monkeys and five pigs that were subjected to diabetes induction, immunosuppressive therapy, or islet allotransplantation. Results: In two monkeys and five pigs, infection was associated with a syndrome of profound hypoglycemia accompanied by severe acidosis, which was resistant to treatment. We do not believe that this syndrome has been reported previously by others. Conclusions: Despite treatment, this syndrome complicated the interpretation of blood glucose readings as a measure of islet graft function and resulted in death or the need for euthanasia in all seven animals. We tentatively suggest that the syndrome may be related to the presence of microorganisms that metabolize glucose and produce lactate

Systemic inflammation in xenograft recipients precedes activation of coagulation.

BACKGROUND: Dysregulation of coagulation is considered a major barrier against successful pig organ xenotransplantation in non-human primates. Inflammation is known to promote activation of coagulation. The role of pro-inflammatory factors as well as the relationship between inflammation and activation of coagulation in xenograft recipients is poorly understood

Laparoscopic Approach for an Intra-Abdominal Kidney Allograft Nephrectomy After Pediatric Transplantation: A Case Report

We report a case of minimally invasive nephrectomy of a kidney transplanted into the abdominal cavity in a child. A 15-year-old girl underwent transplantation with a cadaveric donor kidney due to congenital pyelonephritis, vesicoureteral reflux, and secondary bladder atrophy. The transplant was complicated by hyperacute rejection, cytomegalovirus infection, and anastomotic stenosis of the Bricker neobladder. After recurrent urinary tract infections, the patient was reintroduced to hemodialysis in 2010. After pneumoperitoneum, we placed 2 10-mm trocars in the hypochondrium and left side and 2 5-mm in the left iliac fossa and right upper quadrant. The transplanted kidney was skeletonized, the artery and vein were cut to the end-to-side anastomoses to the juxta-renal aorta and cava using an automatic 35-mm, stapler, and the ureter was dissected and closed with clips. Via a Pfannestiel minilaparotomy we extracted the allograft. The patient was discharged on the third postoperative day. After 4 months of follow-up, she is alive an on dialysis. Laparoscopic nephrectomy of a kidney transplanted into the abdominal cavity is feasible and safe in centers with skilled minimally invasive techniques

Costimulation blockade in pig artery patch xenotransplantation - a simple model to monitor the adaptive immune response in nonhuman primates.

BACKGROUND: CD154 blockade-based immunosuppression successfully prevents both humoral and cellular adaptive immune responses in baboons receiving α1,3-galactosyltransferase gene-knockout (GTKO) pig organs. Using a GTKO pig artery transplantation model in baboons, we evaluated the efficacy of CD28/B7 costimulatory pathway blockade in comparison with CD154 blockade

Simultaneous kidney and pancreas transplantation in patients with type 1 diabetes mellitus at Clínica Fundación Valle del Lily, Cali, Colombia

Clinical outcomes in patients with Type 1 diabetes mellitus (DM 1) after simultaneous kidney-pancreas transplantation (SRP) and end stage renal disease have shown to be a therapeutic option with successful clinical results, making it the best metabolic control option for this population group. Objective. Clinical results show the short and medium term DM1 patients undergoing simultaneous kidney transplantation - Pancreas (SRP) in our institution. Material and method. Institutional registry of renal transplantation (Trenal), which includes 1300 patients, we selected patients undergoing simultaneous kidney pancreas transplantation. We performed a nonparametric statistical analysis and survival was estimated by Kaplan-Meier. Results. Between 2001 and 2012 there were a total of 27 simultaneous kidney - pancreas transplants , individuals mostly male (59%), with age at transplant of 34, a time from the diagnosis of DM I 22 years. The goal of achieving glycemic control was achieved in 24 to 48 hours post-op. The patient survival rate at one and two years is 92% and 87%, and of the pancreatic graft at one year was 88%, values comparable to the best expected results. Conclusion. The simultaneous kidney-pancreas transplantation is a therapeutic option with good clinical results in patients with DM1 and end stage renal disease. The small number of the sample reflects not only the difficulties in obtaining donors, but also the lack of diffusion and recognition of potential candidates, hence the importance of the diffusion of existing experience in order to facilitate access to the best treatment option.Los resultados clínicos obtenidos con el trasplante simultáneo de riñón y páncreas en pacientes con diabetes mellitus de tipo 1 e insuficiencia renal terminal, permiten afirmar que esta modalidad de trasplante constituye la mejor opción de control metabólico para este grupo de población. Objetivo. Presentar los resultados clínicos en pacientes con diabetes mellitus de tipo 1 e insuficiencia renal terminal, sometidos a trasplante simultáneo de riñón y páncreas. Materiales y métodos. Del registro institucional de trasplante renal (TRENAL), que incluye 1.300 pacientes, se seleccionaron los sometidos a trasplante simultáneo de riñón y páncreas. Se hizo un análisis con estadísticas no paramétricas y se estimó la supervivencia mediante el método de Kaplan-Meier