Acute liver allograft antibody-mediated rejection:an inter-institutional study of significant histopathological features

Acute antibody-mediated rejection (AMR) occurs in a minority of sensitized liver transplant recipients. Although histopathologic characteristics have been described, a generalizable scoring system used to trigger a more in-depth analysis is needed to screen for this rare but important finding. Toward this goal, we created a training and validation cohort from 3 high volume liver transplant programs of putative acute AMR and control cases that were evaluated blindly by 4 independent transplant pathologists. The evaluations were performed on H&E sections alone without knowledge of serum DSA results nor C4d stains. Characteristics strongly correlated with acute AMR included portal eosinophilia (OR=4.37, p<0.001), portal vein endothelial cell hypertrophy (OR=2.88, p<0.001), and eosinophilic central venulitis (OR=2.48, p=0.003). These and other characteristics were incorporated into models created from the training cohort alone. The final Acute-AMR (aAMR) score exhibited a strong correlation with acute AMR in the training (OR=2.86, p<0.001) and validation cohort (OR=2.49, p<0.001). SPSS tree classification was used to select 2 cutoffs, one that optimized specificity at a score >1.75 (sensitivity = 34%, specificity = 87%) and a second that optimized sensitivity at a score >1.0 (sensitivity = 81%, specificity = 71%). In conclusion, routine histopathological features of the aAMR score can be used to screen for acute AMR on routine H&E in liver transplant biopsies, a diagnosis that requires substantiation by donor-specific HLA alloantibody testing, C4d staining, and exclusion of other insults

2016 Comprehensive Update of the Banff Working Group on Liver Allograft Pathology: Introduction of Antibody-Mediated Rejection

The Banff Working Group on Liver Allograft Pathology reviewed and discussed literature evidence regarding antibody-mediated liver allograft rejection at the 11th (Paris, France, June 5-10, 2011), 12th (Comandatuba, Brazil, August 19-23, 2013), and 13th (Vancouver, British Columbia, Canada, October 5-10, 2015) meetings of the Banff Conference on Allograft Pathology. Discussion continued online. The primary goal was to introduce guidelines and consensus criteria for the diagnosis of liver allograft antibody-mediated rejection and provide a comprehensive update of all Banff Schema recommendations. Included are new recommendations for complement component 4d tissue staining and interpretation, staging liver allograft fibrosis, and findings related to immunosuppression minimization. In an effort to create a single reference document, previous unchanged criteria are also included

Improvement proposal to reduce waste in a metalworking company through lean manufacturing tools

Las herramientas Lean Manufacturing son empleadas en diferentes rubros de negocio para eliminar, combinar, replantear y/o simplificar actividades que no agregan valor a la empresa, esto debido a los resultados positivos obtenidos tras su implementación. En el presente trabajo de investigación se desarrollan diversas herramientas Lean que son implementadas en una MYPE del sector metalmecánico dedicada a la elaboración de equipos de cocina en el Perú. Como punto inicial se realiza un análisis macro de la empresa para conocer a detalle todos los procesos involucrados y los desperdicios generados en cada una de ellas. Para ello, es necesario conocer la materia prima, maquinaria, mano de obra y los costos involucrados para una óptima toma de decisiones. Tras la visión del panorama general de la empresa se definen las herramientas a usar para alcanzar los objetivos principales que son estandarizar el trabajo, reducir el porcentaje de mudas en el proceso productivo, reducir las fallas por maquinaria y organizar las áreas de trabajo para agilizar el flujo en la línea de producción. Para lograr ello, se implementa como base la herramienta 5S para así continuar con el trabajo estandarizado, el cual permitirá homogeneizar los procedimientos de cada proceso, reducir el tiempo de producción y variabilidad en los métodos de trabajo; y el mantenimiento preventivo, el cual reducirá las fallas por maquinaria con un plan de mantenimiento estructurado. Tras la implementación de las herramientas Lean se logran obtener ahorros del 13% en costos operativos de la empresa.Lean Manufacturing tools are used at any type of company to eliminate non-added activities, this because them give positive results after its implementation. In the present research work, different Lean tools that are implemented in a metalworking SME dedicated to the manufacture of kitchen equipment are developed. As a starting point, a macro analysis of the company is carried out to find out in detail all the processes involved and the waste generated in each of them. For this, it is necessary to know raw material, machinery, labor and all the costs involved for an optimal decision making. Following the vision of the general panorama of the company, the tools to be used to achieve the main objectives are defined, which are to standardize work, reduce the percentage of wastes in the production process, reduce machinery failures and organize work areas to speed up the flow on the production line. To achieve this, the 5S tool is implemented as a basis to continue with the standard work, which will make it possible to standardize the procedures of each process, reduce production time and variability in work methods; and preventive maintenance, which will reduce machinery failures with a structured maintenance plan. After the implementation of Lean tools, results have shown savings of 13% in the company's operating costs is achieved.Trabajo de Suficiencia Profesiona