6 research outputs found
Combined paediatric liver-kidney transplantation: analysis of our experience
Thesis (M.Med.(General Surgery)--University of the Witwatersrand, Faculty of Health Sciences, 2014.Background. Renal insufficiency is increasingly common in end-stage liver disease and allocation
of livers to this category of patient has escalated. The frequency of combined liver-kidney
transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from
those for adults and typically include rare congenital conditions; subsequently limited numbers of
this procedure have been performed in paediatric patients worldwide. Scant literature exists on the
subject.
Methods. Subsequent to institutional approval, a retrospective chart analysis of all paediatric
CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the
Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted.
Results. Defining children as younger than 18 years of age, 43 patients had received a liver
transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive
polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H
deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole
liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one
kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and
included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one
in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from
6 to 65 months.
Conclusions. Although rarely indicated in children, CLKT is an effective treatment option,
appropriately utilising a scarce resource and significantly improving quality of life in the recipient
Combined paediatric liver-kidney transplantation: Analysis of our experience and literature review
Background. Renal insufficiency is increasingly common in end-stage liver disease and allocation of livers to this category of patient has escalated. The frequency of combined liver-kidney transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from those for adults and typically include rare congenital conditions; subsequently limited numbers of this procedure have been performed in paediatric patients worldwide. Scant literature exists on the subject. Methods. Subsequent to institutional approval, a retrospective chart analysis of all paediatric CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted. Results. Defining children as younger than 18 years of age, 43 patients had received a liver transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from 6 to 65 months. Conclusions. Although rarely indicated in children, CLKT is an effective treatment option, appropriately utilising a scarce resource and significantly improving quality of life in the recipient.
Living donor liver transplant from an HIV-positive mother to her HIV-negative child : opening up new therapeutic options
OBJECTIVE : Transplant a liver from an HIV-positive mother to her HIV-negative child to
save the child’s life.
DESIGN : A unique case of living donor liver transplantation from an HIV-positive
mother to her HIV-negative child in South Africa. Two aspects of this case are
ground-breaking. First, it involves living donation by someone who is HIVpositive
and second it involves controlled transplant of an organ from an HIV-positive
donor into an HIV-negative recipient, with the potential to prevent infection in the
recipient.
METHODS : Standard surgical procedure for living donor liver transplantation at our
centre was followed. HIV-prophylaxis was administered preoperatively. Extensive,
ultrasensitive HIV testing, over and above standard diagnostic assays, was undertaken
to investigate recipient serostatus and is ongoing.
RESULTS : Both mother and child are well, over 1 year posttransplantation. HIV seroconversion
in our recipient was detected with serological testing at day 43 posttransplant.
However, a decline in HIV antibody titres approaching undetectable levels is now being
observed. No plasma, or cell-associated HIV-1 DNA has been detected in the recipient
at any time-point since transplant.
CONCLUSION : This case potentially opens up a new living liver donor pool which might
have clinical relevance in countries where there is a high burden of HIV and a limited
number of deceased donor organs or limited access to transplantation. However, our
recipient’s HIV status is equivocal at present and additional investigation regarding
seroconversion events in this unique profile is ongoing.The South African
Research Chairs Initiative of the Department of Science
and Technology and National Research Foundation of
South Africa.http://journals.lww.com/aidsonlineam2019Medical Virolog
The James Webb Space Telescope Mission
Twenty-six years ago a small committee report, building on earlier studies,
expounded a compelling and poetic vision for the future of astronomy, calling
for an infrared-optimized space telescope with an aperture of at least .
With the support of their governments in the US, Europe, and Canada, 20,000
people realized that vision as the James Webb Space Telescope. A
generation of astronomers will celebrate their accomplishments for the life of
the mission, potentially as long as 20 years, and beyond. This report and the
scientific discoveries that follow are extended thank-you notes to the 20,000
team members. The telescope is working perfectly, with much better image
quality than expected. In this and accompanying papers, we give a brief
history, describe the observatory, outline its objectives and current observing
program, and discuss the inventions and people who made it possible. We cite
detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space
Telescope Overview, 29 pages, 4 figure
Paediatric liver transplantation in Johannesburg revisited: 59 transplants and challenges met
Background. A paediatric liver transplant programme was started at the Wits Donald Gordon Medical Centre, Johannesburg, South Africa (SA), in November 2005. We reported on the first 29 patients in 2012. Since then we have performed a further 30 transplants in 28 patients, having met the major challenge of donor shortage by introducing a living related donor programme and increasing the use of split liver grafts.Objective. To review the Wits Donald Gordon Medical Centre paediatric liver transplant programme to date. We describe how the programme has evolved and specifically compare the outcomes of the first cohort with the most recent 28 patients.Methods. Case notes of all paediatric liver transplants performed between 14 November 2005 and 30 June 2014 were retrospectively reviewed. Data were analysed for age and weight at transplantation, indication and type of graft. Morbidity and mortality were documented, specifically biliary and vascular complications. Comparison was made between Era 1 (November 2005 - October 2012) and Era 2 (November 2012 - June 2014).Results. A total of 59 transplants were performed in 57 patients. Age at transplantation ranged from 9 months to 213 months (mean 82.39 months) and weight ranged from 5 kg to 62 kg (mean 21 kg). A total of 23 whole livers, 10 reduced-size grafts, 14 split liver grafts and 12 living donor liver transplants (LDLTs) were performed. Eight patients were referred with fulminant hepatic failure (FHF), all in Era 2. Of these, three patients were successfully transplanted. Of the 57 patients, 45 are alive and well with actuarial 1-year patient and graft survival of 85% and 84% and 5-year patient and graft survival of 78% and 74%, respectively. Sixteen (25.42%) biliary complications occurred in 15 of our 59 transplants. Seven patients developed significant vascular complications. Comparing Era 1 with Era 2, mean age at transplant decreased from 100.86 months to 64.73 months, mean weight from 25.2 kg to 16.9 kg, and type of graft utilised changed with a trend away from the use of whole livers and reduced-sized grafts to split livers and segment 2,3 LDLT grafts.Conclusion. Initially limited by a shortage of donor organs, we aggressively explored optimal utilisation, splitting liver grafts from deceased donors as often as possible and establishing an LDLT programme. This increased access to donor livers allowed us to include patients with FHF and to perform retransplantation in recipients with early graft failure. It remains to offer liver transplantation to the entire paediatric community in SA, in conjunction with the only other established paediatric liver transplant unit, at Red Cross War Memorial Children’s Hospital in Cape Town
The James Webb Space Telescope Mission
Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least 4 m. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the 6.5 m James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 yr, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit