Pancreas transplantation using compatible but non‐identical ABO blood group donors

Methods A review of all pancreas transplants from a single institution from 01/2003 to 07/2016 (n=606) revealed 41 recipients of a NIC donor pancreas which were matched for age, race, gender, year and type of transplant with 41 ABO identical cases. Groups were compared for allograft survival, incidence of acute cellular rejection (ACR), length of hospital stay, 3‐month readmissions and transfusion requirements. Serum haptoglobin and Lactate dehydrogenase were used to identify hemolysis in patients requiring repeated transfusions without overt blood loss. Results The 1‐year graft survival was 100% and 88% in the study and control groups. In the study group, 6/41(14%) developed hemolysis, all of which were ABO O into A. All responded to donor blood type specific transfusions. Discussion There are limited data on outcomes of solid organ transplant using NIC donors with almost none specifically addressing pancreas transplantation. In this study, graft survival was similar but 14% developed hemolysis, which was transient and treated with transfusion of donor blood type specific blood. Conclusion NIC pancreas transplants have similar graft survival compared to ABO identical. Hemolysis may occur so some caution is required

Impact of Donor Pre-Procurement Cardiac Arrest (PPCA) on Clinical Outcomes in Liver Transplantation

BACKGROUND Transplantation of liver grafts from deceased donors who experienced cardiac arrest prior to liver procurement is now common. This single-center study analyzed the impact of pre-donation arrest time on clinical outcomes in liver transplantation. MATERIAL AND METHODS Records of all orthotopic liver transplants performed at a single center over a 15-year period were reviewed. Donor records were reviewed and total arrest time was calculated as cumulative minutes. Post-transplant liver graft function was assessed using laboratory values. Graft survival was assessed with Cox regression analysis. RESULTS Records for 1830 deceased donor transplants were reviewed, and 521 donors experienced pre-procurement cardiac arrest (28%). Median arrest time was 21 min (mean 25 min, range 1-120 min). After transplant, the peak alanine aminotransferase and bilirubin levels for liver grafts from donors with arrest were lower compared to those for donors without arrest (p40 min arrest) demonstrated no statistically significant difference in survival at 10 years. Subgroup analysis of 93 donation after cardiac death grafts showed no significant difference for these same outcomes. CONCLUSIONS These results support the use of select deceased liver donors who experience pre-donation cardiac arrest. Pre-donation arrest may be associated with less early allograft dysfunction, but had no impact on long-term clinical outcomes. The results for donation after cardiac death donors were similar

One Year Incidence of Infection in Pediatric Intestine Transplantation

Background: This study reports the infection rate, location of infection, and pathogen causing bacterial, fungal, or viral infections in intestine transplant recipients at a pediatric transplant center. Methods: Records from a pediatric center were reviewed for patients receiving an intestine transplant. Positive cultures and pathology reports were used to diagnose bacterial, fungal, and viral infections and also to determine location and infectious agent. Risk for infection was assessed based on liver or colon inclusion, and immunosuppression induction, as part of the intestine transplant. Results: During the study period 52 intestine transplants were performed on 46 patients. Bacterial, fungal, and viral infection rates were 90%, 25%, and 75%, respectively. Enterococcus (non-vancomycin resistant enterococci (VRE)) species were the most common pathogens and were isolated from 52% of patients. VRE was present in 12% of transplant recipients. Candida species were the most common fungal pathogens (23% of patients). Respiratory viral infections were common (44%) and cytomegalovirus infection rate was 17%. Common sites of infection were bloodstream, urinary, and upper respiratory tract. Colon and liver inclusion in the transplant graft was not associated with increased risk of infection, nor was addition of rituximab to the immunosuppression induction protocol. Conclusion: Post-intestine transplant infections are ubiquitious in the pediatric population, including high rates of infection from bacterial, viral and fungal sources. Inclusion of the liver and/or colon as a component of the transplant graft did not appear to greatly impact the infectious risk. Adding rituximab to the immunosuppression induction protocol did not impact on infectious risk

RAM function is dependent on Kapβ2-mediated nuclear entry

Eukaryotic gene expression is dependent on the modification of the first transcribed nucleotide of pre-mRNA by the addition of the 7-methylguanosine cap. The cap protects transcripts from exonucleases and recruits complexes which mediate transcription elongation, processing and translation initiation. The cap is synthesized by a series of reactions which link 7-methylguanosine to the first transcribed nucleotide via a 5′ to 5′ triphosphate bridge. In mammals, cap synthesis is catalysed by the sequential action of RNGTT (RNA guanylyltransferase and 5′-phosphatase) and RNMT (RNA guanine-7 methyltransferase), enzymes recruited to RNA pol II (polymerase II) during the early stages of transcription. We recently discovered that the mammalian cap methyltransferase is a heterodimer consisting of RNMT and the RNMT-activating subunit RAM (RNMT-activating mini-protein). RAM activates and stabilizes RNMT and thus is critical for cellular cap methylation and cell viability. In the present study we report that RNMT interacts with the N-terminal 45 amino acids of RAM, a domain necessary and sufficient for maximal RNMT activation. In contrast, smaller components of this RAM domain are sufficient to stabilize RNMT. RAM functions in the nucleus and we report that nuclear import of RAM is dependent on PY nuclear localization signals and Kapβ2 (karyopherin β2) nuclear transport protein

Pancreas Transplantation: Personal Factors Associated with Good and Poor Post-Transplant Adaptive Response

Notable differences in patient adaptation after pancreas transplant cause some to thrive and return to independent living, while others struggle with emotional and social problems. In order to prepare vulnerable individuals to better cope after transplant, we investigated pre-transplant factors associated with post-transplant adaptive capacity. The pancreas transplant team de ned; good adaptive response (GAR) in patients who were responsible, resourceful, and optimistic. Poor adaptive response (PAR) was associated with patients who tended to complain and were emotionally dependent. METHODS: Experts included 3 nurse coordinators and 3 social workers. A modified Delphi approach was used to achieve consensus on the de nition of GAR and PAR. 200 of the last transplanted pancreas recipients were selected if they: received a pancreas transplant for type 1 DM, with, or without a kidney, and survived a minimum of six months post-transplant. The experts classified cases into GAR and PAR, contextualized by confidence. We completed a chart abstraction of all 200 cases using pre-transplant data and the extracted variables were regressed on the 54 top weighted GAR cases and the top 40 weighted PAR cases. RESULTS: In the final model, past smoker, currently on disability, simultaneous pancreas and kidney (SPK), and less than high school education significantly predicted probability of having a PAR (p<0.05). The model was a well-fitting model with a Hosmer and Lemeshow goodness of t test of (p=0.8250 < 0.05). Given the lack of inclusion of any of the predicted social variables for PAR patients we looked at predictors of GAR. The goodness of fit test was a well-fitting model (p= 0.6294 < 0.05). In addition to pancreas after kidney (PAK) having an odds ratio of 10.39, past smoker was 10.99 and current disability was 5.8. Discussion: The association of PAK with GAR and SPK with PAR suggests a possible effect from prior experience with transplant aiding in coping afterwards. Our findings support the need for a prospective study of coping with pancreas transplant and points to more intensive pre-transplant preparation of recipients, particularly those with lesser education

Home range, habitat selection and diet of foxes (vulpes vulpes) in a semi-urban riparian environment

Between 2000 and 2002 the home range, habitat selection and diet of foxes were examined in the Dandenong Creek Valley, Melbourne, Australia. The mean home range was 44.6 ha (range 19.2&ndash;152.6 ha). A significant selection towards blackberry and gorse used as diurnal shelter was found during the day with an active avoidance of less structurally complex vegetation types. Although there was obvious selection of certain habitats, the diet of the foxes was highly general and opportunistic and thus offers little potential as a factor to manipulate in order to reduce fox abundance. Given the strong preference for blackberry and gorse as a shelter resource, a habitat-manipulation strategy is suggested whereby patches of blackberry and gorse are removed and replaced with less structurally complex vegetation. Such a strategy has the potential to influence the density of foxes in semi-urban riparian environments such as those discussed in this study.<br /

Digital talking books. Daisy converter

PFC del programa Erasmus EPSTreball desenvolupat dins el marc del programa 'European Project Semester'.The “DIGITAL TALKING BOOKS. DAISY CONVERTER” Project is developed by the EPS students in the February-June 2011 period for “Càtedra D`Accessibilitat”, of the University`s Chair. The “Digital Talking Books. DAISY Converter” project has been carried out within the European Project Semester with the help of Càtedra D`Accessibilitat of Universitat Politécnica de Catalunya, Vilanova i la Geltrù. The main purpose of the project is to develop an application that will convert a Text file to a Daisy File and a Daisy File to a MP3 Playlist. This application is correlated with the Marketing and User Research part; and in its essence aims at showing you that without a proper Marketing strategy and without a user profile this application cannot be feasible. Therefore, in this report the emphasis will be on the following presentations: the Marketing analysis with as an end result a clear advertisement campaign advice. Furthermore the User Research includes a profile from the future user of the Daisy Converter. Another topic that will be mentioned in this report is the programming language that was used to develop the application and the design of the interface, which is the link between the product and the user

Re-exposure to beta cell autoantigens in pancreatic allograft recipients with pre-existing beta cell autoantibodies

Re-exposure to beta cell autoantigens and its relevance in the presence of donor-specific antibodies (DSA) in pancreatic allograft recipients is not well known. Thirty-three patients requiring a pancreas transplant were enrolled in an IRB approved study. They underwent prospective monitoring for DSA and beta cell autoantibody (BCAA) levels to GAD65, insulinoma-associated antigen 2 (IA-2), insulin (micro-IAA [mIAA]), and islet-specific zinc transporter isoform-8 (ZnT8). Twenty-five (75.7%) had pre-transplant BCAA. Twenty had a single antibody (mIAA n = 15, GAD65 n = 5); five had two or more BCAA (GAD65 + mIAA n = 2, GAD65 + mIAA+IA-2 n = 2, GA65 + mIAA+IA-2 + ZnT8 = 1). No changes in GAD65 (p > 0.29), IA-2 (>0.16), and ZnT8 (p > 0.07) were observed between pre-transplant and post-transplant at 6 or 12 months. A decrease in mIAA from pre- to post-6 months (p < 0.0001), 12 months (p < 0.0001), and from post-6 to post-12 months (p = 0.0002) was seen. No new BCAA was observed at one yr. Seven (21.0%) developed de novo DSA. The incidence of DSA was 24% in patients with BCAA vs. 25% in patients without BCAA (p = 0.69). Pancreatic allograft function of patients with vs. without BCAA, and with and without BCAA + DSA was comparable until last follow-up (three yr). Re-exposure to beta cell autoantigens by pancreas transplant may not lead to increased levels or development of new BCAA or pancreatic allograft dysfunction