Utilidad de la tomografía computada de cavidades paranasales como evaluación otorrinolaringológica pretrasplante renal / Usefulness of computed tomography of the paranasal sinus as a kidney pre-transplant otorhinolaryngological evaluation

Resumen Introducción: El trasplante renal corresponde al tratamiento de elección para la enfermedad renal crónica. No existe un protocolo universalmente aceptado para la evaluación otorrinolaringológica del receptor del riñón a implantar, existiendo una gran heterogeneidad en su práctica. La tomografía computada de cavidades paranasales es uno de los estudios más habitualmente utilizados para descartar patologías otorrinolaringológicas que contraindiquen la intervención. Objetivo: Describir los hallazgos imagenológicos de las tomografías computadas solicitadas como evaluación pretrasplante renal. Determinar si estos hallazgos condicionaron una contraindicación para trasplante o algún cambio en el manejo del paciente. Material y Método: Estudio descriptivo de corte transversal mediante la revisión de fichas clínicas de pacientes derivados a estudio pretrasplante renal durante el año 2018 en el Hospital Carlos Van Buren. Resultados: Se obtuvo información de 40 pacientes derivados para evaluación otorrinolaringológica. El promedio de edad fue de 49 ± 11,4 años; 55% fueron mujeres. La causa más frecuente de enfermedad renal fue idiopática (70%). A 34 de 40 pacientes se les solicitó evaluación tomográfica. A cinco pacientes se les indicó corticoides intranasales y se derivó un paciente a evaluación dental. No se generó ninguna contraindicación para el trasplante renal. Discusión: Existe poca literatura sobre la utilidad de la tomografía de cavidades paranasales como estudio pretrasplante renal. En el presente estudio no se encontró ningún hallazgo que contraindicara la intervención. Conclusión: Se necesitan más estudios para poder asegurar si la evaluación otorrinolaringológica y el uso de tomografía tiene alguna implicancia en la evolución de los pacientes sometidos a trasplante renal.

Abstract Introduction: Kidney transplantation is the treatment of choice for chronic kidney disease. There is no universally accepted protocol for the otorhinolaryngological evaluation of the recipient, and there is heterogeneity in clinical practice. Computed tomography of the paranasal cavities is one of the most commonly used studies to rule out otorhinolaryngological pathologies that contraindicate the intervention. Aim: To describe the imaging findings of the computed tomographies requested as a pre-transplant evaluation. To determine if these findings determined a contraindication for transplantation or any change in the patient's management. Material and Method: Descriptive cross-sectional study by reviewing the clinical records of patients referred to a pre-kidney transplant study during 2018 at the Hospital Carlos Van Buren. Results: Information was obtained from 40 patients referred for otorhinolaryngological evaluation. The average age was 49 ± 11.4 years; 55% were women. The most common cause of kidney disease was idiopathic (70%). 34 of 40 patients had a computed tomography. Five patients received intranasal corticosteroids and one patient was referred for dental evaluation. There were no contraindications for renal transplantation. Conclusion: There is little literature on the usefulness of paranasal cavity tomography as a pre-kidney transplant study. In the present study, no finding was found that would contraindicate the intervention. More studies are needed to be able to ascertain whether the otorhinolaryngological evaluation and the use of tomography have any implications in the evolution of patients undergoing kidney transplantation.

Incidence of pretransplant sarcopenia and its effect on prognosis in patients receiving hematopoietic stem cell transplantation: a meta-analysis / 中华临床营养杂志

Objective:To evaluate the incidence of pretransplant sarcopenia and its effect on prognosis in patients receiving hematopoietic stem cell transplantation (HSCT).Methods:Several electronic databases (PubMed, Embase, Web of Science, Cochrane Library, EBSCO, CINAHL, CBM, CNKI, VIP, WanFang data) were searched from inception to March 2022. Cohort and case-control studies on the outcomes of HSCT patients with pre-transplant sarcopenia were collected, and the quality of the studies was evaluated using the Newcastle-Ottawa Scale. After literature screening, data extraction and quality evaluation, meta-analysis was performed using RevMan 5.3.Results:9 cohort studies were included, of which 6 were of high quality and 3 were of medium quality. The total sample size was 2,255 cases, including 862 cases in the sarcopenia group. The incidence of pretransplant sarcopenia in HSCT patients was 40% (95% CI: 0.35 to 0.46). Pretransplant sarcopenia was associated with decreased overall survival rate ( HR = 1.73, 95% CI: 1.38 to 2.04, P = 0.04) and increased non-relapse mortality after transplantation ( HR = 1.84,95% CI: 1.47 to 2.32, P < 0.01). There was no significant correlation between pretransplant sarcopenia and the incidence of acute graft-versus-host disease ( OR = 1.08, 95% CI: 0.84 to 1.39, P = 0.55). Sarcopenia before transplantation had no significant effect on the duration of hospital stay ( MD = 3.57, 95% CI: -0.13 to 7.26, P = 0.06). Conclusions:Pretransplant sarcopenia was associated with reduced overall survival and increased non-relapse mortality after transplantation. More attention to pretransplant sarcopenia is needed domestically and large-scale, multi-center, prospective studies assessing early screening for sarcopenia are necessary to provide guidance about prevention and treatment strategies.

Changing pattern and safety of pretransplant malignancy in kidney transplant recipients

BACKGROUND: Cancer rates are increasing not only in the general population but also in patients with end-stage renal disease. We investigated the changing pattern of pretransplant malignancy in kidney transplant recipients over 5 decades.METHODS: We reviewed 3,748 kidney transplant recipients between 1969 and 2016. We divided patients into three groups (1969–1998, 1999–2006, 2007–2016) based on the era of the cancer screening system used throughout the nation. We analyzed the incidence and pattern of pretransplant malignancy among the three groups. We also evaluated recurrent and de novo malignancy in these patients compared to patients without pretransplant malignancy.RESULTS: A total of 72 patients exhibited pretransplant malignancy (1.9%). There were no cases of pretransplant cancer until 1998, but the rate of pretransplant malignancy gradually increased to 1.1% during 1999–2006 and further increased to 4.3% thereafter. The most frequent types of pretransplant malignancy changed from the bladder, liver, and stomach cancers to thyroid cancer and renal cell carcinoma. There were no de novo cases, but there were three cases of recurrent cancer in patients with pretransplant malignancy; the recurrence rate among kidney transplant recipients with pretransplant malignancy was not significantly different from the incidence rate of de novo malignancy among kidney transplant recipients without pretransplant malignancy (4.2% vs. 6.9%, P = 0.48).CONCLUSION: The incidence of pretransplant malignancy in kidney transplantation candidates is gradually increasing, and recent increases were accompanied by changes in cancer types. Pretransplant malignancy may not be a hindrance to kidney transplantation because of the low incidence of posttransplant recurrence and de novo malignancy.

Aspectos histopatológicos de la evaluación del donante en trasplante hepático, una aproximación a la consulta intraoperatoria: An Approach to Intraoperative Consultation during Liver Transplantation / Histopathological Evaluation of Liver Donors

El éxito de un trasplante hepático en gran parte radica en la selección del candidato óptimo y del mejor órgano. En los últimos años se ha trabajado de forma importante hacia la elaboración de criterios de selección y de asignación basados en la evidencia. La evaluación histopatológica de las biopsias hepáticas desempeña un papel importante en el contexto del trasplante hepático, tanto en la evaluación pretrasplante de órganos considerados como marginales y en el diagnóstico y el tratamiento del paciente que ha recibido un trasplante. El uso de la biopsia intraoperatoria para evaluar órganos marginales en la evaluación pretrasplante es debatido por unos grupos y apoyado por otros. Por otra parte, los cambios morfológicos que ocurren en el postrasplante como el rechazo agudo celular y el rechazo crónico están muy bien reconocidos y la biopsia hepática sigue siendo considerada el patrón oro para el diagnóstico de estas condiciones, no así la biopsia del posible donante, sin embargo su precisión ha sido cuestionada debido en gran parte a la gran variabilidad y subjetividad, dadas principalmente por las dificultades diagnósticas que plantea esta patología y a la experiencia del patólogo (1). En esta revisión se discutirán los tópicos más importantes y frecuentes, así como algunos que pueden crear problemas de diagnóstico en patología del trasplante, se hará énfasis en las características patológicas y el diagnóstico diferencial. Los temas serán tratados en tres partes, esta primera entrega corresponde a los aspectos relevantes de la biopsia del donante.

The success of liver transplantation depends largely on the selection of the optimal donor and the best organ. In recent years significant work has been done to develop selection criteria and evidence-based organ assignments. Histopathological evaluation of liver biopsies plays an important role both in pretransplant evaluation of possibly marginal organs and in the diagnosis and treatment of patients who receive transplants. The use of intraoperative biopsies to evaluate organs found to be marginal in the pretransplant evaluation is opposed by some groups and supported by others. On the other hand, in contrast to the debate about the use of liver biopsies to evaluate donor organs, liver biopsies are still considered to be the “gold standard” for diagnosis of morphological changes such as acute rejection and chronic rejection that occur following transplantation. Nevertheless, the accuracy of biopsies has been questioned due to the variability and subjectivity of these evaluations which is caused primarily by the diagnostic difficulties posed by this disease and by the experience of the pathologist (1). The most important and frequent topics in this area will be discussed in this review. In addition, issues that can cause problems for diagnosing pathologies of the donor organ will be discussed. The article emphasizes pathological features and differential diagnosis. It is organized into three installments. This installment, the first, is about issues relevant aspects to biopsies of the donor organ.

Pre-transplant Predictors for 3-Month Mortality after Living Donor Liver Transplantation / 대한이식학회지

BACKGROUND: High model for end-stage liver disease (MELD) scores (> or =35) is closely associated with poor posttransplantation outcomes in patients who undergo living donor liver transplantation (LDLT). There is little information regarding factors that negatively impact the survival of patients with high MELD scores. The aim of this study was to identify factors associated with 3-month mortality of patients after LDLT. METHODS: We retrospectively analyzed 774 patients who underwent adult LDLT with right lobe grafts between 1996 and 2012. Exclusion criteria were re-transplantation, left graft, auxiliary partial orthotopic liver transplantation, and inadequate medical recording. Preoperative variables were analyzed retrospectively. RESULTS: The overall 3-month survival rate was 92%. In univariate analysis, acute progression of disease, severity of hepatic encephalopathy, Child-Pugh class C, hepatorenal syndrome, use of continuous renal replacement therapy, use of ventilator, intensive care unit (ICU) care before transplantation, and MELD scores > or =35 were identified as potential risk factors. However, only ICU care before transplantation and MELD scores > or =35 were independent risk factors for 3-month mortality after LDLT. Three-month and 1-year patient survival rates for those with no risk factors were 95.5% and 88.6%, respectively. In contrast, patients with at least one risk factor had 3-month and 1-year patient survival rates of 88.4% and 81.1%, respectively, while patients with two risk factors had 3-month and 1-year patient survival rates of 55.6% and 55.6%, respectively. CONCLUSIONS: Patients with both risk factors (ICU care before LDLT and MELD scores > or =35) should be cautiously considered for treatment with LDLT.

Pre-transplant Serum Soluble CD30 Level; Correlation with Panel Reactive Antibodies and Lymphocyte Cross Matching / 대한이식학회지

PURPOSE: Serum level of soluble form CD30 (sCD30), a marker for T helper 2-type cytokine-producing T cells, is used as a marker of immunologic status of pre-transplant recipient that can predict graft rejection and graft survival. This study compared pre-transplant serum sCD30 levels with conventional pre-transplant immunologic parameter, such as panel- reactive antibodies (PRA) and lymphocyte cross matching (LCM). METHODS: Adult seventy two patients were enrolled this study. The blood for tests was sampled simultaneously. Measurement of serum sCD30 level was performed using enzyme-linked immunosorbent assay kit (Bender MedSystems, Co. CA, USA). We tested PRA using a commercial ELISA kit (Lambda Cell Tray Lymphocytotoxicity assay)(One Lambda Inc. CA, USA). We established LCM tests for T cells by Modified NIH (National institute center of health)/Johnson's Method/AHG (Anti human globulin), and for B cells by warm test. RESULTS: Mean score of sCD30 was 90.3+/-6.4 U/mL, ranged from 12.2 to 244.4 U/mL. There was no significant correlation between patient's age or sex and sCD30 level. The correlation between sCD30 and mode or duration of dialysis was not statistically significant clinical situation. The result of LCM didn't show significant correlation with sCD30 level (87.3+/-55.7 U/mL in LCM positive group versus 91.9+/-1.3 U/mL in LCM negative group, P=0.696). And sCD30 level equal to or more than 86 U/mL could not predict the positive result of LCM. The positive and negative predictive value of sCD30 to LCM was merely 27.8% and 58.3% (P=0.322). Also the correlation between sCD30 level and PRA was not significant (P=1.0). CONCLUCION: There was no significant correlation between serum sCD30 level and conventional immunologic parameter such as PRA or LCM. That means the pre-transplant monitoring of the sCD30 level can be used as an independent immunologic parameter.

Clinical Outcome of Renal Transplantation in Patients with Positive Pretransplant Hepatitis B Surface Antigen / 대한이식학회지

PURPOSE: The natural history of renal transplant recipients with positive HBs Ag is still unclear and unpredictable. Liver-related morbidity and mortality after long-term immunosuppression need clinical challenges. We retrospectively investigated the clinical outcome of pre-transplant HBs Ag positive renal recipients in a single transplant center located in endemic area. METHODS: After excluding post-transplant de novo HBV infected, and peri-transplant anti-hepatitis C virus positive recipients, the clinical outcome of 1,816 recipients was examined by the nature of pre-transplant HBs Ag positivity. RESULTS: Pre-transplant HBs Ag positivity was documented in 61 recipients (M/F=47/14). During mean follow up of 71.61+/-54.14 months, 24 recipients died (6 by infection, 12 by hepatic failure, 2 by hepatocellular carcinoma, 2 by other malignancies, 1 by suicide, 1 by gastrointestinal bleeding). In 14 recipients (58.3%), death was related to liver-associated reasons. The 10-year patient survival rates in HBs Ag negative and positive groups were 90.0% and 62.6%, respectively (P<0.0001). The 10-year graft survival rates in HBs Ag negative and positive groups were 82.0% and 55.6%, respectively (P<0.0001). When pre-transplant HBV DNA viral load by PCR was positive or when the level of post-transplant HBV-DNA viral load flared up, we started lamivudine therapy since 1997. Seventeen recipients received daily 100 mg lamivudine. The mean duration of patients survival with (n=17) and without (n=44) lamivudine therapy was 104.3+/-45.6 and 59.0+/-51.2 months, respectively (P= 0.003). The 10-year patient survival rates in patients with and without lamivudine therapy were 80.7% and 55.4%, respectively (P=0.0698). CONCLUSION: Overall patient and graft survival in patients with positive pre-transplant HBs Ag was lower than negative recipients. Although, statistically not significant, lamivudine therapy showed a marginally positive impact on the survival of patients with pre-transplant positive HBs Ag.