Search results for "Graft Survival"
showing 10 items of 88 documents
Impact of Extended-Criteria Donor Liver Grafts on Benchmark Metrics of Clinical Outcome After Liver Transplantation: A Single Center Experience.
2020
Abstract Background The adoption of extended criteria for donors remains the best strategy to widen the pool of available liver graft against the chronic shortage of donors. Benchmarking in liver transplantation (LT) offers the unprecedented opportunity to compare clinical outcome measures to a set of validated reference values. We aimed to evaluate the impact of marginal grafts usage in a cohort of low-risk benchmark cases from an area with a very low rate of deceased donation. Methods A cohort of low-risk benchmark cases was identified from all adult patients who underwent LT at our center. Among these patients, those transplanted with a graft from an extended-criteria donor (ECD) were id…
Pharmacological thrombolysis: one more weapon for free-flap salvage.
2005
Despite the high success rate of free-tissue transfer, thrombosis still complicates 5-30% of cases. Meticoulous technique, careful vessel selection, and pharmacological prophylaxis are not always enough to avoid thrombosis. Early diagnosis and reintervention provide the only way to salvage a thrombosed free flap, in case of either arterial or venous thrombosis. When kinking, torsion, or external compression of the pedicle are ruled out, and thrombectomy and redo of the anastomosis are unsuccessful, the last resort to save the flap is thrombolytic therapy. The authors present their experience with the salvage of two otherwise lost flaps by means of urokinase thrombolysis through direct intra…
Use of Hepatitis C-Positive Deceased Liver Donors in Response to the Organ Shortage in an Endemic Area
2017
The region of Sicily, Italy, is witnessing a chronic organ shortage. Thus, to face this critical issue, the use of marginal donors has increased over time. An example of marginal donor expansion is the use of liver donors who are positive for the hepatitis C antibody (HCV+) for HCV+ patients requiring liver transplantation (LT). In view of new advances in HCV therapy, including direct-acting agents (DAAs) to treat HCV in the post-transplant setting, our study focused on a monocentric experience in a series of consecutive LTs performed in adult patients receiving HCV+ liver donor allografts. From 2003 to 2016 at our institute we performed 10 LT using HCV+ deceased donors. In particular, the …
How to Handle Arterial Conduits in Liver Transplantation? Evidence From the First Multicenter Risk Analysis
2020
OBJECTIVE: The aims of the present study were to identify independent risk factors for conduit occlusion, compare outcomes of different AC placement sites, and investigate whether postoperative platelet antiaggregation is protective. BACKGROUND: Arterial conduits (AC) in liver transplantation (LT) offer an effective rescue option when regular arterial graft revascularization is not feasible. However, the role of the conduit placement site and postoperative antiaggregation is insufficiently answered in the literature. STUDY DESIGN: This is an international, multicenter cohort study of adult deceased donor LT requiring AC. The study included 14 LT centers and covered the period from January 2…
Vascular Grafts and Flow-through Flaps for Microsurgical Lower Extremity Reconstruction
2017
Background The use of vascular grafts is indicated in case of insufficient pedicle length or for complex defects involving both soft tissues and vessels. Venous grafts (for both venous and arterial reconstructions) and arterial grafts (arterial reconstruction) can be used. This study retrospectively evaluated the needs for vascular reconstruction and its results in a clinical series of lower limb reconstructions with microsurgical free flaps. Materials and Methods From 2010 to 2015, a total of 16 vascular grafts or flow-through flaps were used in 12 patients out of a total of 150 patients undergoing microsurgical reconstruction (8%). Arterial reconstruction was performed in seven cases (si…
Salvage (tertiary) breast reconstruction after implant failure
2011
Summary Background Salvage breast reconstruction is defined as a complete revision of a previous reconstruction in case of unsatisfactory results or failure of primary or secondary breast reconstruction. We have termed this ‘tertiary breast reconstruction'. This article presents our experience with tertiary reconstructions, including the indications, method of reconstruction and outcomes. Methods A retrospective note review was performed for all patients who underwent breast reconstruction with autologous tissue under one surgeon between 2002 and 2009 at the University Hospital, Ghent. Out of these 688 patients, 54 patients (7.8%) required tertiary surgery with autologous tissue after failu…
Double Endocrine Neoplasia in a Renal Transplant Recipient: Case Report and Review of the Literature
2011
Abstract Introduction The incidence of cancer compared for age groups is 3–4 times higher in transplant recipients than the general population. The increased risk is related to immunosuppressive therapy as well as the use of increasingly older donors and recipients. Although cardiovascular disease with a functioning transplant is the leading cause of death (47%), cancer mortality is significant especially among older patients. However, the most frequent posttransplantation cancers relate to hemolymphopoietic organs and skin, whereas the occurrence of solid tumors elsewhere is rare. Herein we have described a rare case of synchronous double malignancy of endocrine organs (thyroid-adrenal) in…
Improved short-term outcomes of kidney transplants in controlled donation after the circulatory determination of death with the use of normothermic r…
2021
Normothermic Regional Perfusion (NRP) allows the in situ perfusion of organs with oxygenated blood in donation after the circulatory determination of death (DCDD). We aimed at evaluating the impact of NRP on the short-term outcomes of kidney transplants in controlled DCDD (cDCDD). This is a multicenter, nationwide, retrospective study comparing cDCDD kidneys obtained with NRP versus the standard rapid recovery (RR) technique. During 2012-2018, 2,302 cDCDD adult kidney transplants were performed in Spain using NRP (n=865) or RR (n=1,437). The study groups differed in donor and recipient age, warm and cold ischemic time and use of ex situ machine perfusion. Transplants in the NRP group were m…
Injection of donor-derived splenic dendritic cells plus a nondepleting anti-CD4 monoclonal antibody to prolong primary skin graft survival indefinite…
2010
Abstract We have previously shown that injection of donor-derived Fischer rat OX62+ dendritic cells plus an anti-CD4 monoclonal antibody generates donor-specific CD4+CD25+FoxP3+ regulatory T cells in Lewis rats spleens. The regulatory T cells indefinitely prolonged the survival of skin graft from Fischer rat and abrogated the antidonor antibody response. We have now shown that an injection of 2 × 10 6 donor-derived OX62+ dendritic cells plus 2 mg nondepleting anti-CD4 monoclonal antibody (W3/25) at 28 days before grafting induced indefinite skin graft survival in this combination; whereas an injection on day −1 prolonged it only to 50 days. This effect is donor specific. In both cases, we s…
Searching for the right timing of surgical delay: angiogenesis, vascular endothelial growth factor and perfusion changes in a skin-flap model.
2009
Summary Background The angiogenic potential of vascular endothelial growth factor (VEGF) and its oxygen pressure-dependent regulation suggest a strong connection between this growth factor and the ‘delay phenomenon'. In this study we focused on the chronological changes in VEGF concentration and flap perfusion in order to optimise the duration of surgical delay. Methods The VEGF concentration in skin and underlying muscle was measured in oversized, random-pattern flaps on 38 male Sprague-Dawley rats after 3, 5 or 7 days of surgical delay. Additionally, flaps were raised 5 or 7 days past preconditioning. The effect on flap perfusion was measured using indocyanine green fluoroscopy and the si…