Organ Transplantation Research Today is a free monthly online journal that collates and summarizes the latest research about Organ Transplantation, including details on risks, prognosis, procedure, surgery.

Severity of lymphocytic bronchiolitis predicts long-term outcome after lung transplantation.

Glanville AR, Aboyoun CL, Havryk A, Plit M, Rainer S, Malouf MA

The Lung Transplant Unit, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia. aglanville@stvincents.com.au

RATIONALE: Severe and recurrent acute vascular rejection of the pulmonary allograft is an accepted major risk factor for obliterative bronchiolitis. OBJECTIVES: We assessed the role of lymphocytic bronchiolitis as a risk factor for bronchiolitis obliterans syndrome (BOS) and death after lung transplantation. METHODS: Retrospective analysis of 341 90-day survivors of lung transplant performed in 1995-2005 who underwent 1,770 transbronchial lung biopsy procedures. MEASUREMENTS AND MAIN RESULTS: Transbronchial biopsies showed grade B0 (normal) (n = 501), B1 (minimal) (n = 762), B2 (mild) (n = 176), B3 (moderate) (n = 70), B4 (severe) (n = 4) lymphocytic bronchiolitis, and Bx (no bronchiolar tissue) (n = 75). A total of 182 transbronchial biopsies were ungraded (8 inadequate, 142 cytomegalovirus, 32 other diagnoses). Lung transplant recipients were grouped by highest B grade before diagnosis of BOS: B0 (n = 12), B1 (n = 166), B2 (n = 89), and B3-B4 (n = 51). Twenty-three were unclassifiable. Cumulative incidence of BOS and death were dependent on highest B grade (Kaplan-Meier, P < 0.001, log-rank). Multivariable Cox proportional hazards analysis showed significant risks for BOS were highest B grade (relative risk [RR], 1.62; 95% confidence interval [CI], 1.31-2.00) (P < 0.001), longer ischemic time (RR, 1.00; CI, 1.00-1.00) (P < 0.05), and recent year of transplant (RR, 0.93; CI, 0.87-1.00) (P < 0.05), whereas risks for death were BOS as a time-dependent covariable (RR, 19.10; CI, 11.07-32.96) (P < 0.001) and highest B grade (RR, 1.36; CI, 1.07-1.72) (P < 0.05). Acute vascular rejection was not a significant risk factor in either model. CONCLUSIONS: Severity of lymphocytic bronchiolitis is associated with increased risk of BOS and death after lung transplantation independent of acute vascular rejection.

Published 24 April 2008 in Am J Respir Crit Care Med, 177(9): 1033-40.
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Articles on Organ Transplantation published 21 April 2008:

Oral bisphosphonates and dental implants: a retrospective study.   J Oral Maxillofac Surg, 66(5): 1022-4.

PURPOSE: The objective of this retrospective study was to examine whether patients who take medications containing bisphosphonates (BPs) are at greater risk of bone graft and implant failure than other patients. PATIENTS AND METHODS: This study involved the examination of 42 patients (101 implants) who had taken medications containing BPs prior to surgeries involving oral bone grafting or endosseous implant placement. Patients had been taking BP medications from 6 months to 11 years prior to ... [Abstract] [Full-text]

IMPDH1 gene polymorphisms and association with acute rejection in renal transplant patients.   Clin Pharmacol Ther, 83(5): 711-7.

Inosine 5'-monophosphate dehydrogenase 1 (IMPDH1) catalyzes the rate-limiting step of the de novo pathway for purine synthesis and is a major target of the immunosuppressive drug mycophenolic acid (MPA). Few variants of the IMPDH1 gene have been reported. The objective of this study was to identify and characterize IMPDH1 variants to determine whether genetic variation contributes to differences in MPA response and toxicity in transplant patients. Seventeen genetic variants were identified in ... [Abstract] [Full-text]

Articles on Organ Transplantation published 18 April 2008:

Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis.   Anesth Analg, 106(5): 1480-6, table of contents.

BACKGROUND: Cardiac output (CO) and invasive hemodynamic measurements are useful during liver transplantation. The pulmonary artery catheter (PAC) is commonly used for these patients, despite the potential complications. Recently, a less invasive device (Vigileo/FloTrac) became available, which estimates CO using arterial pressure waveform analysis without external calibration. In this study, we compared CO obtained with a PAC using automatic thermodilution, instantaneous CO stat-mode ... [Abstract] [Full-text]

Articles on Organ Transplantation published 16 April 2008:

Leukocyte integrin Mac-1 promotes acute cardiac allograft rejection.   Circulation, 117(15): 1997-2008.

BACKGROUND: In allograft rejection, recipient leukocytes and alloantibodies first target donor endothelial cells. Although the leukocyte integrin Mac-1 (alpha(Mbeta2), CD11b/CD18) facilitates cell-cell interactions among leukocytes and interactions between leukocytes and endothelial cells or platelets, its role in allograft survival and vasculopathy is incompletely defined. METHODS AND RESULTS: This study examined parenchymal rejection and graft arterial disease after total allomismatched ... [Abstract] [Full-text]

Articles on Organ Transplantation published 15 April 2008:

Infectious, malignant, and autoimmune complications in pediatric heart transplant recipients.   J Pediatr, 152(5): 671-7.

OBJECTIVE: To review clinical courses of pediatric heart transplant survivors after 5 years from transplantation for infections, lymphoproliferative, and autoimmune diseases. STUDY DESIGN: A total of 71 patients were examined in 2 groups, infant recipients (underwent transplant <1 year of age, n = 38) and older recipients (underwent transplant >1 year, n = 33). All patients received comparable immunosuppression. Calculated occurrence rates were reported as means per 10 years of follow-up ... [Abstract] [Full-text]

Polyomavirus BK with rearranged noncoding control region emerge in vivo in renal transplant patients and increase viral replication and cytopathology.   J Exp Med, 205(4): 841-52.

Immunosuppression is required for BK viremia and polyomavirus BK-associated nephropathy (PVAN) in kidney transplants (KTs), but the role of viral determinants is unclear. We examined BKV noncoding control regions (NCCR), which coordinate viral gene expression and replication. In 286 day-matched plasma and urine samples from 129 KT patients with BKV viremia, including 70 with PVAN, the majority of viruses contained archetypal (ww-) NCCRs. However, rearranged (rr-) NCCRs were more frequent in ... [Abstract] [Full-text]

Articles on Organ Transplantation published 4 April 2008:

Donor preconditioning with taurine protects kidney grafts from injury after experimental transplantation.   J Surg Res, 146(1): 127-34.

BACKGROUND: Ischemia/reperfusion injury is a major problem in clinical transplantation (Tx). Taurine has been shown to protect liver grafts from ischemia/reperfusion injury after Tx. Thus, this study was designed to evaluate its effect on kidney grafts after transplantation. MATERIALS AND METHODS: Various concentrations of taurine were infused before donor nephrectomy (1.5 mL; 30, 100, 300 mM). Controls were given the same volume of Ringers' solution. Subsequently, grafts were cold-stored for ... [Abstract] [Full-text]

Articles on Organ Transplantation published 2 April 2008:

Autograft contamination during preparation for anterior cruciate ligament reconstruction.   J Bone Joint Surg Am, 90(4): 760-4.

BACKGROUND: The autograft preparation process for anterior cruciate ligament reconstruction has a potential for graft contamination. The purpose of this study was to evaluate the possibility of contamination of the bone-patellar tendon-bone and hamstring tendon autograft during preparation for anterior cruciate ligament reconstruction. METHODS: A primary isolated reconstruction of the anterior cruciate ligament with use of bone-patellar tendon-bone autograft (thirty patients) and hamstring ... [Abstract] [Full-text]

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