P001 - Sepsis impairs the capillary response within hypoxic capillaries and decreases erythrocyte oxygen-dependent ATP efflux

Background. Randomized clinical trials have supported the use of interleukin-2 receptor (IL-2R) antagonists as induction therapy in renal transplantation. This strategy has reduced the incidence of acute rejection episodes (ARE) but not improved graft survival. Our objective was to investigate the impact of induction therapy using the IL-2R antagonist basiliximab, as compared with no induction therapy, on relevant clinical outcomes initial length of stay, incidence of ARE, long-term graft function, and graft survival.Methods. We retrospectively reviewed the medical records of patients transplanted in a tertiary care center between 1996 and 2011. We selected patients who received cyclosporine, mycophenolate mofetil, and prednisolone (n = 334) to classify as: no induction therapy (n = 131; group 1); induction therapy with basiliximab (n = 203; group 2). Estimated glomerular filtration rate (eGFR) was assessed with the 4-variable Modification of Diet in Renal Disease (MDRD) equation.Results. Mean follow-up was 72.7 +/- 35.4 months. Patients who received basiliximab had a shorter mean hospital stay (19.2 versus 22.5 days; P = .02), lower incidence of ARE (10.8% versus 23.7%; P = .02) and better graft function post transplantation at 12 months (mean eGFR 59.4 +/- 18.4 versus 54.8 +/- 18.7 mL/min/1.73 m(2); P = .015) and 5 years (mean eGFR 64.1 +/- 21.5 versus 55.4 +/- 19.6 mL/min/1.73 m(2); P = .009). On multivariate analysis, induction therapy with basiliximab was independently associated with a lower incidence of ARE and better graft function at 1 and 5 years after transplantation. There was no difference in 5-year graft survival between the two groups (log-rank: P = .54).Conclusions. Induction therapy with basiliximab was associated with a reduced incidence of ARE and better long-term graft function but no difference in 5-year graft survival.

Introduction. Intermediate early graft function is associated with increased incidence of graft loss and worse long-term graft function in kidney transplantation. Background. Delayed graft function (DGF) is associated with premature graft loss, increased rate of allograft function decline, and greater incidence of acute rejection episodes (ARE). Regarding early intermediate graft function (IGF), these prognostic observations have not been clearly made. Our objective was to investigate the impact of IGF as compared with excellent graft function (EGF) on these outcomes.Methods. Retrospective analysis included all patients who underwent transplantation in a tertiary care center between 1989 and 2009. Definitions are as follows: DGF, need for dialysis in the first 7 days posttransplantation; EGF, serum creatinine (sCr) <3 mg/dL at 5 days posttransplantation; IGF, absence of dialysis need but with a sCr >3 mg/dL at 5 days posttransplantation. For univariate analysis we performed Student t test, Mann-Whitney test, or Chi-square test, as appropriate. For survival analysis we performed Kaplan-Meier method to determine survival curves and we used the log-rank test for comparison. Multivariate logistic regression analysis was used to determine independent predictors of IGF and of graft survival.Results. Five hundred seventy patients were included: 69.0% had EGF, 22.6% had IGF, and 8.4% had DGF. Patients with IGF had worse graft survival at 5 and 10 years posttransplantation (75% vs 92% and 69% vs 85%, respectively; P < .001 for both comparisons) and higher incidence of ARE (41% vs 27%; P = .001), compared with EGF. In multivariate analysis, IGF was independently associated with an increased risk of graft loss compared with EGF (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.32-4.35; P = .004]. Donor age (OR, 1.03 per year; 95% CI, 1.02-1.05; P < .001) was the strongest predictor of the occurrence of IGF. IGF was also associated with worse long-term graft function until 7 years posttransplantation (mean glomerular filtration rate [GFR] 48.3 +/- 18.9 vs 57.4 +/- 20.4 mL/min/1.73 m(2); P = .008).Conclusions. IGF, as DGF, is associated with increased rates of graft loss and ARE, as well as worse long- term graft function. Donor age was the strongest risk factor for the occurrence of IGF. This is especially relevant regarding the increasing use of extended criteria donors.

BACKGROUND:Donor age, cold ischemia time, delayed graft function (DGF), prior sensitization, HLA mismatches, acute rejection episodes, glomerular disease and viral nephropathy are some factors that shorten graft survival. Patients with excellent graft function at 10 years posttransplant have probably successfully overcome these detrimental factors. The effect of initial functional renal mass is probably associated with this outcome. The objective of the present study was to identify factors that show predictive value for the population of patients with excellent graft function at 10 years posttransplantation. PATIENTS AND METHODS:This retrospective observational study included 117 patients transplanted from deceased donors. They all presented glomerular filtration rates (GFR) ≥ 40 mL/min. They were stratified as group I (n = 56) estimated GFR ≥ 40 <60 mL/min versus group II (n = 61) estimated GFR ≥ 60 mL/min. We analyzed the variables of donor age, recipient age and gender, DGF, immunosuppression, obesity, acute rejection episodes, HLA mismatches, panel-reactive antibodies and the mean estimated GFR at 1, 5, and 10 years posttransplant. RESULTS:Donor age and patients with DGF were significantly different between the two groups upon univariate analysis. Multivariate logistic regression analysis showed only donor age to be independently associated with an eGFR < 60 mL/min at 10 years. In both groups a decrease of eGFR > 10 mL/min between the 1st and the 10th year correlated significantly with donor age (P = .04). The deterioration of graft function was greater among group I than group II (6.7 vs 0.23 mL/min; P = .007). CONCLUSION:Donor age was the most significant predictive factor for graft function at 10 years.

Introduction and Aims: Gadolinium chelate (GC)s using in magnetic resonance imaging (MRI) have been traditionally considered as non-nephrotoxic contrast materials.But, in some recent articles it has been suggested that GCs may have a nephrotoxic potential.Nevertheless, most of these reports are retrospective, and evaluated contrast agents and their doses were not homogenous.To investigate the effect of gadopentetate dimeglumine (GD) and magnetic field on renal function in patients with high-risk for acute kidney injury (AKI).Methods: We designed a prospective case control study, and age and sex-matched two groups of patients were included the study.Both of groups were consisted of the patients with high-risk for AKI (diabetes mellitus, hypotension, chronic renal failure, using nephrotoxic material, i.e.) (n=40, for each group).While contrast (gadopentetate dimeglumin)-enhanced non-vascular MRI was performed to group 1 patients, MRI without conrast agent was performed in goup 2 patients.Fixed dose of GD (0.2 mmol/kg) were administered to group 1 patients.All patients were followed up 72 hours.Before and at the 6, 24 and 72 hours after the MRI; biochemical markers, urinalysis, microalbumin/creatinine ratio in spot urine, serum creatinine, and glomerular filtration rate were measured.Results: Baseline serum creatinine, microalbumin/creatinine ratio, and GFR was not different between group 1 and group 2 ( p>0.05).We did not observe adverse effect related to procedures.There were no significant changes in renal functional tests (? serum creatinine, ?microalbumin/creatinin ratio, and ?GFR) in both groups after 6, 24 or 72 hours of the procedures ( p>0,05).Conclusions: Non-vascular contrast-enhanced (GD, 0.2 mmol/kg) MRI is a safe procedure for patients with high-risk for AKI.

Correction to: Bone Marrow Transplantation advance online publication, 14 July 2008; doi:10.1038/bmt.2008.207 In this article published online and also in this issue, the authors wish to make a number of changes to the text under the section heading Reduced intensity conditioning regime and HCT procedure.

This paper, develops the concept of epistemic frames as a mechanism through which students can use experiences in video games, computer games, and other interactive learning environments to help them deal more effectively with situations outside of the original context of learning. Building on ideas of islands of expertise [Crowley, K., & Jacobs, M. (2002). Islands of expertise and the development of family scientific literacy. In G. Leinhardt, K. Crowley, & K. Knutson (Eds.), Learning conversations in museums. Mahwah, NJ: Lawrence Erlbaum], communities of practice [Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge, UK: Cambridge University Press], and ways of knowing [Broudy, H. (1977). Types of knowledge and purposes of education. In R. C. Anderson, R. J. Spiro, & W. E. Montague (Eds.), Schooling and the acquisition of knowledge (pp. 1–17). Hillsdale, NJ: Lawrence Erlbaum], epistemic frames are described as the ways of knowing, of deciding what is worth knowing, and of adding to the collective body of knowledge and understanding of a community of practice. Data from two experiments [Shaffer, D. W. (2004a). Pedagogical praxis: the professions as models for post-industrial education. Teachers College Record, 106(7); Shaffer, D. W. (2004b). When computer-supported collaboration means computer-supported competition: professional mediation as a model for collaborative learning. Journal of Interactive Learning Research, 15(2); Shaffer, D. W. (2005a). Studio mathematics: The epistemology and practice of design pedagogy as a model for mathematics learning (WCER Working Paper Series No. 2005-3). Madison, WI: University of Wisconsin-Madison, Wisconsin Center for Educational Research] are used to show that students can incorporate epistemic frames into their identities when engaged in extended educational role-playing games. Epistemic frames are thus proposed as a possible mechanism through which sufficiently rich experiences in computer-supported games based on real-world practices may help students deal more effectively with situations in the real-world and in school subjects.

BACKGROUND/AIMS:The natural history of chronic hepatitis C virus (HCV) infection still has some details to be established, namely in what concerns progression to hepatic cirrhosis (HC). The study aims to define predictive factors for progression to HC in patients with HCV chronic infection.METHODOLOGY:A cross-sectional study was performed on 129 patients consecutively submitted to liver biopsy. Thirty-six percent (n=46) had HC at histological evaluation.RESULTS:Patients with HC did not show statistically significant differences on gender, viruses genotypes, alcohol consumption or proportion of positivity to markers of previous hepatitis B virus (HBV) infection - anti-HBc/anti-HBs+. Patients with HC seem to have had their infection sporadically (50%) or post-transfusion (35%) -p=0.052, and iv drugs addiction was related to non-HC patients (39%) -p=0.006. Age at infection, time of infection and positivity for anti-HBc/anti-HBs were factors independently related to HC (multivariate analysis). Patients older than 40 years by the time of infection [OR=4.5 (95% CI=1.9-10.8], those with less than 5 years of time of infection [OR=4.2 (95% CI=1.6-10.8)], and patients with previous HBV infection [OR=2.51 (1.00-6.69)] are at higher risk for HC.CONCLUSIONS:We argue that older patients, with a shorter time interval between HCV infection and diagnosis, and namely those with markers for previous HBV infection represent patients with higher risk for progression to hepatic cirrhosis.

Hepatobiliary manifestations of hereditary hemorrhagic telangiectasia (HHT) are rare, but often involve cholestasis. We report here a case of HHT associated with cholestasis due to common bile duct stenosis. Attempted balloon dilation of the stenosis during endoscopic retrograde cholangiopancreatography (ERCP) resulted in hemobilia. Hemostasis was achieved by adjusting the nasobiliary drain. The aim of this report is to highlight the biliary manifestations of HHT and draw attention to an unusual complication of ERCP in this setting.

INTRODUCTION:Spontaneous bacterial peritonitis is a common and severe complication in patients with cirrhosis and ascitis. Its prognosis clearly depends on its precocious clinical recognition and efficacious therapy.AIM:To optimize a treatment protocol, after auditing clinical efficacy and describe microorganisms implicated at our institution.MATERIAL AND METHODS:Retrospective study of clinical files of patients with hepatic cirrhosis with positive culture of ascitic fluid (AF) and/or an AF polymorphonuclear (PMN) count of more than 250/mm3, treated at our units between 1st January, 2000 and 31st December, 2001 (n = 38). Patients showed a median age of 49 years (30-76), 63% of which were male. Forty-eight percent were classified as belonging to Child-Pugh B class, and 52% to C.RESULTS:First, considering cases with PMN > 250/mm3 (n = 29), antibiotics were given to all patients (cefotaxime and ampiciline). Fifty-two percent had hepatic encephalopathy, 42% had fever, 66% abdominal pain. In 42% a microorganism was isolated. Although 24% of fatal cases (only two related to infection), we noted a 73% clinical and laboratorial response. Five patients (72%) that died, showed renal failure by the time of death. Second, in all cases with positive culture of ascitic fluid (n = 21), 42% of which with PMN > 250/mm3 and 9 monobacterial nonneutrocytic bacterascites' cases, one only agent was found: E. coli in 36%, Streptococci (37%), Staphylococci (14%), and other (14%): Klebsiella oxytoca, n = 1; Salmonella enteritidis, n = 1; Enterococcus faecium, n = 1, Acinectobacter anitratus, n = 1. Only one of the agents, E. faecium (3%) showed in vitro sensitivity exclusively to ampiciline; all other were cefotaxime sensitivite.CONCLUSIONS:Our protocol will be modified, to treat patients with spontaneous bacterial peritonitis with cefotaxime, as monotherapy. Albumin infusion will also be added to the protocol, as, we found renal failure to be an important negative prognosis factor.

Figure 1A 50-year-old man was admitted with obstructive acute renal failure. In the second week after admission he suffered an episode of upper gastrointestinal bleeding. Emergency upper endoscopy revealed black diffuse mucosa and mucosal bridges resulting from laceration of the submucosal layer in the lower esophagus. Biopsies showed unspecified esophagitis with necrosis. The patient's condition deteriorated and he died with multiple organ failure.

The aim of this study was to evaluate the importance of different factors that may be associated with progression to cirrhosis in chronic hepatitis C virus (HCV) infection. We studied 117 consecutive patients HCV-RNA positive who undergone liver biopsy. Each patient was assessed to risk factors to HCV infection, daily alcohol intake, age at entry in the study, duration of infection? HCV genotypes and hepatitis B virus (HBV) markets. The presence of cirrhosis was used as the dependent variable in multivariate logistic regression analysis. The age of the patient and duration of infection were independent determinants of development of cirrhosis, whereas HCV genotype, alcohol abuse and HBV markers were not.