Background: We investigated if LDLT vs. full graft deceased donor liver transplantation (DDLT) offers similar outcome for patents with HRS after liver transplantation. Methods: Outcomes of LDLT and DDLT in patients with chronic liver disease with HRS were compared. A matched pair 3:1 study design was used with presence of HRS, Meld score, and preoperative dialysis as matching criteria. Thirty-one patients with HRS receiving a LDLT and 93 HRS patients receiving a full graft DDLT were identified. Liver injury and graft function were assessed by AST, bilirubin, and INR after transplantation. Long-term graft and patient survival, as well as kidney function were investigated. Risk factors for graft loss were evaluated by univariate analysis. Results: LDLT vs. DDLT of patients with HRS was associated with decreased peak AST levels (332 ± 215 U/L vs. 927 ± 1233U/L; p= 0.0001), and similar 7-day bilirubin (144 ± 135 μmol/L vs. 119 ± 122 μmol/L; p= 0.35), and INR levels (1.93 ± 0.62 vs. 1.78 ± 0.78; p= 0.314) as marker of graft injury and function. DDLT had an increased ICU (2 (1-39) days vs.4 (0-93) days; p= 0.01) and hospital stay (26 (4-313) days vs. 29 (0-126) days; p= 0.04) when compared to the LDLT group. Incidence of overall postoperative complications (19% vs. 26%; p= 0.62) was similar between both groups. Postoperative biliary complications were more common in LDLT vs. DDLT patients (23% vs. 6%; p= 0.01). LDLT vs. DDLT patients with HRS had similar graft survival at 1- (80% vs. 82%), at 3- (69% vs. 76%), and 5-years (65% vs. 76%) (p= 0.63), as well as an identical 1- (82% vs. 83%), 3- (77% vs. 72%), and 5-years (77% vs. 72%) patient survival (p= 0.93). Incidence of renal failure post liver transplantation (9% vs. 5%; p= 0.4%), as well as creatinine values 5-years after liver transplantation (129 ± 46 μmol/L vs. 119 ± 46 μmol/L; p= 0.3) were identical between LDLT and DDLT groups. In univariate analysis the use of cyclosporine vs. tacrolimus (HR: 0.36, CI: 0.18-0.72, p= 0.004) and ICU stay (HR: 1.032, CI: 1.01-1.05, p= 0.002) was associated with graft loss, while the type of liver graft (LDLT vs. DDLT) did not impact on graft survival. Conclusion: LDLT results in identical long-term outcome when compared with DDLT in patients with HRS. Patients on the liver transplant waiting list with HRS should be encouraged to proceed with LDLT.

OBJECTIVE To validate a model to stratify patients with obstructive nephropathy due to malignant ureteric obstruction, associated with a poor prognosis, into different prognostic groups, as a recent report identified low serum albumin, degree of hydronephrosis and number of events related to metastatic disease as prognostic indicators before palliative decompression. PATIENTS AND METHODS We retrospectively review the charts to identify all patients who had a nephrostomy tube inserted for malignant ureteric obstruction. Laboratory and clinical factors that might influence prognosis were reviewed to attempt to externally validate the previously identified factors and model for risk stratification. RESULTS The median (range) age of the 49 patients identified was 71 (36–91) years, and the median survival was 174 (14–602) days. Tumours were of urological origin in 66% of patients. Patients with prostate cancer had nephrostomy tubes indwelling for a mean of 279 days, vs 190 days ( P = 0.07) for patients with tumours not of prostatic origin. A serum albumin level of >30 g/L ( P ≤ 0.001), serum sodium <135 mmol/L ( P = 0.019) and three or more events related to dissemination of cancer ( P = 0.04) were factors associated with a significantly shorter mean survival. Complications related to the nephrostomy tube were experienced by 39% of patients. The model proved useful in stratifying these patients into different risk groups ( P = 0.002). CONCLUSION Consistent with a previous report we showed that a low serum albumin level and events related to metastatic disease were indicative of a poor prognosis. We also found that a low serum sodium level might be associated with a worse prognosis. We externally validated a model for stratifying patients into different prognostic groups. Palliative decompression is associated with significant morbidity.

Lilly, L; Girgrah, N; Therapondos, G; Renner, E; McGilvray, I; Greig, P; Cattral, M; Grant, D; Levy, G Author Information

Introduction: Renal replacement therapy is the best management for end stage renal failure. Laparoscopic Donor Nephrectomy (LDN), which is considered safe and effective, began in our unit in July 2003 with an average transplant rate of 12 per year. The aim of this study is to compare the donor morbidity, recovery and costs between Open Donor Nephrectomy (ODN) and LDN.Method: A retrospective consecutive series of all Donor Nephrectomies since June 2002 were included in this study. Operative details, postoperative donor recovery, donor and recipients renal functions were reviewed. The total costs will also be calculated and compared.Results: There were 18 LDN and 18 ODN (Total 36 cases) included in this series and equal number of male to female cases.Average operative time for ODN was 2.07 h and LDN was 3.36 h. There was no intra‐operative conversion from LDN to ODN and no peri‐operative morbidities in either group. The transplanted renal vessel lengths were also compared which showed an average artery length of 40 mm and vein length of 50 mm in the LDN group versus an average of 35 mm artery length and 30 mm vein length in the ODN group. The outcome of the recipient's renal function was not affected whether the donor had OPD or LDN. Average length of hospital stay was 6 days in ODN and 4.5 days in LDN. Costs data to follow.Conclusion: Laparoscopic Donor Nephrectomy (LDN) is safe and effective in a smaller renal transplant unit.

Fibrinogen-like protein 2 (fgl2)/fibroleukin is a member of the fibrinogen-related protein superfamily. In addition to its established role in triggering thrombosis, it is known to be secreted by T cells. The soluble fgl2 (sfgl2) protein generated in a baculovirus expression system bound to both T cells and bone marrow-derived dendritic cells (DC) in a specific manner. sfgl2 exhibited immunomodulatory properties capable of inhibiting T cell proliferation stimulated by alloantigens, anti-CD3/anti-CD28 mAbs, and Con A in a dose-dependent manner; however, it had no inhibitory effects on CTL activity. The time- and dose-dependent inhibitory effect of sfgl2 on alloreactive T cell proliferation could be neutralized by a mAb against mouse fgl2. Polarization toward a Th2 cytokine profile with decreased production of IL-2 and IFN-γ and increased production of IL-4 and IL-10 was observed in sfgl2-treated allogeneic cultures. Exposure of immature DC to sfgl2 abrogated the expression of CD80high and MHC class IIhigh molecules and markedly inhibited NF-κB nuclear translocation, thus inhibiting their maturation. sFgl2-treated DC had an impaired ability to stimulate allogeneic T cell proliferation. Maximal inhibition of proliferation was observed when allogeneic T cells were cultured with sfgl2-treated DC and sfgl2 protein was added in the culture. These data provide the first evidence to demonstrate that sfgl2 exerts immunosuppressive effects on T cell proliferation and DC maturation.

American Journal of TransplantationVolume 2, Issue s3 p. 49-71 Free Access American Transplant Congress. Day-at-a-Glance, Sunday, April 28,2002 First published: 22 July 2008 https://doi.org/10.1034/j.1600-0854.2004.00009.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume2, Issues3April 2002Pages 49-71 AST and ASTS members - please log in via your Society website for full journal access.AST Members >> ASTS Members >> RelatedInformation